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Baksh RA, Strydom A, Carter B, Carriere I, Ritchie K. Toward the right treatment at the right time: Modeling the trajectory of cognitive decline to identify the earliest age of change in people with Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12563. [PMID: 38463041 PMCID: PMC10921067 DOI: 10.1002/dad2.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 03/12/2024]
Abstract
Introduction Age is the greatest risk factor for Alzheimer's disease (AD). A limitation of randomized control trials in AD is a lack of specificity in the age ranges of participants who are enrolled in studies of disease-modifying therapies. We aimed to apply Emax (i.e., maximum effect) modeling as a novel approach to identity ideal treatment windows. Methods Emax curves were fitted to longitudinal cognitive data of 101 participants with AD and 1392 healthy controls. We included the Mini-Mental State Examination (MMSE) and tests of verbal fluency and executive functioning. Results In people with AD, the earliest decline in the MMSE could be detected in the 67-71 age band while verbal fluency declined from the 41-45 age band. In healthy controls, changes in cognition showed a later trajectory of decline. Discussion Emax modeling could be used to design more efficient trials which has implications for randomized control trials targeting the earlier stages of AD.
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Affiliation(s)
- R. Asaad Baksh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonDenmark HillLondonUK
- The LonDownS ConsortiumDenmark HillLondonUK
| | - André Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonDenmark HillLondonUK
- The LonDownS ConsortiumDenmark HillLondonUK
- South London and Maudsley NHS Foundation TrustMichael Rutter CentreLondonUK
| | - Ben Carter
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Isabelle Carriere
- INSERM, Institut de Neurosciences de Montpellier INMMontpellierFrance
| | - Karen Ritchie
- INSERM, Institut de Neurosciences de Montpellier INMMontpellierFrance
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152
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Gang C, Sha H, Qamruzzaman M. Nexus between energy efficiency, green investment, urbanization and environmental quality: Evidence from MENA region. PLoS One 2023; 18:e0295628. [PMID: 38157360 PMCID: PMC10756557 DOI: 10.1371/journal.pone.0295628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Environmental protection holds a paramount position in the pursuit of sustainable development. The existing body of literature has extensively examined various driving forces for environmental enhancement, including renewable energy sources, innovation, and governmental interventions. This study aims to assess the impact of green investment, energy efficiency, and urbanization on achieving environmental sustainability in the MENA region during the period 2004-2019. A comprehensive set of econometric tools has been employed to achieve this goal, including the CADF and CIPS panel unit root tests, error correction-based panel cointegration analysis, Cross-sectional ARDL, and asymmetric ARDL models. The key findings of this research are as follows: Cross-sectional dependency and homogeneity tests demonstrated that the research units shared common dynamics and heterogeneity properties. The stationarity tests based on CIPS and CADF indicated that all variables became stationary after the first differencing. The panel cointegration analysis established a long-term relationship between green investment (GI), energy efficiency (EE), urbanization (UR), and environmental sustainability (ES) in MENA nations. Empirical model estimations using Cross-sectional ARDL revealed significant contributions of GI, EE, and UR to ES in the long and short run. The asymmetry assessment uncovered a nonlinear relationship between the explanatory and dependent variables, both in the long and short run. Specifically, the asymmetric coefficients of GI, EE, and UR displayed negative statistical significance at the 1% level, highlighting their significant roles in promoting environmental sustainability. In light of these findings, this study provides valuable insights for policymakers to formulate strategies to further environmental sustainability in the MENA region.
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Affiliation(s)
- Chen Gang
- School of Economics and Management, Southwest Petroleum University, Sichuan Province, China
- Xi’an Bomay Electric Industries Co., Ltd, Xi’an, China
| | - He Sha
- Southwest Petroleum University, Sichuan Province, China
| | - Md Qamruzzaman
- School of Business and Economics, United International University, Dhaka, Bangladesh
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Zhang J, Liu S, Wu Y, Tang Z, Wu Y, Qi Y, Dong F, Wang Y. Enlarged Perivascular Space and Index for Diffusivity Along the Perivascular Space as Emerging Neuroimaging Biomarkers of Neurological Diseases. Cell Mol Neurobiol 2023; 44:14. [PMID: 38158515 DOI: 10.1007/s10571-023-01440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
The existence of lymphatic vessels or similar clearance systems in the central nervous system (CNS) that transport nutrients and remove cellular waste is a neuroscientific question of great significance. As the brain is the most metabolically active organ in the body, there is likely to be a potential correlation between its clearance system and the pathological state of the CNS. Until recently the successive discoveries of the glymphatic system and the meningeal lymphatics solved this puzzle. This article reviews the basic anatomy and physiology of the glymphatic system. Imaging techniques to visualize the function of the glymphatic system mainly including post-contrast imaging techniques, indirect lymphatic assessment by detecting increased perivascular space, and diffusion tensor image analysis along the perivascular space (DTI-ALPS) are discussed. The pathological link between glymphatic system dysfunction and neurological disorders is the key point, focusing on the enlarged perivascular space (EPVS) and the index of diffusivity along the perivascular space (ALPS index), which may represent the activity of the glymphatic system as possible clinical neuroimaging biomarkers of neurological disorders. The pathological link between glymphatic system dysfunction and neurological disorders is the key point, focusing on the enlarged perivascular space (EPVS) and the index for of diffusivity along the perivascular space (ALPS index), which may represent the activity of the glymphatic system as possible clinical neuroimaging biomarkers of neurological disorders.
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Affiliation(s)
- Jun Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shengwen Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yaqi Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhijian Tang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yasong Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yiwei Qi
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fangyong Dong
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Schindler LS, Subramaniapillai S, Ambikairajah A, Barth C, Crestol A, Voldsbekk I, Beck D, Gurholt TP, Topiwala A, Suri S, Ebmeier KP, Andreassen OA, Draganski B, Westlye LT, de Lange AMG. Cardiometabolic health across menopausal years is linked to white matter hyperintensities up to a decade later. Front Glob Womens Health 2023; 4:1320640. [PMID: 38213741 PMCID: PMC10783171 DOI: 10.3389/fgwh.2023.1320640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
Introduction The menopause transition is associated with several cardiometabolic risk factors. Poor cardiometabolic health is further linked to microvascular brain lesions, which can be detected as white matter hyperintensities (WMHs) using T2-FLAIR magnetic resonance imaging (MRI) scans. Females show higher risk for WMHs post-menopause, but it remains unclear whether changes in cardiometabolic risk factors underlie menopause-related increase in brain pathology. Methods In this study, we assessed whether cross-sectional measures of cardiometabolic health, including body mass index (BMI) and waist-to-hip ratio (WHR), blood lipids, blood pressure, and long-term blood glucose (HbA1c), as well as longitudinal changes in BMI and WHR, differed according to menopausal status at baseline in 9,882 UK Biobank females (age range 40-70 years, n premenopausal = 3,529, n postmenopausal = 6,353). Furthermore, we examined whether these cardiometabolic factors were associated with WMH outcomes at the follow-up assessment, on average 8.78 years after baseline. Results Postmenopausal females showed higher levels of baseline blood lipids (HDL β = 0.14, p < 0.001, LDL β = 0.20, p < 0.001, triglycerides β = 0.12, p < 0.001) and HbA1c (β = 0.24, p < 0.001) compared to premenopausal women, beyond the effects of age. Over time, BMI increased more in the premenopausal compared to the postmenopausal group (β = -0.08, p < 0.001), while WHR increased to a similar extent in both groups (β = -0.03, p = 0.102). The change in WHR was however driven by increased waist circumference only in the premenopausal group. While the group level changes in BMI and WHR were in general small, these findings point to distinct anthropometric changes in pre- and postmenopausal females over time. Higher baseline measures of BMI, WHR, triglycerides, blood pressure, and HbA1c, as well as longitudinal increases in BMI and WHR, were associated with larger WMH volumes (β range = 0.03-0.13, p ≤ 0.002). HDL showed a significant inverse relationship with WMH volume (β = -0.27, p < 0.001). Discussion Our findings emphasise the importance of monitoring cardiometabolic risk factors in females from midlife through the menopause transition and into the postmenopausal phase, to ensure improved cerebrovascular outcomes in later years.
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Affiliation(s)
- Louise S. Schindler
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sivaniya Subramaniapillai
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ananthan Ambikairajah
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arielle Crestol
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Irene Voldsbekk
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dani Beck
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tiril P. Gurholt
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anya Topiwala
- Nuffield Department Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Sana Suri
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Klaus P. Ebmeier
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Ole A. Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Bogdan Draganski
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Lars T. Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Ann-Marie G. de Lange
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Chen H, Jiang Z, Hu J, Yang X, Gui S, Li Q, Wang J, Yang J. A bidirectional relationship between cognitive reserve and cognition among older adults in a rural Chinese community: a cross-lagged design. Front Psychol 2023; 14:1297699. [PMID: 38192390 PMCID: PMC10773703 DOI: 10.3389/fpsyg.2023.1297699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Background The concept of cognitive reserve (CR) plays a crucial role in understanding cognitive aging and resilience. Accumulating evidence revealed the influence of CR proxy on cognitive function, but it remains unknown whether a reverse association or reciprocal effect exists. Objective The aim of this study is to observe the bidirectional relationship between cognitive reserve proxies and cognitive function among older adults in rural Chinese communities, providing a better understanding of the underlying mechanisms and potential moderating factors involved. Method This longitudinal study analyzed 792 older adults (70.23 ± 5.87 years; 59.8%female) aged 60 years and older from the health status of rural older adults (HSRO) study over a 3-year period. Cognition was assessed by the Mini-Mental State Examination (MMSE). Cross-lagged panel modeling was utilized to analyze the interrelationship between cognitive reserve proxies and cognitive performance. Additionally, latent profile analysis was employed to identify different subtypes of neuropathic load within the study population. Results Our cross-lagged analyses revealed significant associations between CR at T0 and MMSE scores at T1 (β = 0.81), as well as between MMSE scores at T0 and CR at T1 (β = 0.04). However, when conducting stratified analyses, we found no significant lagged relationships among individuals with high neuropathic load or those at an advanced age (p > 0.05). Furthermore, our longitudinal comparisons indicated changes in the contribution of CR proxy factors over time. Conclusion The findings suggested a bidirectional relationship between cognitive reserve and cognitive performance in older adults. These results emphasized the importance of implementing timely public health measures to enhance cognitive reserve and cognitive performance ultimately promoting healthier aging among older adults.
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Affiliation(s)
- Hao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
- The Third People's Hospital of Guizhou Province, Guiyang, China
| | - Zhiyue Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Jin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Xing Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Shiqi Gui
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Qiushuo Li
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Jing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Jingyuan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
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Zainuddin MS, Bhuvanendran S, Radhakrishnan AK, Azman AS. Alzheimer's Disease-Related Proteins Targeted by Secondary Metabolite Compounds from Streptomyces: A Scoping Review. J Alzheimers Dis Rep 2023; 7:1335-1350. [PMID: 38143777 PMCID: PMC10741902 DOI: 10.3233/adr-230065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 12/26/2023] Open
Abstract
Background Alzheimer's disease (AD) is a neurodegenerative disease that is characterized as rapid and progressive cognitive decline affecting 26 million people worldwide. Although immunotherapies are ideal, its clinical safety and effectiveness are controversial, hence, treatments are still reliant on symptomatic medications. Concurrently, the Streptomyces genus has attracted attention given its pharmaceutically beneficial secondary metabolites to treat neurodegenerative diseases. Objective To present secondary metabolites from Streptomyces sp. with regulatory effects on proteins and identified prospective target proteins for AD treatment. Methods Research articles published between 2010 and 2021 were collected from five databases and 83 relevant research articles were identified. Post-screening, only 12 research articles on AD-related proteins were selected for further review. Bioinformatics analyses were performed through the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) network, PANTHER Go-Slim classification system (PANTHER17.0), and Kyoto Encyclopedia of Genes and Genomes (KEGG) Mapper. Results A total of 20 target proteins were identified from the 12 shortlisted articles. Amyloid-β, BACE1, Nrf-2, Beclin-1, and ATG5 were identified as the potential target proteins, given their role in initiating AD, mitigating neuroinflammation, and autophagy. Besides, 10 compounds from Streptomyces sp., including rapamycin, alborixin, enterocin, bonnevillamides D and E, caniferolide A, anhydroexfoliamycin, rhizolutin, streptocyclinone A and B, were identified to exhibit considerable regulatory effects on these target proteins. Conclusions The review highlights several prospective target proteins that can be regulated through treatments with Streptomyces sp. compounds to prevent AD's early stages and progression. Further identification of Streptomyces sp. compounds with potential anti-AD properties is recommended.
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Affiliation(s)
| | | | - Ammu K. Radhakrishnan
- Jeffery Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Malaysia
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Angelidou IA, Makri M, Beyreuther K, Boada Rovira M, Despoti A, Engelborghs S, Miguel A, Rodríguez I, Stocker H, Temmerman J, Tsolaki M, Yener G, Yerlikaya D, Teichmann B. Attitudes toward pre-symptomatic screening for Alzheimer's dementia in five European countries: a comparison of family members of people with Alzheimer's dementia versus non-family members. Front Genet 2023; 14:1305107. [PMID: 38162684 PMCID: PMC10757380 DOI: 10.3389/fgene.2023.1305107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction: Pre-symptomatic screening is getting more attention in healthcare as it detects the risk for developing neurodegenerative diseases like Alzheimer's disease (AD), which is very useful for treatment or prevention. AD screening could play an important role in individuals with at least one affected first-degree relative, but also without family history. As the demand for screening is rising worldwide, it is important to consider possible cross-cultural differences in attitudes toward pre-symptomatic screening in order to tailor healthcare services to the needs of each country. Objective: This study aims to investigate the attitudes of family members and non-family members of people with dementia toward pre-symptomatic screening and explore possible differences in attitudes across five European countries (Belgium, Germany, Greece, Spain, Turkey) using translated versions of the "Perceptions regarding pRE-symptomatic Alzheimer's Disease Screening" questionnaire (PRE-ADS). Methods: The multicultural sample (N = 650) was recruited from samples that were previously used in validation studies of the translated PRE-ADS versions. The subscale "Acceptability of Screening", consisting of five PRE-ADS items to specifically explore willingness to undergo screening, was created. Ιnternal consistency was measured, and structural validity was determined using Confirmatory Factor Analysis (CFA). Group comparisons were performed to investigate differences in attitudes toward pre-symptomatic AD screening regarding family history and country of origin using the PRE-ADS and the "Acceptability of Screening" mean scores. Results: Construct validity was acceptable for the PRE-ADS. Both the PRE-ADS (α = 0.76) and its subscale "Acceptability of Screening" (α = 0.90) had good internal consistency. Overall, 56.9% of the total sample expressed a positive intention toward pre-symptomatic AD screening. T-tests showed significantly higher mean scores of participants with an affected family member. An international comparison revealed differences in the "Acceptability of Screening" mean score across the five European countries. No cross-cultural differences were found for the PRE-ADS mean score after adjusting for confounding variables. Conclusion: The PRE-ADS and its subscale are reliable tools for assessing pre-symptomatic AD screening attitudes. Variations in the acceptability of screening seem to be linked to family history and cultural influences. Further research with larger samples is needed to explore underlying relationships.
