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Maher P. The flavonoid fisetin reduces multiple physiological risk factors for dementia. Neurochem Int 2024; 178:105805. [PMID: 39004102 DOI: 10.1016/j.neuint.2024.105805] [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: 05/27/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/16/2024]
Abstract
Dementia is a growing problem around the globe as the world's population continues to age. Multiple studies have identified potentially modifiable risk factors for the development of dementia suggesting that addressing some or all of these risk factors might have a significant impact on the aging population worldwide. However, this is not always as straightforward as it seems since many of these risk factors are currently treated with drugs specific to the risk factor. Moreover, since people can have multiple risk factors, addressing each of them individually could be highly problematic as it would likely lead to negative outcomes associated with polypharmacy and, in the long term, could do significant harm. A potential alternative is to identify compounds that have shown efficacy against a number of these different risk factors. As discussed in this review, there is strong evidence that the flavonol fisetin is one such compound. In animal studies it has shown efficacy against many of the risk factors that have been associated with an increased risk of developing dementia and also exhibits direct neuroprotective effects. Thus, further human research on fisetin in the context of dementia risk factors is clearly warranted.
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Affiliation(s)
- Pamela Maher
- Salk Institute for Biological Studies, La Jolla, CA, 92037, USA.
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Reparaz-Escudero I, Izquierdo M, Bischoff-Ferrari HA, Martínez-Lage P, Sáez de Asteasu ML. Effect of long-term physical exercise and multidomain interventions on cognitive function and the risk of mild cognitive impairment and dementia in older adults: A systematic review with meta-analysis. Ageing Res Rev 2024; 100:102463. [PMID: 39179115 DOI: 10.1016/j.arr.2024.102463] [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: 06/16/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION Recent studies have suggested that sustained multidomain interventions, including physical exercise, may be beneficial in preventing cognitive decline. This review aims to assess the impact of prolonged physical exercise and multidomain strategies on overall cognitive faculties and dementia risk among community-dwelling older adults without dementia. METHODS We systematically searched PubMed, Web of Science, PsychInfo, and CINHAL databases from inception until April 1, 2024, for randomized controlled trials that investigated the effects of long-term (≥ 12 months) physical exercise or multidomain interventions on non-demented, community-dwelling older adults. The primary outcomes assessed were changes in global cognition and the risk of mild cognitive impairment (MCI) or dementia. Standardized mean differences (SMD) and risk ratios (RR) with 95 % confidence intervals were computed using a random-effects inverse-variance method with the Hartung-Knapp-Sidik-Jonkman adjustment for effect size calculation. The Cochrane Risk-of-Bias-2 tool (RoB-2) was used for bias assessment, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was applied to evaluate the certainty of evidence. RESULTS Sixteen trials, including 11,402 participants (mean age 73.2 [±5.5] years; 62.3 % female) were examined. The risk of bias was low. Moderate-certainty evidence indicated that physical exercise interventions had modest to no effect on cognitive function (k= 9, SMD: 0.05; 95 % CI: -0.04-0.13; p = 0.25), whereas multidomain interventions were significantly impactful (k=7, SMD: 0.09; 95 % CI: 0.04-0.15; p < 0.01). Physical exercise interventions did not alter MCI risk (k= 4, RR: 0.98; 95 % CI: 0.73-1.31; p = 0.79) or dementia onset (k= 4, RR: 0.61; 95 % CI: 0.25-1.52; p = 0.19), with very low-to low-certainty evidence, respectively. CONCLUSIONS Integrative multidomain strategies incorporating physical exercise may benefit the global cognitive function of older adults. However, long-term physical exercise alone did not yield any cognitive gains. The effectiveness of such exercise interventions to mitigate the overall risk of incident MCI and dementia warrants further research.