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Affiliation(s)
| | - Marina Makri
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Association of Alzheimer Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Disease, Center for Interdisciplinary Research and Innovation (CIRI—AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konrad Beyreuther
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Mercè Boada Rovira
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona–Universitat Internacional de Catalunya, Barcelona, Spain
| | - Akyllina Despoti
- Clinical Ergospirometry, Exercise and Rehabilitation Lab, School of Medicine, National and Kapodistrian University of Athens, Zografou, Greece
| | - Sebastiaan Engelborghs
- Department of Neurology and NEUR Research Group, Center for Neurosciences, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussel, Belgium
| | - Andrea Miguel
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona–Universitat Internacional de Catalunya, Barcelona, Spain
| | - Isabel Rodríguez
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona–Universitat Internacional de Catalunya, Barcelona, Spain
| | - Hannah Stocker
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Joke Temmerman
- Department of Neurology and NEUR Research Group, Center for Neurosciences, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussel, Belgium
| | - Magda Tsolaki
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Görsev Yener
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkiye
| | - Deniz Yerlikaya
- Faculty of Medicine, Izmir University of Economics, Izmir, Turkiye
| | - Birgit Teichmann
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
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Novobilský R, Bartova P, Lichá K, Bar M, Stejskal D, Kusnierova P. Serum neurofilament light chain levels in patients with cognitive deficits and movement disorders: comparison of cerebrospinal and serum neurofilament light chain levels with other biomarkers. Front Hum Neurosci 2023; 17:1284416. [PMID: 38164192 PMCID: PMC10757912 DOI: 10.3389/fnhum.2023.1284416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024] Open
Abstract
Background Serum neurofilament light chain (S NfL) is a non-specific marker of neuronal damage, including Alzheimer's disease (AD). We aimed to verify the reference interval (RI) of serum NfL using a highly sensitive ELISA, and to estimate the optimal cut-off value for neuronal damage. Our second objective was to compare NfL in cerebrospinal fluid (CSF) and serum (S) with the routine neurodegeneration biomarkers used in AD, and to assess their concentrations relative to the degree of cognitive deficit. Methods Samples from 124 healthy volunteers were used to estimate the S NfL RI. For the comparison study, we used CSF and S samples from 112 patients with cognitive disorders. Cognitive functions were assessed using the mini-mental state examination. ELISA assays were used to determine the CSF and S NfL levels, CSF β-amyloid peptide42 (Aβ42), CSF β-amyloid peptide40 (Aβ40), CSF total tau protein (tTau), CSF phosphorylated tau protein (pTau), and CSF alpha-synuclein (αS). Results The estimated RI of S NfL were 2.25-9.19 ng.L-1. The cut-off value of S NfL for assessing the degree of neuronal impairment was 10.5 ng.L-1. We found a moderate statistically significant correlation between S NfL and CSF Aβ42 in the group with movement disorders, without dementia (rs = 0.631; p = 0.016); between S NfL and CSF Aβ40 in the group with movement disorder plus dementia (rs = -0.750; p = 0.052); between S NfL and CSF tTau in the control group (rs = 0.689; p = 0.009); and between S NfL and CSF pTau in the control group (rs = 0.749; p = 0.003). The non-parametric Kruskal-Wallis test revealed statistically significant differences between S NfL, CSF NfL, CSF Aβ42, CSF tTau, and CSF pTau and diagnosis within groups. The highest kappa coefficients were found between the concentrations of S NfL and CSF NfL (κ = 0.480) and between CSF NfL and CSF tTau (κ = 0.351). Conclusion Our results suggested that NfL and tTau in CSF of patients with cognitive decline could be replaced by the less-invasive determination of S NfL using a highly sensitive ELISA method. S NfL reflected the severity of cognitive deficits assessed by mini-mental state examination (MMSE). However, S NfL is not specific to AD and does not appear to be a suitable biomarker for early diagnosis of AD.
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Affiliation(s)
- Richard Novobilský
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
- Department of Clinical Neurosciences, University of Ostrava, Ostrava, Czechia
| | - Petra Bartova
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
- Department of Clinical Neurosciences, University of Ostrava, Ostrava, Czechia
| | - Karin Lichá
- Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czechia
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
- Department of Clinical Neurosciences, University of Ostrava, Ostrava, Czechia
| | - David Stejskal
- Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czechia
- Institute of Laboratory Medicine, University of Ostrava, Ostrava, Czechia
| | - Pavlína Kusnierova
- Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czechia
- Institute of Laboratory Medicine, University of Ostrava, Ostrava, Czechia
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Chen HL, Yu XH, Yin YH, Shan EF, Xing Y, Min M, Ding YP, Fei Y, Li XW. Multimorbidity patterns and the association with health status of the oldest-old in long-term care facilities in China: a two-step analysis. BMC Geriatr 2023; 23:851. [PMID: 38093203 PMCID: PMC10720091 DOI: 10.1186/s12877-023-04507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The increasing prevalence of multimorbidity has created a serious global public health problem in aging populations. Certain multimorbidity patterns across different age ranges and their association with health status remain unclear. The main aim of this study is to identify multimorbidity patterns discrepancies and associated health status between younger-old and oldest-old. METHODS The Ethics Committee of Nanjing Medical University approved the study protocol (No.2019-473). Convenience sampling method was used to recruit older adults aged ≥ 60 years with multimorbidity from July to December 2021 from 38 Landsea long-term care facilities in China. The multimorbidity patterns were analyzed using network analysis and two-step cluster analysis. One-Way ANOVA was utilized to explore their association with health status including body function, activity of daily living, and social participation. A Sankey diagram visualized the flow of health status within different multimorbidity patterns. This study is reported following the STROBE guidelines. RESULTS A total of 214 younger-old (60-84 years) and 173 oldest-old (≥ 85 years) were included. Leading coexisting diseases were cardiovascular disease (CD), metabolic and endocrine disease (MED), neurological disease (ND), and orthopedic disease (OD). Cluster 1 (53, 24.8%) of CD-ND (50, 94.3%; 31, 58.8%), cluster 2 (39, 18.2%) of MED-ND-CD (39, 100%; 39, 100%; 37, 94.9%), cluster 3 (37, 17.3%) of OD-CD-MED-ND (37, 100%; 33, 89.2%; 27, 73.0%; 16, 43.2%), and cluster 4 (34, 15.9%) of CD-MED (34, 100%; 34, 100%) were identified in the younger-old. In the oldest-old, the primary multimorbidity patterns were: cluster 1 (33, 19.1%) of CD-respiratory disease-digestive disease-urogenital disease (CD-RD-DSD-UD) (32, 97.0%; 9, 27.3%; 8, 24.2%; 7, 21.2%), cluster 2 (42, 24.3%) of ND-CD-MED (42, 100%; 35, 83.3%; 14, 33.3%), cluster 3 (28, 16.2%) of OD-CD-MED (28, 100%; 25, 89.3%; 18, 64.3%), and cluster 4 (35, 20.2%) of CD-MED (35, 100%; 35, 100%). Younger-old with CD-ND or MED-ND-CD, and oldest-old with ND-CD-MED have worse health status compared with other multimorbidity patterns (e.g., CD-MED and OD-CD-MED). CONCLUSION Discrepancies in common patterns of multimorbidity across age groups suggest that caregivers in long-term care facilities should consider changes in multimorbidity patterns with ageing when developing prevention plans for individualized management. Neurological disease concurrent with other diseases was the major determinant of health status, especially for the oldest-old. Interventions targeting multimorbidity need to be focused, yet generic. It is essential to assess complex needs and health outcomes that arise from different multimorbidity patterns and manage them through an interdisciplinary approach and consider their priorities to gain high-quality primary care for older adults living in long-term care facilities.
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Affiliation(s)
- Hong-Li Chen
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiao-Hong Yu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yue-Heng Yin
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Min Min
- Landsea Long-Term Care Facility, Nanjing, Jiangsu province, China
- Xia Man Yun Jian Social Welfare Development Centre, Shanghai, China
| | - Ya-Ping Ding
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yang Fei
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Svedin F, Blomberg O, Farrand P, Brantnell A, von Essen L, Åberg AC, Woodford J. Effectiveness, acceptability, and completeness and quality of intervention reporting of psychological interventions for people with dementia or mild cognitive impairment: protocol for a mixed-methods systematic review. BMJ Open 2023; 13:e077180. [PMID: 38086581 PMCID: PMC10729069 DOI: 10.1136/bmjopen-2023-077180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Mental health difficulties such as anxiety and depression have negative impacts on psychological well-being and are common in people with dementia and mild cognitive impairment. However, access to psychological treatments is limited. This mixed-method systematic review will: (1) examine the effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment; (2) examine the effectiveness of these psychological interventions to improve mental health and psychological well-being in informal caregivers; (3) examine potential clinical and methodological moderators associated with effectiveness; (4) explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders; and (5) examine the completeness and quality of intervention reporting. METHODS AND ANALYSIS Electronic databases (ASSIA, CENTRAL, CINAHL, EMBASE, PsycINFO and MEDLINE) will be systematically searched and supplemented with expert contact, reference and citation checking, and grey literature searches. If possible, we will conduct a meta-analysis to examine the overall effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment and their informal caregivers; and examine potential clinical and methodological moderators associated with effectiveness. We will conduct a deductive framework synthesis, informed by the theoretical framework of acceptability, to explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders. In accordance with Joanna Briggs Institute guidance, we will adopt a convergent segregated approach to data synthesis and integration of quantitative and qualitative findings. We will examine the completeness and quality of intervention reporting according to the Template for Intervention Description and Replication checklist and guide. ETHICS AND DISSEMINATION No primary data will be collected, and therefore, ethical approval is not required. Results will be disseminated through a peer-reviewed publication, academic conferences, and plain language summaries. PROSPERO REGISTRATION NUMBER CRD42023400514.
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Affiliation(s)
- Frida Svedin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Oscar Blomberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education Development and Research (CEDAR), University of Exeter, Exeter, UK
| | - Anders Brantnell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Dalarna University, Falun, Sweden
| | - Joanne Woodford
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Isop LM, Neculau AE, Necula RD, Kakucs C, Moga MA, Dima L. Metformin: The Winding Path from Understanding Its Molecular Mechanisms to Proving Therapeutic Benefits in Neurodegenerative Disorders. Pharmaceuticals (Basel) 2023; 16:1714. [PMID: 38139841 PMCID: PMC10748332 DOI: 10.3390/ph16121714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Metformin, a widely prescribed medication for type 2 diabetes, has garnered increasing attention for its potential neuroprotective properties due to the growing demand for treatments for Alzheimer's, Parkinson's, and motor neuron diseases. This review synthesizes experimental and clinical studies on metformin's mechanisms of action and potential therapeutic benefits for neurodegenerative disorders. A comprehensive search of electronic databases, including PubMed, MEDLINE, Embase, and Cochrane library, focused on key phrases such as "metformin", "neuroprotection", and "neurodegenerative diseases", with data up to September 2023. Recent research on metformin's glucoregulatory mechanisms reveals new molecular targets, including the activation of the LKB1-AMPK signaling pathway, which is crucial for chronic administration of metformin. The pleiotropic impact may involve other stress kinases that are acutely activated. The precise role of respiratory chain complexes (I and IV), of the mitochondrial targets, or of the lysosomes in metformin effects remains to be established by further research. Research on extrahepatic targets like the gut and microbiota, as well as its antioxidant and immunomodulatory properties, is crucial for understanding neurodegenerative disorders. Experimental data on animal models shows promising results, but clinical studies are inconclusive. Understanding the molecular targets and mechanisms of its effects could help design clinical trials to explore and, hopefully, prove its therapeutic effects in neurodegenerative conditions.
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Affiliation(s)
- Laura Mihaela Isop
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania; (L.M.I.)
| | - Andrea Elena Neculau
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania; (L.M.I.)
| | - Radu Dan Necula
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania
| | - Cristian Kakucs
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania
| | - Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania
| | - Lorena Dima
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, Transilvania University of Brasov, 500036 Brașov, Romania; (L.M.I.)
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Zegarra-Valdivia JA, Aguzzoli-Peres F, Kornhuber A, Arshad F, Paredes-Manrique CN. One step beyond the lab and clinic: "walking the dementia conversation". Front Public Health 2023; 11:1284692. [PMID: 38145063 PMCID: PMC10748414 DOI: 10.3389/fpubh.2023.1284692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/23/2023] [Indexed: 12/26/2023] Open
Abstract
Millions of dollars have been lost in dementia research over the last 30 years owing to unsuccessful clinical trials aimed at finding an effective treatment for the condition. Although two promising drugs have been identified, the research effort is insufficient. The dehumanization of patients and the pressure to publish have led to a decline in the quality and usefulness of scientific research. One way to tackle these problems is establishing close contact with those who put their faith in researchers. Fine-tuning the participation of patients with dementia and caregivers in research design and improving their connection and communication with researchers could positively contribute to enhancing the perspectives and designing strategies for scientists in order to generate a new and enriching vision. The Walking the Talk for Dementia event showed that people can still live with dementia despite their condition. Approximately 300 people participated in the all-week "Santiago's Camino" symposium. People living with dementia, caregivers, healthcare professionals, activists, clinicians, and researchers participated in this event. The "Walking the Talk for Dementia" (WTD) event vividly demonstrated a strong commitment to upholding Global Brain Health Institute's (GBHI) core values of Authenticity, Fairness, Openness, Respect, Courage, and Empathy (A FORCE) to advance equity in brain health. These values provide clear guidance for their advocacy initiatives aimed at mitigating the global impact of dementia. Research and development are essential across scientific fields, especially in clinical contexts where involving patients and caregivers is critical. The WTD initiative exemplifies this aspect by bringing together researchers, caregivers, and dementia patients on the Camino de Santiago in Spain.
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Affiliation(s)
- Jonathan Adrián Zegarra-Valdivia
- Global Brain Health Institute – University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
- Faculty of Health Sciences, Universidad Señor de Sipán, Chiclayo, Peru
| | - Fernando Aguzzoli-Peres
- Global Brain Health Institute – University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
| | - Alex Kornhuber
- Global Brain Health Institute – University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
| | - Faheem Arshad
- Global Brain Health Institute – University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Gao C, Liu Y, Zhang TL, Luo Y, Gao J, Chu JJ, Gong BF, Chen XH, Yin T, Zhang J, Yin Y. Biomembrane-Derived Nanoparticles in Alzheimer's Disease Therapy: A Comprehensive Review of Synthetic Lipid Nanoparticles and Natural Cell-Derived Vesicles. Int J Nanomedicine 2023; 18:7441-7468. [PMID: 38090364 PMCID: PMC10712251 DOI: 10.2147/ijn.s436774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Current therapies for Alzheimer's disease used in the clinic predominantly focus on reducing symptoms with limited capability to control disease progression; thus, novel drugs are urgently needed. While nanoparticles (liposomes, high-density lipoprotein-based nanoparticles) constructed with synthetic biomembranes have shown great potential in AD therapy due to their excellent biocompatibility, multifunctionality and ability to penetrate the BBB, nanoparticles derived from natural biomembranes (extracellular vesicles, cell membrane-based nanoparticles) display inherent biocompatibility, stability, homing ability and ability to penetrate the BBB, which may present a safer and more effective treatment for AD. In this paper, we reviewed the synthetic and natural biomembrane-derived nanoparticles that are used in AD therapy. The challenges associated with the clinical translation of biomembrane-derived nanoparticles and future perspectives are also discussed.
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Affiliation(s)
- Chao Gao
- Department of Neurology, Second Affiliated Hospital (Shanghai Changzheng Hospital) of Naval Medical University, Shanghai, People’s Republic of China
| | - Yan Liu
- Department of Clinical Pharmacy, Shanghai Jiao Tong University of Medicine, Shanghai, People’s Republic of China
| | - Ting-Lin Zhang
- Changhai Clinical Research Unit, Shanghai Changhai Hospital of Naval Medical University, Shanghai, People’s Republic of China
| | - Yi Luo
- Department of Clinical Pharmacy, Shanghai Jiao Tong University of Medicine, Shanghai, People’s Republic of China
- New Drug Discovery and Development, Biotheus Inc., Zhuhai, People’s Republic of China
| | - Jie Gao
- Changhai Clinical Research Unit, Shanghai Changhai Hospital of Naval Medical University, Shanghai, People’s Republic of China
| | - Jian-Jian Chu
- Department of Neurology, Second Affiliated Hospital (Shanghai Changzheng Hospital) of Naval Medical University, Shanghai, People’s Republic of China
| | - Bao-Feng Gong
- Department of Neurology, Second Affiliated Hospital (Shanghai Changzheng Hospital) of Naval Medical University, Shanghai, People’s Republic of China
| | - Xiao-Han Chen
- Department of Neurology, Second Affiliated Hospital (Shanghai Changzheng Hospital) of Naval Medical University, Shanghai, People’s Republic of China
| | - Tong Yin
- Department of Neurology, Second Affiliated Hospital (Shanghai Changzheng Hospital) of Naval Medical University, Shanghai, People’s Republic of China
| | - Jian Zhang
- Department of Clinical Pharmacy, Shanghai Jiao Tong University of Medicine, Shanghai, People’s Republic of China
| | - You Yin
- Department of Neurology, Second Affiliated Hospital (Shanghai Changzheng Hospital) of Naval Medical University, Shanghai, People’s Republic of China
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164
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Shen R, Ardianto C, Celia C, Sidharta VM, Sasmita PK, Satriotomo I, Turana Y. Brain-derived neurotrophic factor interplay with oxidative stress: neuropathology approach in potential biomarker of Alzheimer's disease. Dement Neuropsychol 2023; 17:e20230012. [PMID: 38053647 PMCID: PMC10695442 DOI: 10.1590/1980-5764-dn-2023-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/05/2023] [Accepted: 07/30/2023] [Indexed: 12/07/2023] Open
Abstract
The aging population poses a serious challenge concerning an increased prevalence of Alzheimer's disease (AD) and its impact on global burden, morbidity, and mortality. Oxidative stress, as a molecular hallmark that causes susceptibility in AD, interplays to other AD-related neuropathology cascades and decreases the expression of central and circulation brain-derived neurotrophic factor (BDNF), an essential neurotrophin that serves as nerve development and survival, and synaptic plasticity in AD. By its significant correlation with the molecular and clinical progression of AD, BDNF can potentially be used as an objectively accurate biomarker for AD diagnosis and progressivity follow-up in future clinical practice. This comprehensive review highlights the oxidative stress interplay with BDNF in AD neuropathology and its potential use as an AD biomarker.
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Affiliation(s)
- Robert Shen
- Atma Jaya Catholic University of Indonesia, School of Medicine and Health Sciences, Jakarta, Indonesia
| | - Christian Ardianto
- Atma Jaya Catholic University of Indonesia, School of Medicine and Health Sciences, Jakarta, Indonesia
| | - Celia Celia
- Atma Jaya Catholic University of Indonesia, School of Medicine and Health Sciences, Jakarta, Indonesia
| | - Veronika Maria Sidharta
- Atma Jaya Catholic University of Indonesia, School of Medicine and Health Sciences, Jakarta, Indonesia
| | - Poppy Kristina Sasmita
- Atma Jaya Catholic University of Indonesia, School of Medicine and Health Sciences, Jakarta, Indonesia
| | - Irawan Satriotomo
- University of Florida, Gainesville, Department of Neurology, Florida, USA
- Satriotomo Foundation, Indonesia Neuroscience Institute, Jakarta, Indonesia
| | - Yuda Turana
- Atma Jaya Catholic University of Indonesia, School of Medicine and Health Sciences, Jakarta, Indonesia
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165
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Bettencourt C, Skene N, Bandres-Ciga S, Anderson E, Winchester LM, Foote IF, Schwartzentruber J, Botia JA, Nalls M, Singleton A, Schilder BM, Humphrey J, Marzi SJ, Toomey CE, Kleifat AA, Harshfield EL, Garfield V, Sandor C, Keat S, Tamburin S, Frigerio CS, Lourida I, Ranson JM, Llewellyn DJ. Artificial intelligence for dementia genetics and omics. Alzheimers Dement 2023; 19:5905-5921. [PMID: 37606627 PMCID: PMC10841325 DOI: 10.1002/alz.13427] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Genetics and omics studies of Alzheimer's disease and other dementia subtypes enhance our understanding of underlying mechanisms and pathways that can be targeted. We identified key remaining challenges: First, can we enhance genetic studies to address missing heritability? Can we identify reproducible omics signatures that differentiate between dementia subtypes? Can high-dimensional omics data identify improved biomarkers? How can genetics inform our understanding of causal status of dementia risk factors? And which biological processes are altered by dementia-related genetic variation? Artificial intelligence (AI) and machine learning approaches give us powerful new tools in helping us to tackle these challenges, and we review possible solutions and examples of best practice. However, their limitations also need to be considered, as well as the need for coordinated multidisciplinary research and diverse deeply phenotyped cohorts. Ultimately AI approaches improve our ability to interrogate genetics and omics data for precision dementia medicine. HIGHLIGHTS: We have identified five key challenges in dementia genetics and omics studies. AI can enable detection of undiscovered patterns in dementia genetics and omics data. Enhanced and more diverse genetics and omics datasets are still needed. Multidisciplinary collaborative efforts using AI can boost dementia research.
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Affiliation(s)
- Conceicao Bettencourt
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Nathan Skene
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Sara Bandres-Ciga
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Emma Anderson
- Department of Mental Health of Older People, Division of Psychiatry, University College London, London, UK
| | | | - Isabelle F Foote
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jeremy Schwartzentruber
- Open Targets, Cambridge, UK
- Wellcome Sanger Institute, Cambridge, UK
- Illumina Artificial Intelligence Laboratory, Illumina Inc, Foster City, California, USA
| | - Juan A Botia
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain
| | - Mike Nalls
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Data Tecnica International LLC, Washington, DC, USA
| | - Andrew Singleton
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Brian M Schilder
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Jack Humphrey
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sarah J Marzi
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Christina E Toomey
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
- The Francis Crick Institute, London, UK
| | - Ahmad Al Kleifat
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric L Harshfield
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Victoria Garfield
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Cynthia Sandor
- UK Dementia Research Institute. School of Medicine, Cardiff University, Cardiff, UK
| | - Samuel Keat
- UK Dementia Research Institute. School of Medicine, Cardiff University, Cardiff, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Section, University of Verona, Verona, Italy
| | - Carlo Sala Frigerio
- UK Dementia Research Institute, Queen Square Institute of Neurology, University College London, London, UK
| | | | | | - David J Llewellyn
- University of Exeter Medical School, Exeter, UK
- The Alan Turing Institute, London, UK
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166
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Lloyd-Hazlegreaves P, Hayes L, Pearce MS. Associations between physical inactivity and dementia prevalence: ecological study using global data. Public Health 2023; 225:299-304. [PMID: 37956642 DOI: 10.1016/j.puhe.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Given the predicted rise in dementia prevalence around the world, targeting modifiable risk factors (often lifestyle related) is a priority. This work sought to understand the role of physical inactivity (PI) as a modifiable risk factor for dementia. STUDY DESIGN Ecological study using globally available ecological data (both 2010 and 2016) from 192 countries. METHODS Age-standardised PI prevalence and dementia prevalence data were accessed from the World Health Organisation (WHO) and the Global Burden of Disease Study. Linear regression was used to assess the relationship between PI and dementia, with stratified analyses used to further explore the impact of sex, WHO region, and World Bank income group on the relationship. RESULTS Linear regression showed a positive association between inactivity and dementia prevalence in 2010 (b = 1.38 [95% confidence interval {CI}: 0.04, 2.71] P = 0.044) and 2016 (coefficient = 2.52 [95% CI: 1.07, 3.96] P = 0.0007). Sub-group analyses of sex-specific data showed the strength of the relationship was stronger in men than in women. Rates of both dementia and inactivity rose with increasing world income group. CONCLUSIONS This analysis of global data indicates the presence of a positive relationship between prevalence of PI and dementia prevalence, which has increased in strength with time, and is stronger in men than in women. This highlights the importance of public health interventions on a global scale to reduce the percentage of the population failing to reach or exceed the recommended physical activity guidelines.
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Affiliation(s)
| | - L Hayes
- Population Health Sciences Institute, Newcastle University, UK
| | - M S Pearce
- Population Health Sciences Institute, Newcastle University, UK.
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167
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Zou D, Liu R, Lv Y, Guo J, Zhang C, Xie Y. Latest advances in dual inhibitors of acetylcholinesterase and monoamine oxidase B against Alzheimer's disease. J Enzyme Inhib Med Chem 2023; 38:2270781. [PMID: 37955252 PMCID: PMC10653629 DOI: 10.1080/14756366.2023.2270781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/27/2023] [Indexed: 11/14/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive brain disease characterised by progressive memory loss and cognition impairment, ultimately leading to death. There are three FDA-approved acetylcholinesterase inhibitors (donepezil, rivastigmine, and galantamine, AChEIs) for the symptomatic treatment of AD. Monoamine oxidase B (MAO-B) has been considered to contribute to pathologies of AD. Therefore, we reviewed the dual inhibitors of acetylcholinesterase (AChE) and MAO-B developed in the last five years. In this review, these dual-target inhibitors were classified into six groups according to the basic parent structure, including chalcone, coumarin, chromone, benzo-fused five-membered ring, imine and hydrazine, and other scaffolds. Their design strategies, structure-activity relationships (SARs), and molecular docking studies with AChE and MAO-B were analysed and discussed, giving valuable insights for the subsequent development of AChE and MAO-B dual inhibitors. Challenges in the development of balanced and potent AChE and MAO-B dual inhibitors were noted, and corresponding solutions were provided.
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Affiliation(s)
- Dajiang Zou
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Renzheng Liu
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Yangjing Lv
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Jianan Guo
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Changjun Zhang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
| | - Yuanyuan Xie
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, China
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceutical, Zhejiang University of Technology, Hangzhou, China
- Key Laboratory for Green Pharmaceutical Technologies and Related Equipment of Ministry of Education, Key Laboratory of Pharmaceutical Engineering of Zhejiang Province, Hangzhou, China
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Vesikansa A, Halminen O, Mehtälä J, Hörhammer I, Mikkola T, Ylisaukko-Oja T, Linna M. Early start of anti-dementia medication is associated with lower health and social care costs in Alzheimer´s patients: a Finnish nationwide register study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1421-1428. [PMID: 36449133 DOI: 10.1007/s10198-022-01553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To evaluate the association between health and social care costs and early start of anti-dementia medication in a nationwide cohort of Finnish Alzheimer's disease (AD) patients. METHODS The cohort included 7454 Finnish AD patients who had their first AD diagnosis in 2012 and lived at home at the time of diagnosis. Data were collected retrospectively from the Finnish national health and social care registers. The primary outcome was 2-year cumulative direct costs after the incident AD diagnosis. The exploratory variable was early anti-dementia medication start (anti-dementia medication started within 3 months of the incident AD diagnosis). Sociodemographic variables, admission to 24-h care and care intensity level, as well as comorbidities were considered as adjusting variables. RESULTS Of all patients, 88.9% started AD medication within 3 months of diagnosis. The 2-year cumulative costs were €30,787 and €40,484 per patient for early and late starters, respectively. When adjusted for possible confounders, early start of anti-dementia medication was associated with 26.5% lower 2-year cumulative costs compared to late starters (relative cost 0.735; p < 0.001). CONCLUSIONS Early diagnosis and start of anti-dementia medication is important for managing the costs of increasing number of AD patients.
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Affiliation(s)
| | - Olli Halminen
- Aalto University/Health Care, Engineering, Management and architecture (HEMA), Espoo , Finland
| | - Juha Mehtälä
- MedEngine Oy, Eteläranta 14, 00130, Helsinki, Finland
| | - Iiris Hörhammer
- Aalto University/Health Care, Engineering, Management and architecture (HEMA), Espoo , Finland
| | | | - Tero Ylisaukko-Oja
- MedEngine Oy, Eteläranta 14, 00130, Helsinki, Finland
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Miika Linna
- Aalto University/Health Care, Engineering, Management and architecture (HEMA), Espoo , Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Yang T, Xiao Y, Cheng Y, Huang J, Wei Q, Li C, Shang H. Epigenetic clocks in neurodegenerative diseases: a systematic review. J Neurol Neurosurg Psychiatry 2023; 94:1064-1070. [PMID: 36963821 DOI: 10.1136/jnnp-2022-330931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Biological ageing is one of the principal risk factors for neurodegenerative diseases. It is becoming increasingly clear that acceleration of DNA methylation age, as measured by the epigenetic clock, is closely associated with many age-related diseases. METHODS We searched the PubMed and Web of Science databases to identify eligible studies reporting epigenetic clocks in several neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS) and Huntington's disease (HD). RESULTS Twenty-three studies (12 for AD, 4 for PD, 5 for ALS, and 2 for HD) were included. We systematically summarised the clinical utility of 11 epigenetic clocks (based on blood and brain tissues) in assessing the risk factors, age of onset, diagnosis, progression, prognosis and pathology of AD, PD, ALS and HD. We also critically described our current understandings to these evidences, and further discussed key challenges, potential mechanisms and future perspectives of epigenetic ageing in neurodegenerative diseases. CONCLUSIONS Epigenetic clocks hold great potential in neurodegenerative diseases. Further research is encouraged to evaluate the clinical utility and promote the application. PROSPERO REGISTRATION NUMBER CRD42022365233.