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Affiliation(s)
- Imanol Reparaz-Escudero
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University of Zurich, Zurich, Switzerland; Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland; IHU HealthAge, University Hospital Toulouse and University III Paul Sabatier, Toulouse, France
| | | | - Mikel L Sáez de Asteasu
- Navarrabiomed, Hospital Universitario de Navarra (HUN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Masurkar AV, Marsh K, Morgan B, Leitner D, Wisniewski T. Factors Affecting Resilience and Prevention of Alzheimer's Disease and Related Dementias. Ann Neurol 2024. [PMID: 39152774 DOI: 10.1002/ana.27055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 07/27/2024] [Accepted: 07/31/2024] [Indexed: 08/19/2024]
Abstract
Alzheimer's disease (AD) is a devastating, age-associated neurodegenerative disorder and the most common cause of dementia. The clinical continuum of AD spans from preclinical disease to subjective cognitive decline, mild cognitive impairment, and dementia stages (mild, moderate, and severe). Neuropathologically, AD is defined by the accumulation of amyloid β (Aβ) into extracellular plaques in the brain parenchyma and in the cerebral vasculature, and by abnormally phosphorylated tau that accumulates intraneuronally forming neurofibrillary tangles (NFTs). Development of treatment approaches that prevent or even reduce the cognitive decline because of AD has been slow compared to other major causes of death. Recently, the United States Food and Drug Administration gave full approval to 2 different Aβ-targeting monoclonal antibodies. However, this breakthrough disease modifying approach only applies to a limited subset of patients in the AD continuum and there are stringent eligibility criteria. Furthermore, these approaches do not prevent progression of disease, because other AD-related pathologies, such as NFTs, are not directly targeted. A non-mutually exclusive alternative is to address lifestyle interventions that can help reduce the risk of AD and AD-related dementias (ADRD). It is estimated that addressing such modifiable risk factors could potentially delay up to 40% of AD/ADRD cases. In this review, we discuss some of the many modifiable risk factors that may be associated with prevention of AD/ADRD and/or increasing brain resilience, as well as other factors that may interact with these modifiable risk factors to influence AD/ADRD progression. ANN NEUROL 2024.
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Affiliation(s)
- Arjun V Masurkar
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Karyn Marsh
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Brianna Morgan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Dominique Leitner
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Comprehensive Epilepsy Center, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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4
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Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, Ames D, Banerjee S, Burns A, Brayne C, Fox NC, Ferri CP, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Nakasujja N, Rockwood K, Samus Q, Shirai K, Singh-Manoux A, Schneider LS, Walsh S, Yao Y, Sommerlad A, Mukadam N. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 2024; 404:572-628. [PMID: 39096926 DOI: 10.1016/s0140-6736(24)01296-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Jonathan Huntley
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia; University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, VIC, Australia
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Nick C Fox
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Cleusa P Ferri
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laura N Gitlin
- College of Nursing and Health Professions, AgeWell Collaboratory, Drexel University, Philadelphia, PA, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Mika Kivimäki
- Division of Psychiatry, University College London, London, UK; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Noeline Nakasujja
- Department of Psychiatry College of Health Sciences, Makerere University College of Health Sciences, Makerere University, Kampala City, Uganda
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Kokoro Shirai
- Graduate School of Social and Environmental Medicine, Osaka University, Osaka, Japan
| | - Archana Singh-Manoux
- Division of Psychiatry, University College London, London, UK; Université Paris Cité, Inserm U1153, Paris, France
| | - Lon S Schneider
- Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Yao Yao
- China Center for Health Development Studies, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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5
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Kivipelto M, Mangialasche F, Anstey KJ. Pivotal points in the science of dementia risk reduction. Lancet 2024; 404:501-503. [PMID: 39096928 DOI: 10.1016/s0140-6736(24)01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; Ageing Epidemiology Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Kensington, NSW, Australia; UNSW Ageing Future Institute, University of New South Wales, Kensington, NSW, Australia; Neuroscience Research Australia, Randwick, NSW, Australia
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Anitha K, Singh MK, Kohat K, Sri Varshini T, Chenchula S, Padmavathi R, Amerneni LS, Vishnu Vardhan K, Mythili Bai K, Chavan MR, Bhatt S. Recent Insights into the Neurobiology of Alzheimer's Disease and Advanced Treatment Strategies. Mol Neurobiol 2024:10.1007/s12035-024-04384-1. [PMID: 39102108 DOI: 10.1007/s12035-024-04384-1] [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: 03/19/2024] [Accepted: 07/18/2024] [Indexed: 08/06/2024]
Abstract
In recent years, significant advancements have been made in understanding Alzheimer's disease from both neurobiological and clinical perspectives. Exploring the complex systems underlying AD has unveiled insights that could potentially revolutionize therapeutic approaches. Recent investigations have highlighted intricate interactions among genetic, molecular, and environmental factors in AD. Optimism arises from neurobiological advancements and diverse treatment options, potentially slowing or halting disease progression. Amyloid-beta plaques and tau protein tangles crucially influence AD onset and progression. Emerging treatments involve diverse strategies, such as approaches targeting multiple pathways involved in AD pathogenesis, such as inflammation, oxidative stress, and synaptic dysfunction pathways. Clinical trials using humanized monoclonal antibodies, focusing on immunotherapies eliminating amyloid-beta, have shown promise. Nonpharmacological interventions such as light therapy, electrical stimulation, cognitive training, physical activity, and dietary changes have drawn attention for their potential to slow cognitive aging and enhance brain health. Precision medicine, which involves tailoring therapies to individual genetic and molecular profiles, has gained traction. Ongoing research and interdisciplinary collaboration are expected to yield more effective treatments.