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Affiliation(s)
- Tianmi Yang
- Department of Neurology, Sichuan University, Chengdu, Sichuan, China
| | - Yi Xiao
- Department of Neurology, Sichuan University, Chengdu, Sichuan, China
| | - Yangfan Cheng
- Department of Neurology, Sichuan University, Chengdu, Sichuan, China
| | - Jingxuan Huang
- Department of Neurology, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, Sichuan University, Chengdu, Sichuan, China
| | - Chunyu Li
- Department of Neurology, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Sichuan University, Chengdu, Sichuan, China
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Zamanian MY, Soltani A, Khodarahmi Z, Alameri AA, Alwan AMR, Ramírez-Coronel AA, Obaid RF, Abosaooda M, Heidari M, Golmohammadi M, Anoush M. Targeting Nrf2 signaling pathway by quercetin in the prevention and treatment of neurological disorders: An overview and update on new developments. Fundam Clin Pharmacol 2023; 37:1050-1064. [PMID: 37259891 DOI: 10.1111/fcp.12926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/16/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Neurological disorders (NLDs) are widely acknowledged as a significant public health concern worldwide. Stroke, Alzheimer's disease (AD), and traumatic brain injury (TBI) are three of these disorders that have sparked major study attention. Neurological dysfunction, protein buildup, oxidation and neuronal injury, and aberrant mitochondria are all prevalent neuropathological hallmarks of these disorders. The signaling cascade of nuclear factor erythroid 2 related factor 2 (Nrf2) shares all of them as a common target. Several studies have found that overexpression of Nrf2 is a promising treatment method in NLDs. Effective treatment of these disorders continues to be a universal concern regardless of various medicines. In order to treat a variety of neurological problems, organic remedies may provide an alternative treatment. It has been demonstrated that polyphenols like quercetin (Que) offer considerable capabilities for treating NLDs. One of Que's greatest key targets, Nrf2, has the capacity to control the production of a number of cytoprotective enzymes that exhibit neuroprotective, detoxifying, and antioxidative effects. Additionally, Que enhanced the expression of Nrf2 and inhibited alterations in the shape and death of neurons in the hippocampus. OBJECTIVE In this review, we have focused on Que's medicinal prospects as a neuroprotective drug. METHODS PubMed, Scopus, Science Direct, and Google Scholar were used to search articles for this study. RESULTS The findings of this research demonstrate that (1) Que protected the blood-brain barrier via stimulating Nrf2 in animal stroke, which alleviated ischemic reperfusion and motor dysfunction. (2) By triggering the Nrf2 pathway, Que reduced the neuroinflammation and oxidative damage brought on by TBI in the cortex. (3) In an experimental model of AD, Que enhanced cognitive function by decreasing A1-4, antioxidant activity, and Nrf2 levels in the brain. CONCLUSION We discuss recent research on Que-mediated Nrf2 expression in the management of several NLDs in this paper.
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Affiliation(s)
- Mohammad Yasin Zamanian
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Afsaneh Soltani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khodarahmi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Athemar M R Alwan
- Department of Radiological Techniques, Al-Mustaqbal University College, Babylon, Iraq
| | - Andrés Alexis Ramírez-Coronel
- Azogues Campus Nursing Career, Health and Behavior Research Group (HBR), Psychometry and Ethology Laboratory, Catholic University of Cuenca, Cuenca, Ecuador
- Doctorate in Psychology, University of Palermo, Buenos Aires, Argentina
- Epidemiology and Biostatistics Research Group, CES University, Medellín, Colombia
| | | | - Munther Abosaooda
- Epidemiology and Biostatistics Research Group, CES University, Medellín, Colombia
| | - Mahsa Heidari
- Department of Biochemistry, Institute of Biochemistry and Biophysics (IBB), University of Tehran, Tehran, Iran
| | - Maryam Golmohammadi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Anoush
- Department of Pharmacology and Toxicology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
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Myrstad C, Engdahl BL, Costafreda SG, Krokstad S, Lin F, Livingston G, Strand BH, Øhre B, Selbæk G. Hearing impairment and risk of dementia in The HUNT Study (HUNT4 70+): a Norwegian cohort study. EClinicalMedicine 2023; 66:102319. [PMID: 38192588 PMCID: PMC10772264 DOI: 10.1016/j.eclinm.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024] Open
Abstract
Background Hearing impairment is strongly associated with future dementia. No studies have reported objectively measured hearing impairment in a cohort with a long period of follow-up (>20 years), and few have reported follow-up over 10 years. Hence, there is a need for high quality studies with sufficient follow-up time and data to account for reverse causality and confounding. We aimed to address this knowledge gap. Methods This cohort study used individual participant data from The Trøndelag Health Study (HUNT) in Norway. All current residents aged at least 20 years in the former Norwegian Nord-Trøndelag County were invited to participate in four decennial surveys: HUNT1 (1984-1986), HUNT2 (1995-1997), HUNT3 (2006-2008), and HUNT4 (2017-2019) with individuals aged at least 70 years included in a substudy, known as HUNT4 70+. Here, we report the findings of this substudy. HUNT4 70+ comprised 7135 participants who were assessed for dementia using the Diagnostic and Statistical Manual of Mental Disorders 5 criteria and who had audiometry between 1996 and 1998. The primary objective was to investigate, with gold standard audiometric testing and dementia diagnostic assessment, whether hearing impairment was an independent risk factor for all-cause dementia. The secondary objective was to investigate if a risk also applied to Alzheimer dementia and non-Alzheimer dementia. We analysed the association using Poisson regression and adjusted for confounders. This study is registered with ClinicalTrials.gov (NCT04284384). Findings At baseline, 1058 (15%) individuals had acquired hearing impairment with a hearing threshold of at least 25 decibel (dB) and, at follow-up, 1089 (15%) had dementia. In the total group, people with hearing impairment had a relative risk (RR) 1.04 (95% confidence interval (CI) 1.00-1.09) per 10 dB increase in hearing thresholds. For individuals younger than 85 years at follow-up the RR was 1.12 (95% CI 1.05-1.21). Associations between hearing impairment and Alzheimer dementia and non-Alzheimer dementia were similar. There was no association for individuals aged at least 85 years. Interpretation We found a moderate association between objectively measured hearing impairment and dementia in the younger age group (<85 years). The findings of no association in the older age group (≥85 years) might be due to the competing risk of death. The present study adds to the literature showing that acquired hearing impairment is a risk for dementias over a period which is too long for reverse causation, and with thorough consideration of confounders. Further research is needed to investigate associations between the different aetiologies of hearing loss and dementia subtypes, and risk differences for sexes. Funding The Norwegian National Centre for Ageing and Health with a grant from Health South-East.
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Affiliation(s)
- Christian Myrstad
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bo Lars Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Sergi Gonzales Costafreda
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Steinar Krokstad
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Frank Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Beate Øhre
- The Norwegian National Unit for Sensory Loss and Mental Health, Oslo University Hospital, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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172
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Li C, Zhu X, Yang K, Ju Y, Shi K, Xiao Y, Su B, Lu F, Cui L, Li M. Relationship of retinal capillary plexus and ganglion cell complex with mild cognitive impairment and dementia. Eye (Lond) 2023; 37:3743-3750. [PMID: 37270614 PMCID: PMC10698172 DOI: 10.1038/s41433-023-02592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To investigate relationship of the retinal capillary plexus (RCP) and ganglion cell complex (GCC) with mild cognitive impairment (MCI) and dementia in a community-based study1. METHODS This cross-sectional study incorporated the participants of the Jidong Eye Cohort Study. Optical coherence tomography angiography was performed to obtain RCP vessel density and GCC thickness with detailed segments. The Mini-mental State Examination and Montreal Cognitive Assessment were used to assess cognitive status by professional neuropsychologists. Participants were thus divided into three groups: normal, mild cognitive impairment, and dementia. Multivariable analysis was used to measure relationship of ocular parameters with cognitive impairment. RESULTS Of the 2678 participants, the mean age was 44.1 ± 11.7 years. MCI and dementia occurred in 197 (7.4%) and 80 (3%) participants, respectively. Compared to the normal group, the adjusted odds ratio (OR) with the 95% confidence interval was 0.76 (0.65-0.90) for the correlation of lower deep RCP with MCI. We found the following items significantly associated with dementia compared with the normal group: a superficial (OR, 0.68 [0.54-0.86]) and deep (OR, 0.75 [0.57-0.99]) RCP, as well as the GCC (OR, 0.68 [0.54-0.85]). Compared to the MCI group, those with dementia had decreased GCC (OR, 0.75 [0.58-0.97]). CONCLUSIONS Decreased deep RCP density was associated with MCI. Decreased superficial and deep RCP and the thin GCC were correlated with dementia. These implied that the retinal microvasculature may develop into a promising non-invasive imaging marker to predict severity of cognitive impairment.
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Affiliation(s)
- Chunmei Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiaoxuan Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Kai Yang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ying Ju
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Keai Shi
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yunfan Xiao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Binbin Su
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Fan Lu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Lele Cui
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Ming Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Tang X, Peng J, Huang S, Xu H, Wang P, Jiang J, Zhang W, Shi X, Shi L, Zhong X, Lü M. Global burden of early-onset colorectal cancer among people aged 40-49 years from 1990 to 2019 and predictions to 2030. J Cancer Res Clin Oncol 2023; 149:16537-16550. [PMID: 37712957 DOI: 10.1007/s00432-023-05395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE To explore the disease burden of early-onset colorectal cancer (EO-CRC) in individuals aged 40-49 years and provide baseline evidence for routine recommended age adjustment for CRC screening and other clinical decision-making. METHODS We collected data stratified by sex, risk factors, and socio-demographic index (SDI) from the Global Burden of Disease Study 2019 Data Resources. Trends in disease burden were analyzed by estimated annual percentage change. The Bayesian age-period-cohort model predicted the burden over the following 10 years. RESULTS In 2019, the global rates of incidence, mortality, prevalence, and disability-adjusted life year (DALY) of EO-CRC in people aged 40-44 years were 11.48 (95% uncertainty interval: 10.50-12.59), 4.35 (4.01-4.70), 72.63 (66.48-79.52), 209.82 (193.55-226.59) per 100,000 population. For people aged 45-49 years, the rates of these four estimates were 19.63 (17.97-21.54), 7.76 (7.16-8.41), 121.73 (110.99-133.84), and 335.83 (310.14-362.91), respectively. The incidence and prevalence rates for both age groups increased while the mortality and DALY rates remained stable from 1990 to 2019. In 2019, high-income North America had the highest incidence and prevalence rates. A low milk diet accounted for the largest proportion of global DALYs in EO-CRC, and there was a tendency for the DALY rate first to increase and then decrease with increasing SDI. The incidence and mortality rates were predicted to increase in the next 10 years. CONCLUSION The current and future burden of EO-CRC among people aged 40-49 years is heavy. Substantial variation exists in disease burden across regions and countries. Urgent screening actions and policies are needed.
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Affiliation(s)
- Xiaowei Tang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
| | - Jieyu Peng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Shu Huang
- Department of Gastroenterology, Lianshui County People' Hospital, Huaian, China
- Department of Gastroenterology, Lianshui People' Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian, China
| | - Huan Xu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Ping Wang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Jiao Jiang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Wei Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Xiaomin Shi
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Lei Shi
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Xiaolin Zhong
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Muhan Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
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Gillett DA, Wallings RL, Uriarte Huarte O, Tansey MG. Progranulin and GPNMB: interactions in endo-lysosome function and inflammation in neurodegenerative disease. J Neuroinflammation 2023; 20:286. [PMID: 38037070 PMCID: PMC10688479 DOI: 10.1186/s12974-023-02965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Alterations in progranulin (PGRN) expression are associated with multiple neurodegenerative diseases (NDs), including frontotemporal dementia (FTD), Alzheimer's disease (AD), Parkinson's disease (PD), and lysosomal storage disorders (LSDs). Recently, the loss of PGRN was shown to result in endo-lysosomal system dysfunction and an age-dependent increase in the expression of another protein associated with NDs, glycoprotein non-metastatic B (GPNMB). MAIN BODY It is unclear what role GPNMB plays in the context of PGRN insufficiency and how they interact and contribute to the development or progression of NDs. This review focuses on the interplay between these two critical proteins within the context of endo-lysosomal health, immune function, and inflammation in their contribution to NDs. SHORT CONCLUSION PGRN and GPNMB are interrelated proteins that regulate disease-relevant processes and may have value as therapeutic targets to delay disease progression or extend therapeutic windows.
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Affiliation(s)
- Drew A Gillett
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Rebecca L Wallings
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Oihane Uriarte Huarte
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Malú Gámez Tansey
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, FL, USA.
- Department of Neuroscience, University of Florida, Gainesville, FL, USA.
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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Lu K, Liu T, Wu X, Zhong J, Ou Z, Wu W. Association between serum iron, blood lead, cadmium, mercury, selenium, manganese and low cognitive performance in old adults from National Health and Nutrition Examination Survey (NHANES): a cross-sectional study. Br J Nutr 2023; 130:1743-1753. [PMID: 36941743 DOI: 10.1017/s0007114523000740] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Cognitive decline is a public health problem for the world's ageing population. This study was to evaluate the relationships between serum Fe, blood Pb, Cd, Hg, Se and Mn and cognitive decline in elderly Americans. Data of this cross-sectional study were extracted from the National Health and Nutritional Examination Survey (NHANES 2011-2014). Cognitive performance was measured by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Animal Fluency and Digit Symbol Substitution Test (DSST) tests. Weighted univariable and multivariate logistic regression analyses were used to assess the associations between six trace elements and low cognitive performance. Subgroup analyses based on diabetes and hypertension history were further assessed the associations. A total of 2002 adults over 60 years old were included. After adjusting covariates, elevated serum Fe levels were associated with the decreased risk of low cognitive performance, especially in the elderly without diabetes history and with hypertension history. High blood Cd levels were associated with the high odds of low cognitive performance in old adults with diabetes and hypertension history. Elevated blood Mn levels were connected with low cognitive performance in old hypertensive people. High blood Pb levels were related to the high odds of low cognitive performance, especially in the elderly without diabetes and hypertension history. High blood Se levels were linked to the decreased risk of low cognitive performance in all the elderly. Appropriate Fe, Se supplementation and Fe-, Se-rich foods intake, while reducing exposure to Pb, Cd and Mn may be beneficial for cognitive function in the elderly.
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Affiliation(s)
- Kui Lu
- Department of Neurology, Zhongshan City People's Hospital, Zhongshan528403, Guangdong, People's Republic of China
| | - Tian Liu
- President's Office, Zhongshan City People's Hospital, Zhongshan 528403, Guangdong, People's Republic of China
| | - Xiaoyan Wu
- Department of Neurology, the Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou511300, Guangdong, People's Republic of China
| | - Jianqiang Zhong
- Department of Neurology, the Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou511300, Guangdong, People's Republic of China
| | - Zhenri Ou
- Department of Neurology, Zhongshan City People's Hospital, Zhongshan528403, Guangdong, People's Republic of China
| | - Wenjun Wu
- Department of Neurology, Zhongshan City People's Hospital, Zhongshan528403, Guangdong, People's Republic of China
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Zhou Z, Ryan J, Tonkin AM, Zoungas S, Lacaze P, Wolfe R, Orchard SG, Murray AM, McNeil JJ, Yu C, Watts GF, Hussain SM, Beilin LJ, Ernst ME, Stocks N, Woods RL, Zhu C, Reid CM, Shah RC, Chong TTJ, Sood A, Sheets KM, Nelson MR. Association Between Triglycerides and Risk of Dementia in Community-Dwelling Older Adults: A Prospective Cohort Study. Neurology 2023; 101:e2288-e2299. [PMID: 37879942 PMCID: PMC10727221 DOI: 10.1212/wnl.0000000000207923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It has been suggested that higher triglyceride levels were associated with a lower risk of Alzheimer disease. This study aimed to examine the association of triglycerides with dementia and cognition change in community-dwelling older adults. METHODS This prospective longitudinal study used data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized trial of adults aged 65 years or older without dementia or previous cardiovascular events at enrollment. The main outcome was incident dementia. Other outcomes included changes in composite cognition and domain-specific cognition (global cognition, memory, language and executive function, and psychomotor speed). The association between baseline triglycerides and dementia risk was estimated using Cox proportional hazard models adjusting for relevant risk factors. Linear mixed models were used to investigate cognitive change. The analysis was repeated in a subcohort of participants with available APOE-ε4 genetic data with additional adjustment for APOE-ε4 carrier status and an external cohort (UK Biobank) with similar selection criteria applied. RESULTS This study included 18,294 ASPREE participants and 68,200 UK Biobank participants (mean age: 75.1 and 66.9 years; female: 56.3% and 52.7%; median [interquartile range] triglyceride: 106 [80-142] mg/dL and 139 [101-193] mg/dL), with dementia recorded in 823 and 2,778 individuals over a median follow-up of 6.4 and 12.5 years, respectively. Higher triglyceride levels were associated with lower dementia risk in the entire ASPREE cohort (hazard ratio [HR] with doubling of triglyceride: 0.82, 95% CI 0.72-0.94). Findings were similar in the subcohort of participants with APOE-ε4 genetic data (n = 13,976) and in the UK Biobank cohort (HR was 0.82 and 0.83, respectively, all p ≤ 0.01). Higher triglycerides were also associated with slower decline in composite cognition and memory over time (p ≤ 0.05). DISCUSSION Older adults with higher triglyceride levels within the normal to high-normal range had a lower dementia risk and slower cognitive decline over time compared with individuals with lower triglyceride levels. Higher triglyceride levels may be reflective of better overall health and/or lifestyle behaviors that would protect against dementia development. Future studies are warranted to investigate whether specific components within the total circulating pool of plasma triglycerides may promote better cognitive function, with the hope of informing the development of new preventive strategies.
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Affiliation(s)
- Zhen Zhou
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia.
| | - Joanne Ryan
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Andrew M Tonkin
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Sophia Zoungas
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Paul Lacaze
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Rory Wolfe
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Suzanne G Orchard
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Anne M Murray
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - John J McNeil
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Chenglong Yu
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Gerald F Watts
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Sultana Monira Hussain
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Lawrence J Beilin
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Michael E Ernst
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Nigel Stocks
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Robyn L Woods
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Chao Zhu
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Raj C Shah
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Trevor T-J Chong
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Ajay Sood
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Kerry M Sheets
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
| | - Mark R Nelson
- From the School of Public Health and Preventive Medicine (Z.Z., J.R., A.M.T., S.Z., P.L., R.W., S.G.O., J.J.M., C.Y., S.M.H., R.L.W.), Central Clinical School (C.Z.), and Turner Institute for Brain & Mental Health (T.T.-J.C.), Monash University, Melbourne, Victoria, Australia; Berman Center for Outcomes and Clinical Research (A.M.M.), Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, MN; School of Medicine (G.F.W., L.J.B.), University of Western Australia, Perth; Department of Pharmacy Practice and Science (M.E.E.), College of Pharmacy, The University of Iowa, Iowa City; Discipline of General Practice (N.S.), University of Adelaide, South Australia; School of Population Health (C.M.R.), Curtin University, Perth, Western Australia; Department of Family and Preventive Medicine and Rush Alzheimer's Disease Center (R.C.S., A.S.), Rush University Medical Center, Chicago, IL; Division of Geriatric Medicine (K.M.S.), Department of Medicine, Hennepin Healthcare, Minneapolis, MN; and Menzies Institute for Medical Research (M.R.N.), University of Tasmania, Hobart, Australia
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177
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Vishwanath S, Hopper I, Chowdhury E, Wolfe R, Freak-Poli R, Reid CM, Tonkin AM, Murray AM, Shah RC, Chong TTJ, Woods RL, McNeil J, Orchard SG, Nelson MR, Steves CJ, Ryan J. Cardiovascular Disease Risk Scores and Incident Dementia and Cognitive Decline in Older Men and Women. Gerontology 2023; 70:143-154. [PMID: 37984339 PMCID: PMC10866179 DOI: 10.1159/000535284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia risk in older adults who do not have a history of CVD, and potential gender differences in this association, remains unclear. The aim of this study was to determine whether CVD risk scores are prospectively associated with cognitive decline and dementia in initially healthy older men and women. METHODS A total of19,114 participants from a prospective cohort of individuals aged 65+ years without known CVD or dementia were recruited. The atherosclerotic cardiovascular disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP), and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (according to DSM-IV criteria) and cognitive decline (defined as a >1.5 standard deviation decline in global cognition, episodic memory, psychomotor speed, or verbal fluency from the previous year) were assessed using hazard ratio. RESULTS Over a median follow-up of 6.4 years, 850 individuals developed dementia and 4,352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95% CI 1.08, 1.85) and 45% (1.11, 1.89) increased risk of dementia compared to the lowest tertile, respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24, 2.16) and 60% (1.22, 2.11) increased risk of dementia compared to the lowest tertile, respectively. Findings were similar, but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. However, FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01-1.26]). CONCLUSION These findings suggest the utility of the ASCVDRS and SCORE2-OP in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment, even in relatively healthy older men and women.
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Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology and General Medicine Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Enayet Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- GenesisCare, Leabrook, South Australia, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Bentley, Washington, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Geriatrics Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
| | - Raj C Shah
- Department of Family and Preventive Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Trevor T-J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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178
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André AD, Martins P. Exo Supportive Devices: Summary of Technical Aspects. Bioengineering (Basel) 2023; 10:1328. [PMID: 38002452 PMCID: PMC10669745 DOI: 10.3390/bioengineering10111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Human societies have been trying to mitigate the suffering of individuals with physical impairments, with a special effort in the last century. In the 1950s, a new concept arose, finding similarities between animal exoskeletons, and with the goal of medically aiding human movement (for rehabilitation applications). There have been several studies on using exosuits with this purpose in mind. So, the current review offers a critical perspective and a detailed analysis of the steps and key decisions involved in the conception of an exoskeleton. Choices such as design aspects, base materials (structure), actuators (force and motion), energy sources (actuation), and control systems will be discussed, pointing out their advantages and disadvantages. Moreover, examples of exosuits (full-body, upper-body, and lower-body devices) will be presented and described, including their use cases and outcomes. The future of exoskeletons as possible assisted movement solutions will be discussed-pointing to the best options for rehabilitation.
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Affiliation(s)
- António Diogo André
- Associated Laboratory of Energy, Transports and Aeronautics (LAETA), Biomechanic and Health Unity (UBS), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
- Faculty of Engineering, University of Porto (FEUP), 4200-465 Porto, Portugal
| | - Pedro Martins
- Associated Laboratory of Energy, Transports and Aeronautics (LAETA), Biomechanic and Health Unity (UBS), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
- Aragon Institute for Engineering Research (i3A), Universidad de Zaragoza, 50018 Zaragoza, Spain
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179
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de Freitas EL, Calil-Elias S, Erbisti RS, Grinberg-Weller B, Miranda ES. Consumption of drugs for Alzheimer's disease on the Brazilian private market. Rev Saude Publica 2023; 57:83. [PMID: 37971177 PMCID: PMC10631752 DOI: 10.11606/s1518-8787.2023057005128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/26/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To analyze the consumption of drugs for Alzheimer's disease on the Brazilian private market and its geographical distribution from 2014 to 2020. METHODS National data from the Brazilian National System of Controlled Product Management were used, regarding sales of donepezil, galantamine, rivastigmine, and memantine from January 2014 to December 2020. Sales data were used as a proxy for drug consumption and expressed as defined daily dose/1,000 inhabitants/year at national, regional, federative unit and microregion levels. RESULTS Drug consumption went from 5,000 defined daily doses/1,000 inhabitants, in 2014, to more than 16,000/1,000 inhabitants, in 2020, and all federative units showed positive variation. The Brazilian Northeast had the highest cumulative consumption in the period but displayed microregional disparities while the North region had the lowest consumption. Donepezil and memantine were the most consumed drugs, with the highest growth in consumption from 2014 to 2020. CONCLUSION The consumption of medicines indicated to treat Alzheimer's disease tripled in Brazil between 2014 and 2020, which may relate to the increase in the prevalence of the disease in the country, greater access to health services, and inappropriate use. This challenges managers and healthcare providers due to population aging and the increased prevalence of chronic-degenerative diseases.
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Affiliation(s)
- Evani Leite de Freitas
- Universidade Federal FluminenseFaculdade de FarmáciaPrograma de Pós-graduação em Administração e Gestão da Assistência FarmacêuticaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Programa de Pós-graduação em Administração e Gestão da Assistência Farmacêutica . Niterói , RJ , Brazil
| | - Sabrina Calil-Elias
- Universidade Federal FluminenseFaculdade de FarmáciaDepartamento de Farmácia e Administração FarmacêuticaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Departamento de Farmácia e Administração Farmacêutica . Niterói , RJ , Brazil
| | - Rafael Santos Erbisti
- Universidade Federal FluminenseInstituto de Matemática e EstatísticaDepartamento de EstatísticaNiteróiRJBrazil Universidade Federal Fluminense . Instituto de Matemática e Estatística . Departamento de Estatística . Niterói , RJ , Brazil
| | - Branca Grinberg-Weller
- Universidade Federal FluminenseFaculdade de FarmáciaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Niterói , RJ , Brazil
| | - Elaine Silva Miranda
- Universidade Federal FluminenseFaculdade de FarmáciaDepartamento de Farmácia e Administração FarmacêuticaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Departamento de Farmácia e Administração Farmacêutica . Niterói , RJ , Brazil
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180
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Vuoksimaa E, Saari TT, Aaltonen A, Aaltonen S, Herukka SK, Iso-Markku P, Kokkola T, Kyttälä A, Kärkkäinen S, Liedes H, Ollikainen M, Palviainen T, Ruotsalainen I, Toivola A, Urjansson M, Vasankari T, Vähä-Ypyä H, Forsberg MM, Hiltunen M, Jalanko A, Kälviäinen R, Kuopio T, Lähteenmäki J, Nyberg P, Männikkö M, Serpi R, Siltanen S, Palotie A, Kaprio J, Runz H, Julkunen V. TWINGEN - protocol for an observational clinical biobank recall and biomarker study to identify individuals with high risk of Alzheimer's disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.03.23298018. [PMID: 37965200 PMCID: PMC10635260 DOI: 10.1101/2023.11.03.23298018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Introduction A better understanding of the earliest stages of Alzheimer's disease (AD) could expedite the development or administration of treatments. Large population biobanks hold the promise to identify individuals at an elevated risk of AD and related dementias based on health registry information. Here, we establish the protocol for an observational clinical recall and biomarker study called TWINGEN with the aim to identify individuals at high risk of AD by assessing cognition, health and AD-related biomarkers. Suitable candidates were identified and invited to participate in the new study among Finnish biobank donors according to TWINGEN study criteria. Methods and analysis A multi-center study (n=800) to obtain blood-based biomarkers, telephone-administered and web-based memory and cognitive parameters, questionnaire information on lifestyle, health and psychological factors, and accelerometer data for measures of physical activity, sedentary behavior and sleep. A sub-cohort are being asked to participate in an in-person neuropsychological assessment (n=200) and wear an Oura ring (n=50). All participants in the TWINGEN study have genome-wide genotyping data and up to 48 years of follow-up data from the population-based older Finnish Twin Cohort (FTC) study of the University of Helsinki. TWINGEN data will be transferred to Finnish Institute of Health and Welfare (THL) biobank and we aim to further to transfer it to the FinnGen study where it will be combined with health registry data for prediction of AD. Ethics and dissemination This recall study consists of FTC/THL/FinnGen participants whose data were acquired in accordance with the Finnish Biobank Act. The recruitment protocols followed the biobank protocols approved by Finnish Medicines Agency. The TWINGEN study plan was approved by the Ethics Committee of Hospital District of Helsinki and Uusimaa (number 16831/2022). THL Biobank approved the research plan with the permission no: THLBB2022_83.
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Affiliation(s)
- Eero Vuoksimaa
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Toni T Saari
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Aino Aaltonen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Sari Aaltonen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Sanna-Kaisa Herukka
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Paula Iso-Markku
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Tarja Kokkola
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Aija Kyttälä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sari Kärkkäinen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Liedes
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- VTT Technical Research Centre of Finland Ltd., Oulu, Finland
| | - Miina Ollikainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Teemu Palviainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Ilona Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- VTT Technical Research Centre of Finland Ltd., Espoo, Finland
| | - Auli Toivola
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mia Urjansson
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henri Vähä-Ypyä
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Markus M Forsberg
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- VTT Technical Research Centre of Finland Ltd., Kuopio, Finland
| | - Mikko Hiltunen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anu Jalanko
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Reetta Kälviäinen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Teijo Kuopio
- Central Finland Biobank, Central Finland Health Care District, Jyväskylä, Finland
| | | | - Pia Nyberg
- Biobank Borealis of Northern Finland, Oulu University Hospital, Wellbeing Services county of North Ostrobothnia, Oulu, Finland
- Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Minna Männikkö
- Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Raisa Serpi
- Biobank Borealis of Northern Finland, Oulu University Hospital, Wellbeing Services county of North Ostrobothnia, Oulu, Finland
| | - Sanna Siltanen
- Finnish Clinical Biobank Tampere, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Department of Medicine, Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Heiko Runz
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Translational Sciences, Biogen, Cambridge, MA, USA
| | - Valtteri Julkunen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Neurocenter, Kuopio University Hospital, Kuopio, Finland
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181
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Zhang W, Liang J, Li C, Gao D, Ma Q, Pan Y, Wang Y, Xie W, Zheng F. Age at Diagnosis of Atrial Fibrillation and Incident Dementia. JAMA Netw Open 2023; 6:e2342744. [PMID: 37938842 PMCID: PMC10632957 DOI: 10.1001/jamanetworkopen.2023.42744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 11/10/2023] Open
Abstract
Importance Epidemiological evidence regarding the association between atrial fibrillation (AF) onset age and risk of incident dementia remains unexplored. Objective To examine whether age at AF diagnosis is associated with risk of incident dementia and its subtypes. Design, Setting, and Participants This prospective, population-based cohort study used data from UK Biobank, a public, open-access database in the UK with baseline information collected from 2006 to 2010. A total of 433 746 participants were included in the main analysis after excluding participants with a diagnosis of dementia or AF at baseline, missing data on covariates, or having dementia before AF onset during a median follow-up of 12.6 years. Data were analyzed from October to December 2022. Exposures AF diagnosis and age at AF diagnosis according to age groups (<65 years, 65-74 years, or ≥75 years). Main Outcomes and Measures Incident dementia, ascertained through linkage from multiple databases until December 31, 2021. Cox proportional hazards models and the propensity score matching method were adopted to estimate the association between AF onset age and incident dementia. Results Of 433 746 included participants, 236 253 (54.5%) were female, the mean (SD) age was 56.9 (8.1) years, and 409 990 (94.5%) were White. Compared with individuals without AF, 30 601 individuals with AF had a higher risk of developing all-cause dementia (adjusted hazard ratio [HR], 1.42; 95% CI, 1.32-1.52) and vascular dementia (VD; adjusted HR, 2.06; 95% CI, 1.80-2.36), but not Alzheimer disease (AD; adjusted HR, 1.08; 95% CI, 0.96-1.21). Among participants with AF, younger age at AF onset was associated with higher risks of developing all-cause dementia (adjusted HR per 10-year decrease, 1.23; 95% CI, 1.16-1.32), AD (adjusted HR per 10-year decrease, 1.27; 95% CI, 1.13-1.42), and VD (adjusted HR per 10-year decrease, 1.35; 95% CI, 1.20-1.51). After propensity score matching, individuals with AF diagnosed before age 65 years had the highest HR of developing all-cause dementia (adjusted HR, 1.82; 95% CI, 1.54-2.15), followed by AF diagnosed at age 65 to 74 years (adjusted HR, 1.47; 95% CI, 1.31-1.65) and diagnosed at age 75 years or older (adjusted HR, 1.11; 95% CI, 0.96-1.28). Similar results can be seen in AD and VD. Conclusions and Relevance In this prospective cohort study, earlier onset of AF was associated with an elevated risk of subsequent all-cause dementia, AD, and VD, highlighting the importance of monitoring cognitive function among patients with AF, especially those younger than 65 years at diagnosis.