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Affiliation(s)
- Anitha K
- School of Pharmacy and Technology Management (SPTM), SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed to University, Shirpur, 425405, India
| | | | - Komal Kohat
- All India Institute of Medical Sciences, Madhya Pradesh, Bhopal, 462020, India
| | - Sri Varshini T
- All India Institute of Medical Sciences, Raipur, 462020, India
| | - Santenna Chenchula
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, 462020, India.
| | - Padmavathi R
- SVS Medical College, Hyderabad, Telangana, India
| | | | - Vishnu Vardhan K
- All India Institute of Medical Sciences, Madhya Pradesh, Bhopal, 462020, India
| | | | - Madhav Rao Chavan
- All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Shvetank Bhatt
- School of Health Sciences and Technology, MIT World Peace University, Dr. Vishwanath Karad, Pune, 411038, Maharashtra, India
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Taylor S, Sachdeva S, Darling S, Arrotta K, Gallagher L, Supan A, Shipta G, Perko J, Bar J, James J, Petschek I, Lioi A, Kundu S, Ellison L, Bekris LM, Willard B, Sangwan N, Mata I, Fernandez H, Katzan I, Conway D, Pillai J, Leverenz J, Busch RM, Floden D, Saper R, Barnard J, Machado A, Najm I, Punia V. Multidisciplinary lifestyle interventions for neurological disorders during the Silent phase (MINDS) study: a multi-omics randomized controlled trial protocol. Neurol Res Pract 2024; 6:39. [PMID: 39085927 PMCID: PMC11293137 DOI: 10.1186/s42466-024-00334-3] [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: 05/24/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Given the prevalence and staggering cost of neurological disorders, there is dire need for effective early detection and intervention tools. Emerging evidence suggests that multidisciplinary lifestyle interventions (MLI) may mitigate the risk and progression of neurological disorders. The objectives of this protocol are (1) to test the impact of MLI on the progression of neurological disorders and (2) to identify multi-omic biomarkers for early stages of neurological disease and the impact of MLIs on these biomarkers. METHODS AND ANALYSIS We present the Multidisciplinary lifestyle Interventions for Neurological Disorders during the Silent phase (MINDS) protocol, a randomized controlled trial of MLI in neurologically healthy older adults (≥ 50 years old) exhibiting elevated risk for common neurological disorders: stroke, epilepsy, Parkinson's Disease, or Alzheimer's disease and related dementias. Participants will be randomly assigned to intervention (n = 100) or control (n = 100) groups. The intervention group will receive 3 months of weekly 2-hour sessions on diet education, yoga, music therapy, and cognitive skills training. The participants' neurological health and engagement in relevant lifestyle practices will be assessed at regular intervals for 12 months. Neuroimaging and samples for multi-omic analyses will be collected at baseline, and at 3 months and 12 months after enrollment. Primary outcomes will be signs of progression of the neurological disorder risk that qualified them for study enrollment or a clinical diagnosis of the disorder. Secondary and exploratory outcomes will be based on self-reported health and multi-omic data. Data analysis will include between-group and longitudinal within-group analyses. PERSPECTIVES The MINDS protocol and trial aims to clarify the impact of MLI on the progression of neurological disorder risk or diagnosis in older adults and to identify biomarkers that can be used to confirm MLI efficacy. The ability to validate the impact of MLI on neurological disorder progression based on biomarker data allows the identification of individuals most likely to benefit from such therapies in the early stages of neurological disease. TRIAL REGISTRATION The trial is registered on the National Institutes of Health (NIH) ClinicalTrials.gov (NCT05984056) site. It was registered on August 2nd, 2023. The trial has full approval of the Cleveland Clinic Internal Review Board.