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Affiliation(s)
- Wenya Zhang
- Department of Clinical Nursing, School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Liang
- Department of Clinical Nursing, School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chenglong Li
- Heart and Vascular Health Research Center, Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Darui Gao
- Heart and Vascular Health Research Center, Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Pan
- Department of Clinical Nursing, School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongqian Wang
- Heart and Vascular Health Research Center, Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Wuxiang Xie
- Heart and Vascular Health Research Center, Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Fanfan Zheng
- Department of Clinical Nursing, School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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182
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O'Neill M, Duffy O, Henderson M, Kernohan WG. Identification of eating, drinking and swallowing difficulties for people living with early-stage dementia: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1994-2007. [PMID: 37483095 DOI: 10.1111/1460-6984.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The prevalence of dementia is increasing, bringing a range of challenges, such as eating, drinking and swallowing (EDS) difficulties, that are associated with aspiration, which can be fatal. Early identification of EDS difficulty in early-stage dementia could prevent complications, but reliable indicators are needed to help develop pathways to support the diagnosis. Previous reviews of this area require updating. AIMS To identify reliable and clinically measurable indicators of EDS difficulty used in early-stage dementia. METHODS & PROCEDURES A systematic search was conducted using common databases (MEDLINE, EMBASE and PsychInfo). Articles reporting indicators of EDS difficulty in early-stage dementia or mild cognitive impairment were included. The reliability of included studies was critically appraised using the risk of bias tools. Study outcomes were narratively reviewed by considering the reliability, clinical measurability and applicability of EDS indicators to early-stage dementia. OUTCOMES & RESULTS Initial searches returned 2443 articles. After removing duplicates, limiting to English language and human studies, 1589 articles remained. After reviewing titles, 60 abstracts were reviewed, yielding 18 full-text articles. A total of 12 articles were excluded that did not report at least one indicator of EDS difficulty in early-stage dementia, or where the reported association was not strong. Six included studies that reported eight indicators of EDS difficulty in early-stage dementia (four studies including people with Alzheimer's disease). On the balance of measurability, reliability and applicability, the most promising indicators of EDS difficulty were: delayed oral transit, rinsing ability, sarcopenia and polypharmacy. Additional, less reliable and applicable indicators included: always opened lips and non-amnestic mild cognitive impairment, especially in men. The delayed pharyngeal response is subjectively measured when instrumental assessment is not available and the 'candy sucking test' cannot be recommended because there is an inherent choking risk. CONCLUSIONS & IMPLICATIONS EDS difficulty in early-stage dementia can be highlighted by indicators that could be combined to create enhanced pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. Exploring the experiences of people living with dementia and their families' perspectives on potential indicators of EDS difficulty may add to the existing evidence base. WHAT THIS PAPER ADDS What is already known on the subject Early identification of EDS difficulty in early-stage dementia may prevent complications, but more reliable and clinically measurable indicators of EDS difficulty are needed to help develop pathways to support diagnosis. What this paper adds to existing knowledge A comprehensive range of studies related to EDS identification in early-stage dementia have been selected and reviewed. Across six included studies, the most promising indicators of EDS difficulty in early-stage dementia included delayed oral transit, poor rinsing ability, presence of sarcopenia and polypharmacy. What are the potential or actual clinical implications of this work? This study could help to develop pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration.
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Affiliation(s)
- Michelle O'Neill
- Speech and Language Therapy, School of Health Sciences, Ulster University, Londonderry, UK
- Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | - Orla Duffy
- Speech and Language Therapy, School of Health Sciences, Ulster University, Londonderry, UK
- Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | - Mo Henderson
- Northern Health and Social Care Trust, Antrim, UK
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Londonderry, UK
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183
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Liu S, Zheng Y, Li H, Pan M, Fang Z, Liu M, Qiao Y, Pan N, Jia W, Ge X. Improving Alzheimer Diagnoses With An Interpretable Deep Learning Framework: Including Neuropsychiatric Symptoms. Neuroscience 2023; 531:86-98. [PMID: 37709003 DOI: 10.1016/j.neuroscience.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
Alzheimer's disease (AD) is a prevalent neurodegenerative disorder characterized by the progressive cognitive decline. Among the various clinical symptoms, neuropsychiatric symptoms (NPS) commonly occur during the course of AD. Previous researches have demonstrated a strong association between NPS and severity of AD, while the research methods are not sufficiently intuitive. Here, we report a hybrid deep learning framework for AD diagnosis using multimodal inputs such as structural MRI, behavioral scores, age, and gender information. The framework uses a 3D convolutional neural network to automatically extract features from MRI. The imaging features are passed to the Principal Component Analysis for dimensionality reduction, which fuse with non-imaging information to improve the diagnosis of AD. According to the experimental results, our model achieves an accuracy of 0.91 and an area under the curve of 0.97 in the task of classifying AD and cognitively normal individuals. SHapley Additive exPlanations are used to visually exhibit the contribution of specific NPS in the proposed model. Among all behavioral symptoms, apathy plays a particularly important role in the diagnosis of AD, which can be considered a valuable factor in further studies, as well as clinical trials.
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Affiliation(s)
- Shujuan Liu
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Yuanjie Zheng
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Hongzhuang Li
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Minmin Pan
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Zhicong Fang
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Mengting Liu
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
| | - Yuchuan Qiao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Ningning Pan
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Weikuan Jia
- School of Information Science and Engineering, Shandong Normal University, Shandong, China
| | - Xinting Ge
- School of Information Science and Engineering, Shandong Normal University, Shandong, China.
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Lin RSY, Su JJ, Kim S, Wong AKC, Chan TW, Lee SHC. Psychometric properties of the Chinese version of the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction scale (MCLHB-DRR) in Chinese community-dwelling older adults. Geriatr Nurs 2023; 54:237-245. [PMID: 37847938 DOI: 10.1016/j.gerinurse.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES To assess the psychometric properties of Chinese version of Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR) scale in Chinese community-dwelling older adults. METHODS A convenience sample of 150 Chinese adults aged ≥50 was recruited from local community facilities. Reliability of MCLHB-DRR was evaluated using internal consistency and test-retest reliability over two weeks. Content validity and construct validity were assessed. Translation process followed Brislin's translation model. RESULTS After excluding two items with poor loadings, the confirmatory factor analysis revealed a good model fit (χ2/df=2.14; CFI=0.91; IFI=0.91; RMSEA=0.087). The scale exhibited good internal consistency (Cronbach's alpha = 0.865), as well as acceptable test-retest reliability (ICC=0.730). CONCLUSIONS The Chinese MCLHB-DRR showed satisfactory psychometric properties, providing valuable insights for promoting dementia risk reduction in Chinese population, considering cultural nuances that shape motivations and knowledge of lifestyle changes.
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Affiliation(s)
- Rose Sin Yi Lin
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rochester, New York, 14620, USA
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Sarang Kim
- Australian Institute of Health and Welfare, 26 Thynne Street, Bruce, ACT, Australia
| | | | - Tsz Wing Chan
- Pamela Youde Nethersole Eastern Hospital, Main Block, Lok Man Rd, Chai Wan, Hong Kong
| | - Sonia Ho Ching Lee
- The Hong Kong Society for Rehabilitation, Units R9-R12, Podium, Wo Che Plaza, Wo Che Estate, Shatin, NT
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185
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Gonçalves NG, Bertola L, Ferri CP, Suemoto CK. Rural-urban disparities in fruit and vegetable consumption and cognitive performance in Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:498-505. [PMID: 37995203 PMCID: PMC10897771 DOI: 10.47626/1516-4446-2023-3316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Rural residents are exposed to many risk factors for poor diet quality, such as low socioeconomic status and food insecurity. However, the differences between urban and rural residents regarding the association of fruit and vegetable consumption with cognitive performance have not been explored. The aim of this study was to investigate the association of fruit and vegetable consumption with cognitive performance in urban and rural areas in a nationally representative sample of Brazilian older adults. METHODS The sample included 9,412 adults aged 50 years or older from the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros [ELSI]). The association between consumption of fruits and vegetables and cognitive performance was evaluated using linear regression. RESULTS In 8,158 participants (mean age 61.6 ± 9.3 years, 54% women, 44% White, and 15% from rural areas), the mean frequency of fruit and vegetable consumption was 2.0 ± 1.3 times a day. Higher intake of fruits and vegetables was associated with better memory (ß = 0.031, 95%CI 0.014-0.049), verbal fluency (ß = 0.030, 95%CI 0.004-0.056), and global cognition (ß = 0.035, 95%CI 0.015-0.055) performance in urban, but not rural residents (p for interaction = 0.036). CONCLUSIONS Higher frequency of fruit and vegetable intake was associated with better cognitive performance in urban, but not in rural areas in Brazil.
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Affiliation(s)
- Natalia Gomes Gonçalves
- Divisão de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Laiss Bertola
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Cleusa Pinheiro Ferri
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Claudia Kimie Suemoto
- Divisão de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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186
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Su WM, Gu XJ, Dou M, Duan QQ, Jiang Z, Yin KF, Cai WC, Cao B, Wang Y, Chen YP. Systematic druggable genome-wide Mendelian randomisation identifies therapeutic targets for Alzheimer's disease. J Neurol Neurosurg Psychiatry 2023; 94:954-961. [PMID: 37349091 PMCID: PMC10579488 DOI: 10.1136/jnnp-2023-331142] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the leading cause of dementia. Currently, there are no effective disease-modifying treatments for AD. Mendelian randomisation (MR) has been widely used to repurpose licensed drugs and discover novel therapeutic targets. Thus, we aimed to identify novel therapeutic targets for AD and analyse their pathophysiological mechanisms and potential side effects. METHODS A two-sample MR integrating the identified druggable genes was performed to estimate the causal effects of blood and brain druggable expression quantitative trait loci (eQTLs) on AD. A repeat study was conducted using different blood and brain eQTL data sources to validate the identified genes. Using AD markers with available genome-wide association studies data, we evaluated the causal relationship between established AD markers to explore possible mechanisms. Finally, the potential side effects of the druggable genes for AD treatment were assessed using a phenome-wide MR. RESULTS Overall, 5883 unique druggable genes were aggregated; 33 unique potential druggable genes for AD were identified in at least one dataset (brain or blood), and 5 were validated in a different dataset. Among them, three prior druggable genes (epoxide hydrolase 2 (EPHX2), SERPINB1 and SIGLEC11) reached significant levels in both blood and brain tissues. EPHX2 may mediate the pathogenesis of AD by affecting the entire hippocampal volume. Further phenome-wide MR analysis revealed no potential side effects of treatments targeting EPHX2, SERPINB1 or SIGLEC11. CONCLUSIONS This study provides genetic evidence supporting the potential therapeutic benefits of targeting the three druggable genes for AD treatment, which will be useful for prioritising AD drug development.
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Affiliation(s)
- Wei-Ming Su
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Jing Gu
- Department of Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Dou
- Chengdu Computer Application Institute, Chinese Academy of Sciences, Chengdu, China
| | - Qing-Qing Duan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kang-Fu Yin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Chen Cai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Wang
- Department of Pathophysiology, West China College of Basic medical sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Yong-Ping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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187
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Hiles M, Simmons A, Hilleman D, Gibson CA, Backes JM. Atherosclerotic Cardiovascular Disease in Women: Providing Protection With Lipid-altering Agents. Clin Ther 2023; 45:1127-1136. [PMID: 37770308 DOI: 10.1016/j.clinthera.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/07/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in women, yet it remains underdiagnosed, undertreated, and understudied in women compared with men. Although estrogen has provided observational evidence of cardioprotection, randomized controlled trials using hormone replacement therapy have generally produced unfavorable results. METHODS For this narrative review, a literature search was performed using the key words cardiovascular disease, women, and dyslipidemia in PubMed and Google Scholar with no date limitations. References within each article were also reviewed for additional relevant articles. FINDINGS Sex-specific risk factors and underrecognized conditions more predominant in women elevate ASCVD risk, creating further clinical challenges, such as the need for accurate risk stratification, compared with in men. Dyslipidemia frequently manifests or worsens during the menopausal transition. Therefore, identification during midlife and implementing lipid-lowering strategies to reduce ASCVD risk is imperative. Women have historically been poorly represented in cardiovascular (CV) outcome trials. However, more recent studies and meta-analyses have indicated that lipid-lowering therapies are equally effective in women and produce similar reductions in CV events and total mortality. Major cholesterol guidelines address many of the challenges that clinicians face when assessing ASCVD risk in women. Key points specific to women include obtaining a detailed history of pregnancy-related conditions, identification of common autoimmune disorders associated with systemic inflammation, and use of 10-year ASCVD risk calculators and imaging modalities (coronary artery calcium) to optimize ASCVD assessment. In terms of treatment, similar to men, women with existing ASCVD or high-risk primary prevention patients should be treated aggressively to achieve ≥50% LDL-C reductions and/or LDL-C goals as low as <55 mg/dL. Appropriate lipid-lowering therapies include high-intensity statins with or without ezetimibe and proprotein convertase subtilisin kexin/type 9 inhibitors. Women with lower ASCVD risk may be considered for low- to moderate-intensity statin therapy (approximately 30%-50% LDL-C reduction). All women, regardless of ASCVD risk category, should implement therapeutic lifestyle changes, which improve many common age-related cardiometabolic conditions. IMPLICATIONS Although ASCVD and current risk factor trends in women are concerning, numerous evidence-based approaches are available to protect women with ASCVD risk from life-changing CV events.
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Affiliation(s)
- Megan Hiles
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ashley Simmons
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Daniel Hilleman
- Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | - Cheryl A Gibson
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - James M Backes
- Departments of Pharmacy Practice and Medicine, Atherosclerosis and LDL-Apheresis Center, University of Kansas Medical Center, Kansas City, Kansas.
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188
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Park HY, Shim WH, Suh CH, Heo H, Oh HW, Kim J, Sung J, Lim JS, Lee JH, Kim HS, Kim SJ. Development and validation of an automatic classification algorithm for the diagnosis of Alzheimer's disease using a high-performance interpretable deep learning network. Eur Radiol 2023; 33:7992-8001. [PMID: 37170031 DOI: 10.1007/s00330-023-09708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/01/2023] [Accepted: 03/18/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To develop and validate an automatic classification algorithm for diagnosing Alzheimer's disease (AD) or mild cognitive impairment (MCI). METHODS AND MATERIALS This study evaluated a high-performance interpretable network algorithm (TabNet) and compared its performance with that of XGBoost, a widely used classifier. Brain segmentation was performed using a commercially approved software. TabNet and XGBoost were trained on the volumes or radiomics features of 102 segmented regions for classifying subjects into AD, MCI, or cognitively normal (CN) groups. The diagnostic performances of the two algorithms were compared using areas under the curves (AUCs). Additionally, 20 deep learning-based AD signature areas were investigated. RESULTS Between December 2014 and March 2017, 161 AD, 153 MCI, and 306 CN cases were enrolled. Another 120 AD, 90 MCI, and 141 CN cases were included for the internal validation. Public datasets were used for external validation. TabNet with volume features had an AUC of 0.951 (95% confidence interval [CI], 0.947-0.955) for AD vs CN, which was similar to that of XGBoost (0.953 [95% CI, 0.951-0.955], p = 0.41). External validation revealed the similar performances of two classifiers using volume features (0.871 vs. 0.871, p = 0.86). Likewise, two algorithms showed similar performances with one another in classifying MCI. The addition of radiomics data did not improve the performance of TabNet. TabNet and XGBoost focused on the same 13/20 regions of interest, including the hippocampus, inferior lateral ventricle, and entorhinal cortex. CONCLUSIONS TabNet shows high performance in AD classification and detailed interpretation of the selected regions. CLINICAL RELEVANCE STATEMENT Using a high-performance interpretable deep learning network, the automatic classification algorithm assisted in accurate Alzheimer's disease detection using 3D T1-weighted brain MRI and detailed interpretation of the selected regions. KEY POINTS • MR volumetry data revealed that TabNet had a high diagnostic performance in differentiating Alzheimer's disease (AD) from cognitive normal cases, which was comparable with that of XGBoost. • The addition of radiomics data to the volume data did not improve the diagnostic performance of TabNet. • Both TabNet and XGBoost selected the clinically meaningful regions of interest in AD, including the hippocampus, inferior lateral ventricle, and entorhinal cortex.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Hyun Shim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hwon Heo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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189
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Lenox ER, Jones MW. Balance-based exercise programs on balance in older adults with mild to moderate dementia: A critically appraised topic. Ageing Res Rev 2023; 91:102073. [PMID: 37709056 DOI: 10.1016/j.arr.2023.102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE It is well established that exercise programs including balanced-based exercises are practical and beneficial for cognitively healthy older adults. However, there is limited evidence to determine if these types of training regimens are effective for individuals with dementia. We conducted a critical appraisal to determine if the addition of balance-based exercise programs, compared with usual care at residential homes, improved balance in adults diagnosed with mild to moderate dementia. MATERIALS AND METHODS Four databases were searched for randomized control trials implementing balanced-based exercise programs with individuals diagnosed with mild to moderate dementia. The articles were evaluated based on the Centre for Evidence Based Medicine level of evidence criteria and appraised using the PEDro scale. RESULTS A comprehensive literature search revealed four studies relevant to the clinical question that fit the inclusion and exclusion criteria. All four studies indicated an improvement in balance following a weekly physical therapy program implementing balance-based exercises. CONCLUSIONS There is sufficient evidence to suggest that the use of physical therapy programs that include balance-based exercises, performed 1-2 times a week over the course of 12-25 weeks, improves balance in elderly adults with mild to moderate dementia.
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Affiliation(s)
- Ella R Lenox
- Biological Sciences Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407, USA.
| | - Michael W Jones
- Biological Sciences Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407, USA.
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190
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Sun J, Ludvigsson JF, Roelstraete B, Pedersen NL, Pawitan Y, Wirdefeldt K, Fang F. Gastrointestinal biopsy of normal mucosa or nonspecific inflammation and risk of neurodegenerative disease: Nationwide matched cohort study. Eur J Neurol 2023; 30:3430-3439. [PMID: 36447380 DOI: 10.1111/ene.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/02/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND PURPOSE Evidence has accumulated to support the early involvement of altered gastrointestinal (GI) function in neurodegenerative disease. However, risk of Alzheimer disease (AD) and Parkinson disease (PD) among individuals with a GI biopsy of normal mucosa or nonspecific inflammation is unknown. METHODS This matched cohort study included all individuals in Sweden with a GI biopsy of normal mucosa (n = 480,346) or nonspecific inflammation (n = 655,937) during 1965-2016 (exposed group) as well as their individually matched population references and unexposed full siblings. A flexible parametric model and stratified Cox model were used to estimate hazard ratio (HR) and its 95% confidence interval (CI). RESULTS Individuals with normal mucosa or nonspecific inflammation had a higher risk of AD and PD during the 20 years after biopsy. Compared with the population references, individuals with normal mucosa had an increased risk of AD (incidence rate [IR] difference = 13.53 per 100,000 person-years, HR [95% CI] = 1.15 [1.11-1.20]) and PD (IR difference = 6.72, HR [95% CI] = 1.16 [1.10-1.23]). Elevated risk was also observed for nonspecific inflammation regarding AD (IR difference = 13.28, HR [95% CI] = 1.11 [1.08-1.14]) and PD (IR difference = 6.83, HR [95% CI] = 1.10 [1.06-1.14]). Similar results were observed in subgroup and sensitivity analyses and when comparing with their unexposed siblings. CONCLUSIONS Individuals with a GI biopsy of normal mucosa or nonspecific inflammation had an increased risk of AD and PD. This adds new evidence of the early involvement of GI dysfunction in neurodegenerative disease.
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Affiliation(s)
- Jiangwei Sun
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Yudi Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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191
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Zhu M, Ding X, Wang Q, Xue J, Shi J, Li Z. Association between self-perception of aging and cognitive function in Chinese older adults: The mediation effect of health behaviors. Geriatr Nurs 2023; 54:350-356. [PMID: 37967507 DOI: 10.1016/j.gerinurse.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To investigate the association between self-perception of aging (SPA) and cognitive function in Chinese older adults, and to explore the mediating role of health behaviors. METHODS This study included 5,445 Chinese older adults from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Correlation, linear regression and mediation effect analysis were employed to evaluate the association. RESULTS SPA is significantly related to the health behaviors (r = 0.160, P < 0.01) and cognition (r = 0.086, P < 0.01), and health behaviors exhibited a positive correlation with cognition (r = 0.179, P < 0.01). SPA and health behaviors significantly impacted cognition (β = 0.032, P = 010; β = 0.103, P < 0.001). Health behaviors partially mediated the effect of SPA on cognitive function, accounting for 27.12 % of the total effect. CONCLUSION Health behaviors mediate the association between SPA and cognitive function. Healthcare providers should prioritize addressing SPA of older adults and encourage them to engage in health behaviors for cognitive health.
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Affiliation(s)
- Mingyue Zhu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaotong Ding
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qing Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; School of Nursing, Lanzhou University, Lanzhou, China
| | - Jiajun Xue
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiyuan Shi
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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192
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Zhao K, Chen P, Alexander-Bloch A, Wei Y, Dyrba M, Yang F, Kang X, Wang D, Fan D, Ye S, Tang Y, Yao H, Zhou B, Lu J, Yu C, Wang P, Liao Z, Chen Y, Huang L, Zhang X, Han Y, Li S, Liu Y. A neuroimaging biomarker for Individual Brain-Related Abnormalities In Neurodegeneration (IBRAIN): a cross-sectional study. EClinicalMedicine 2023; 65:102276. [PMID: 37954904 PMCID: PMC10632687 DOI: 10.1016/j.eclinm.2023.102276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023] Open
Abstract
Background Alzheimer's disease (AD) is a prevalent neurodegenerative disorder that poses a worldwide public health challenge. A neuroimaging biomarker would significantly improve early diagnosis and intervention, ultimately enhancing the quality of life for affected individuals and reducing the burden on healthcare systems. Methods Cross-sectional and longitudinal data (10,099 participants with 13,380 scans) from 12 independent datasets were used in the present study (this study was performed between September 1, 2021 and February 15, 2023). The Individual Brain-Related Abnormalities In Neurodegeneration (IBRAIN) score was developed via integrated regional- and network-based measures under an ensemble machine learning model based on structural MRI data. We systematically assessed whether IBRAIN could be a neuroimaging biomarker for AD. Findings IBRAIN accurately differentiated individuals with AD from NCs (AUC = 0.92) and other neurodegenerative diseases, including Frontotemporal dementia (FTD), Parkinson's disease (PD), Vascular dementia (VaD) and Amyotrophic Lateral Sclerosis (ALS) (AUC = 0.92). IBRAIN was significantly correlated to clinical measures and gene expression, enriched in immune process and protein metabolism. The IBRAIN score exhibited a significant ability to reveal the distinct progression of prodromal AD (i.e., Mild cognitive impairment, MCI) (Hazard Ratio (HR) = 6.52 [95% CI: 4.42∼9.62], p < 1 × 10-16), which offers similar powerful performance with Cerebrospinal Fluid (CSF) Aβ (HR = 3.78 [95% CI: 2.63∼5.43], p = 2.13 × 10-14) and CSF Tau (HR = 3.77 [95% CI: 2.64∼5.39], p = 9.53 × 10-15) based on the COX and Log-rank test. Notably, the IBRAIN shows comparable sensitivity (beta = -0.70, p < 1 × 10-16) in capturing longitudinal changes in individuals with conversion to AD than CSF Aβ (beta = -0.26, p = 4.40 × 10-9) and CSF Tau (beta = 0.12, p = 1.02 × 10-5). Interpretation Our findings suggested that IBRAIN is a biologically relevant, specific, and sensitive neuroimaging biomarker that can serve as a clinical measure to uncover prodromal AD progression. It has strong potential for application in future clinical practice and treatment trials. Funding Science and Technology Innovation 2030 Major Projects, the National Natural Science Foundation of China, Beijing Natural Science Funds, the Fundamental Research Funds for the CentralUniversity, and the Startup Funds for Talents at Beijing Normal University.
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Affiliation(s)
- Kun Zhao
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Pindong Chen
- School of Artificial Intelligence, University of Chinese Academy of Sciences & Brainnetome Centre, Chinese Academy of Sciences, Beijing, China
| | - Aaron Alexander-Bloch
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Yongbin Wei
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Martin Dyrba
- German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Fan Yang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Xiaopeng Kang
- School of Artificial Intelligence, University of Chinese Academy of Sciences & Brainnetome Centre, Chinese Academy of Sciences, Beijing, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
- Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
- Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yi Tang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Hongxiang Yao
- Department of Radiology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bo Zhou
- Department of Neurology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chunshui Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Pan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhengluan Liao
- Department of Psychiatry, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yan Chen
- Department of Psychiatry, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Longjian Huang
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Xi Zhang
- Department of Neurology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- National Clinical Research Centre for Geriatric Disorders, Beijing, China
- Centre of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China
| | - Shuyu Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yong Liu
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences & Brainnetome Centre, Chinese Academy of Sciences, Beijing, China
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193
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Shahidi R, Baradaran M, Asgarzadeh A, Bagherieh S, Tajabadi Z, Farhadi A, Korani SS, Khalafi M, Shobeiri P, Sadeghsalehi H, Shafieioun A, Yazdanifar MA, Singhal A, Sotoudeh H. Diagnostic performance of MRI radiomics for classification of Alzheimer's disease, mild cognitive impairment, and normal subjects: a systematic review and meta-analysis. Aging Clin Exp Res 2023; 35:2333-2348. [PMID: 37801265 DOI: 10.1007/s40520-023-02565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is a debilitating neurodegenerative disease. Early diagnosis of AD and its precursor, mild cognitive impairment (MCI), is crucial for timely intervention and management. Radiomics involves extracting quantitative features from medical images and analyzing them using advanced computational algorithms. These characteristics have the potential to serve as biomarkers for disease classification, treatment response prediction, and patient stratification. Of note, Magnetic resonance imaging (MRI) radiomics showed a promising result for diagnosing and classifying AD, and MCI from normal subjects. Thus, we aimed to systematically evaluate the diagnostic performance of the MRI radiomics for this task. METHODS AND MATERIALS A comprehensive search of the current literature was conducted using relevant keywords in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases from inception to August 5, 2023. Original studies discussing the diagnostic performance of MRI radiomics for the classification of AD, MCI, and normal subjects were included. Method quality was evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and the Radiomics Quality Score (RQS) tools. RESULTS We identified 13 studies that met the inclusion criteria, involving a total of 5448 participants. The overall quality of the included studies was moderate to high. The pooled sensitivity and specificity of MRI radiomics for differentiating AD from normal subjects were 0.92 (95% CI [0.85; 0.96]) and 0.91 (95% CI [0.85; 0.95]), respectively. The pooled sensitivity and specificity of MRI radiomics for differentiating MCI from normal subjects were 0.74 (95% CI [0.60; 0.85]) and 0.79 (95% CI [0.70; 0.86]), respectively. Also, the pooled sensitivity and specificity of MRI radiomics for differentiating AD from MCI were 0.73 (95% CI [0.64; 0.80]) and 0.79 (95% CI [0.64; 0.90]), respectively. CONCLUSION MRI radiomics has promising diagnostic performance in differentiating AD, MCI, and normal subjects. It can potentially serve as a non-invasive and reliable tool for early diagnosis and classification of AD and MCI.
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Affiliation(s)
- Ramin Shahidi
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mansoureh Baradaran
- Department of Radiology, Imam Ali Hospital, North Khorasan University of Medical Science, Bojnurd, Iran
| | - Ali Asgarzadeh
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sara Bagherieh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohreh Tajabadi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Farhadi
- Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Mohammad Khalafi
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Hamidreza Sadeghsalehi
- Department of Artificial Intelligence in Medical Sciences, Faculty of Advanced Technologies in Medicine, Iran University Of Medical Sciences, Tehran, Iran
| | - Arezoo Shafieioun
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Aparna Singhal
- Neuroradiology Section, Department of Radiology, The University of Alabama at Birmingham, Alabama, USA
| | - Houman Sotoudeh
- Neuroradiology Section, Department of Radiology, The University of Alabama at Birmingham, Alabama, USA.
- O'Neal Comprehensive Cancer Center, UAB, The University of Alabama at Birmingham, JTN 333, 619 19th St S, Birmingham, AL, 35294, USA.
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Du Y, Luo Y, Zheng X, Liu J. Number of children and cognitive function among Chinese menopausal women: The mediating role of depressive symptoms and social participation. J Affect Disord 2023; 340:758-765. [PMID: 37591349 DOI: 10.1016/j.jad.2023.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES This study examined the association between number of children and cognitive function and its possible hormone and psychosocial pathways in Chinese menopausal women. METHODS We analyzed data from the China Health and Retirement Longitudinal Study (CHALRS), including 4803 menopausal women. Ordinary least squares (OLS) regression modeling and structural equation modeling (SEM) were applied to explore the association between number of children and cognitive function and the potential mechanisms. RESULTS Overall, the median number of biological children was three among participants. The cognitive function score decreased significantly with increasing numbers of children [β = -0.547, 95 % confidence interval (CI): -0.677, -0.416]. There was a significant interaction between number of children and residence (P = 0.003). Compared with older women with three or less children, women with more than three children had worse cognitive function (β = -0.798, 95 % CI: -1.081, -0.514). Mediation analysis verified that depressive symptoms and social participation partially mediate the associations between the number of children and cognitive function. LIMITATIONS First, because of the cross-sectional design, our study was unable to make causal inferences. Second, information about endogenous estrogen exposure was not collected in CHARLS. Third, recall bias may exist due to the use of self-reported data. CONCLUSION Our results indicated that a higher number of children is associated with an increased risk for cognitive impairment. We suggest paying special attention to mental and social health among women with multiple children (>3).
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Affiliation(s)
- Yushan Du
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
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Cunha ILDOM, Garrafa V. Supported decision-making for older people living with dementia: contributions from bioethics. CIENCIA & SAUDE COLETIVA 2023; 28:3149-3158. [PMID: 37970999 DOI: 10.1590/1413-812320232811.00882023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 11/19/2023] Open
Abstract
The significant increase in the elderly population and the high incidence of chronic and degenerative diseases are a matter of concern with regard to issues inherent to promotion of autonomy and preservation of human rights and quality of life in this population group. Exercising the right to make a decision impacts various aspects of human life, such as health care, asset management, relationships, choice of housing, family care, religious activities and even daily routine activities. Supported decision-making (SDM) can be an important tool for promoting autonomy among elderly people living with dementia, as it consists of an approach based on respect for human rights, in which the aim is to establish control over the mechanisms for provision of support so that all people can exercise the right to make decisions inherent to their lives. In order to implement this more robustly in Brazil, it is fundamental to change the culture towards valuing elderly people and implementing the notion that protection involves offering mechanisms for promoting personal autonomy, which is partly achieved through encouragement of social engagement and strengthening community ties. In this regard, the notion of empowerment, based on concepts arising from Intervention Bioethics, is relevant.
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Affiliation(s)
- Isis Laynne de Oliveira Machado Cunha
- Programa de Pós-Graduação em Bioética, Universidade de Brasília (UnB). Campus Universitário Darcy Ribeiro s/n, Asa Norte. 70910-900 Brasília DF Brasil.
| | - Volnei Garrafa
- Centro Internacional de Bioética e Humanidades, UnB. Brasília DF Brasil
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196
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Basutkar RS, Sudarsan P, Robin SM, Bhaskar V, Viswanathan B, Sivasankaran P. Drug Repositioning of Pioglitazone in Management and Improving the Cognitive Function among the Patients With Mild to Moderate Alzheimer's Disease: A Systematic Review and Meta-Analysis. Neurol India 2023; 71:1132-1141. [PMID: 38174446 DOI: 10.4103/0028-3886.391397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Disease-modifying agents like Pioglitazone have shown promising effects on neuroinflammation and homeostasis of amyloid plaques, but there is a lack of research papers providing conclusive evidence. Objectives This study is aimed to determine the safety and efficacy of Pioglitazone in improving cognitive function in patients with mild-moderate Alzheimer's disease (AD). Materials and Methods Trials published in the last 12 years were identified from PubMed, Scopus, Cochrane Central, and other trial registries. Five hundred twenty-five records were obtained, from which five studies were included for quantitative analysis. Studies comparing Pioglitazone with a suitable placebo or other oral hypoglycemic agent were considered for review. Data was extracted using a pretested form, which was followed by a risk of bias assessment (ROB) with Cochrane's ROB assessment tool. Results This meta-analysis included studies where Pioglitazone (15-30 mg) was compared to other oral hypoglycemic agents, placebo, or diabetic diet for a minimum duration of 6 months. Pioglitazone did not show a statistically significant improvement in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores [mean difference (MD): -1.16; 95% confidence interval (CI): -4.14-1.81]. By conducting sensitivity analysis with the removal of one study, significant efficacy was obtained [MD: -2.75; 95% CI: -4.84--0.66]. The Wechsler Memory Scale-Revised logical memory I (WMS-R) scores had a significant improvement in the Pioglitazone group [MD: 2.02; 95% CI: 0.09-3.95]. Conclusion Pioglitazone is a safe medication that has a promising effect in slowing the advancement of AD.
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Affiliation(s)
- Roopa S Basutkar
- Department of Pharmacy Practice, Nitte (Deemed to be University) NGSM Institute of Pharmaceutical Sciences, Mangalore, Karnataka, India
| | - Pooja Sudarsan
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Ooty, The Nilgiris, Tamil Nadu, India
| | - Sandra M Robin
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Ooty, The Nilgiris, Tamil Nadu, India
| | - Vahini Bhaskar
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Ooty, The Nilgiris, Tamil Nadu, India
| | | | - Ponnusankar Sivasankaran
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Ooty, The Nilgiris, Tamil Nadu, India
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197
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Trenaman SC, Quach J, Bowles SK, Kirkland S, Andrew MK. An investigation of psychoactive polypharmacy and related gender-differences in older adults with dementia: a retrospective cohort study. BMC Geriatr 2023; 23:683. [PMID: 37864154 PMCID: PMC10590009 DOI: 10.1186/s12877-023-04353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Older adults living with dementia may express challenging responsive behaviours. One management strategy is pharmacologic treatment though these options often have limited benefit, which may lead to multiple treatments being prescribed. METHODS The aim of the present study was to describe psychoactive medication polypharmacy and explore factors associated with psychoactive polypharmacy in a cohort of older adults living with dementia in Nova Scotia, Canada, including a gender-stratified analysis. This was a retrospective cohort study of those aged 65 years or older with a recorded diagnosis of dementia between 2005 and 2015. Medication dispensation data was collected from April 1, 2010, or dementia diagnosis (cohort entry) to either death or March 31, 2015 (cohort exit). Psychoactive medication claims were captured. Psychoactive medication polypharmacy was defined as presence of three or more psychoactive prescription medications dispensed to one subject and overlapping for more than 30 days. Psychoactive polypharmacy episodes were described in duration, quantity, and implicated medications. Regression analysis examined factors associated with experience and frequency of psychoactive polypharmacy. All analysis were stratified by gender. RESULTS The cohort included 15,819 adults living with dementia (mean age 80.7 years; 70.0% female), with 99.4% (n = 15,728) receiving at least one psychoactive medication over the period of follow-up. Psychoactive polypharmacy was present in 19.3% of the cohort. The gender specific logistic regressions demonstrated that for both men and women a younger age was associated with an increased risk of psychoactive polypharmacy (women: OR 0.97, 95%CI[0.96, 0.98], men: OR 0.96, 95%CI[0.95, 0.97]). Men were less likely to experience psychoactive polypharmacy if their location of residence was urban (OR 0.86, 95%CI[0.74, 0.99]). There was no significant association between location of residence (urban or rural) and psychoactive polypharmacy for women living with dementia. Antidepressants were the most dispensed medication class, while quetiapine was the most dispensed medication. CONCLUSIONS This study suggests that of adults living with dementia those of younger ages were more likely to experience psychoactive polypharmacy and that men living with dementia in rural locations may benefit from increased access to non-pharmacological options for dementia management.
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Affiliation(s)
- Shanna C Trenaman
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, B3H 4R2, Halifax, NS, Canada.
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada.
| | - Jack Quach
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Susan K Bowles
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, B3H 4R2, Halifax, NS, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - Susan Kirkland
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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198
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Dong W, Kan L, Zhang X, Li M, Wang M, Cao Y. Association between body mass index and cognitive impairment in Chinese older adults. Front Public Health 2023; 11:1255101. [PMID: 37927863 PMCID: PMC10622794 DOI: 10.3389/fpubh.2023.1255101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background The association between body mass index (BMI) and the risk of cognitive impairment remains uncertain. Relatively few studies have analyzed the dose-response relationship between BMI and cognitive impairment. This article utilized nationally representative longitudinal data to assess the association between BMI and cognitive impairment in Chinese older adults. Objective The present study aimed to analyze the association between BMI and cognitive impairment in Chinese older people, including an investigation of gender differences and the dose-response relationship. Methods Data were obtained from the China Health and Retirement Longitudinal Study database in 2015 and 2018. The present study used logistic regression to analyze the relationship between baseline BMI and cognitive impairment, and adopted a restricted cubic spline model to plot dose-response curves for baseline BMI and prevalence of risk of cognitive impairment. Results The mean BMI of the survey population was 23.48 ± 3.66 kg/m2, and the detection rate of cognitive impairment was 34.2%. Compared to the normal weight group (18.5 ≤ BMI < 23.9 kg/m2), the odds ratio (OR) for cognitive impairment was 1.473 (95% CI: 1.189-1.823) in the underweight group (BMI < 18.5 kg/m2), whereas the corresponding OR was 0.874 (95% CI: 0.776-0.985) for the overweight or obese group (BMI ≥ 24.0 kg/m2) after adjusting for confounders. Gender subgroup analysis showed that overweight or obese older women were less likely to develop cognitive impairment (OR = 0.843; 95% CI: 0.720-0.987). The results of the restricted cubic spline analysis revealed a curvilinear L-shaped relationship between BMI and the risk of cognitive impairment (P non-linearity <0.05). In particular, the risk of cognitive impairment was higher at a lower baseline BMI. In contrast, BMI in the range of 23.2-27.8 kg/m2 was associated with a decreased risk of cognitive impairment. Conclusion BMI is a dose-dependent related factor for cognitive impairment in Chinese older adults. Being underweight is a risk factor for the development of cognitive impairment, while being overweight or obese is less likely to have cognitive impairment, particularly in female older people. Keeping BMI ranging from 23.2-27.8 kg/m2 in older adults can help maintain cognitive function.
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Affiliation(s)
- Wenshuo Dong
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Lichao Kan
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Xinyue Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Mengli Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Meijuan Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
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199
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Srivastava S, Sharma S, Deep S, Khare SK. Screening of Multitarget-Directed Natural Compounds as Drug Candidates for Alzheimer's Disease Using In Silico Techniques: Their Extraction and In Vitro Validation. ACS OMEGA 2023; 8:38118-38129. [PMID: 37867692 PMCID: PMC10586450 DOI: 10.1021/acsomega.3c04261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 10/24/2023]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder that impairs neurocognitive function. Acetylcholinesterase (AChE) and β-site APP cleaving enzyme 1 (BACE1) are the two main proteins implicated in AD. Indeed, the major available commercial drugs (donepezil, rivastigmine, and galantamine) against Alzheimer's are AChE inhibitors. However, none of these drugs are known to reverse or reduce the pathophysiological condition of the disease since there are multiple contributing factors to AD. Therefore, there is a need to develop a multitarget-directed ligand approach for its treatment. In the present study, plant bioactive compounds were screened for their AChE and BACE1 inhibition potential by conducting molecular docking studies. Considering their docking score and pharmacokinetic properties, limonin, peimisine, serratanine B, and withanolide A were selected as the lead compounds. Molecular dynamics simulations of these protein-ligand complexes confirmed the conformational and energetically stabilized enzyme-inhibitor complexes. The inhibition potential of the lead compounds was validated by in vitro enzyme assay. Withanolide A inhibited AChE (IC50 value of 107 μM) and showed mixed-type inhibition. At this concentration, it inhibited BACE1 activity by 57.10% and was stated as most effective. Both the compounds, as well as their crude extracts, were found to have no cytotoxic effect on the SH-SY5Y cell line.
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Affiliation(s)
- Sukriti Srivastava
- Enzyme
and Microbial Biochemistry Laboratory, Department of Chemistry, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Shilpa Sharma
- Biophysical
Chemistry Laboratory, Department of Chemistry, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Shashank Deep
- Biophysical
Chemistry Laboratory, Department of Chemistry, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Sunil Kumar Khare
- Enzyme
and Microbial Biochemistry Laboratory, Department of Chemistry, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
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200
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Gregory S, Harrison J, Herrmann J, Hunter M, Jenkins N, König A, Linz N, Luz S, Mallick E, Pullen H, Welstead M, Ruhmel S, Tröger J, Ritchie CW. Remote data collection speech analysis in people at risk for Alzheimer's disease dementia: usability and acceptability results. FRONTIERS IN DEMENTIA 2023; 2:1271156. [PMID: 39081993 PMCID: PMC11285540 DOI: 10.3389/frdem.2023.1271156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/19/2023] [Indexed: 08/02/2024]
Abstract
Introduction Digital cognitive assessments are gathering importance for the decentralized remote clinical trials of the future. Before including such assessments in clinical trials, they must be tested to confirm feasibility and acceptability with the intended participant group. This study presents usability and acceptability data from the Speech on the Phone Assessment (SPeAk) study. Methods Participants (N = 68, mean age 70.43 years, 52.9% male) provided demographic data and completed baseline and 3-month follow-up phone based assessments. The baseline visit was administered by a trained researcher and included a spontaneous speech assessment and a brief cognitive battery (immediate and delayed recall, digit span, and verbal fluency). The follow-up visit repeated the cognitive battery which was administered by an automatic phone bot. Participants were randomized to receive their cognitive test results acer the final or acer each study visit. Participants completed acceptability questionnaires electronically acer each study visit. Results There was excellent retention (98.5%), few technical issues (n = 5), and good interrater reliability. Participants rated the assessment as acceptable, confirming the ease of use of the technology and their comfort in completing cognitive tasks on the phone. Participants generally reported feeling happy to receive the results of their cognitive tests, and this disclosure did not cause participants to feel worried. Discussion The results from this usability and acceptability analysis suggest that completing this brief battery of cognitive tests via a telephone call is both acceptable and feasible in a midlife-to-older adult population in the United Kingdom, living at risk for Alzheimer's disease.
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Affiliation(s)
- Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - John Harrison
- Scottish Brain Sciences, Edinburgh, United Kingdom
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | | | - Matthew Hunter
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Natalie Jenkins
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Alexandra König
- ki:elements GmbH, Saarbrücken, Germany
- CoBTek (Cognition-Behaviour-Technology) Lab, Université Côte d'Azur, Nice, France
| | | | - Saturnino Luz
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Hannah Pullen
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Brain Sciences, Edinburgh, United Kingdom
| | - Miles Welstead
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Brain Sciences, Edinburgh, United Kingdom
| | - Stephen Ruhmel
- Janssen Research & Development, LLC, Raritan, NJ, United States
| | | | - Craig W. Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Brain Sciences, Edinburgh, United Kingdom
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