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Affiliation(s)
- Sara Taylor
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sandra Darling
- Primary Care Institute, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Arts & Medicine Department, Patient Experience, Cleveland Clinic, Cleveland, OH, USA
| | - Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Gallagher
- Primary Care Institute, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Alexis Supan
- Primary Care Institute, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Gabrielle Shipta
- Primary Care Institute, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jim Perko
- Primary Care Institute, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Judi Bar
- Primary Care Institute, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Joe James
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Iris Petschek
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Lioi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suman Kundu
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Ellison
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lynn M Bekris
- Lerner Research Institute, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Belinda Willard
- Lerner Research Institute, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Naseer Sangwan
- Lerner Research Institute, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ignacio Mata
- Lerner Research Institute, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hubert Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Irene Katzan
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Devon Conway
- Mellen Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jagan Pillai
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - James Leverenz
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Darlene Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Saper
- Primary Care Institute, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - John Barnard
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Andre Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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Abramowitz A, Weber M. Management of MCI in the Outpatient Setting. Curr Psychiatry Rep 2024; 26:413-421. [PMID: 38856858 DOI: 10.1007/s11920-024-01514-3] [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] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE OF REVIEW We review current literature related to the clinical assessment of Mild Cognitive Impairment (MCI). We compile recommendations related to the evaluation of MCI and examine literature regarding the use of clinical biomarkers in this assessment, the role of non-pharmacologic therapy in the prevention of cognitive decline, and recent approval of anti-amyloid therapy in the treatment of MCI. RECENT FINDINGS The role of imaging and plasma biomarkers in the clinical assessment of MCI has expanded. There is data that non-pharmacologic therapy may have a role in the prevention of neurocognitive decline. Anti-amyloid therapies have recently been approved for clinical use. Clinical assessment of MCI remains multifactorial and includes screening and treating for underlying psychiatric and medical co-morbidities. The use of biomarkers in clinical settings is expanding with the rise of anti-amyloid therapies. These new diagnostics and therapeutics require nuanced discussion of risks and benefits. Psychiatrist's skillset is uniquely suited for these complex evaluations.
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Affiliation(s)
- Amy Abramowitz
- UNC School of Medicine and UNC Hospitals, Chapel Hill, NC, USA.
| | - Michael Weber
- UNC School of Medicine and UNC Hospitals, Chapel Hill, NC, USA
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Hyle EP, Wattananimitgul N, Mukerji SS, Foote JHA, Reddy KP, Thielking A, Yu L, Viswanathan A, Rubin LH, Shebl FM, Althoff KN, Freedberg KA. Age-associated dementia among older people aging with HIV in the United States: a modeling study. AIDS 2024; 38:1186-1197. [PMID: 38329107 PMCID: PMC11141339 DOI: 10.1097/qad.0000000000003862] [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] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Almost 400 000 people with HIV (PWH) in the United States are over age 55 years and at risk for age-associated dementias (AAD), including Alzheimer's disease and vascular contributions to cognitive impairment and dementia (VCID). We projected the cumulative incidence and mortality associated with AAD among PWH at least 60 years in the United States compared with the general population. DESIGN/METHODS Integrating the CEPAC and AgeD-Pol models, we simulated two cohorts of 60-year-old male and female individuals: PWH, and the general US population. We estimated AAD incidence and AAD-associated mortality rates. Projected outcomes included AAD cumulative incidence, life expectancy, and quality-adjusted life-years (QALYs). We performed sensitivity and scenario analyses on AAD-specific (e.g. incidence) and HIV-specific (e.g. disengagement from HIV care) parameters, as well as premature aging among PWH. RESULTS We projected that 22.1%/16.3% of 60-year-old male individuals/female individuals with HIV would develop AAD by 80 years compared with 15.9%/13.3% of male individuals/female individuals in the general population. Accounting for age-associated and dementia-associated quality of life, 60-year-old PWH would have a lower life expectancy (QALYs): 17.4 years (14.1 QALYs) and 16.8 years (13.4 QALYs) for male and female individuals, respectively, compared with the general population [male individuals, 21.7 years (18.4 QALYs); female individuals, 24.7 years (20.2 QALYs)]. AAD cumulative incidence was most sensitive to non-HIV-related mortality, engagement in HIV care, and AAD incidence rates. CONCLUSION Projected estimates of AAD-associated morbidity, mortality, and quality of life can inform decision-makers and health systems planning as the population of PWH ages. Improved AAD prevention, treatment, and supportive care planning are critical for people aging with HIV.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School, Boston
- Harvard University Center for AIDS Research, Cambridge
| | | | - Shibani S Mukerji
- Harvard Medical School, Boston
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Julia H A Foote
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital
| | - Krishna P Reddy
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital
- Harvard Medical School, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | - Acadia Thielking
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital
| | - Liyang Yu
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital
| | - Anand Viswanathan
- Harvard Medical School, Boston
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital
- Harvard Medical School, Boston
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital
- Division of Infectious Diseases, Massachusetts General Hospital
- Harvard Medical School, Boston
- Harvard University Center for AIDS Research, Cambridge
- Harvard T.H. Chan School of Public Health
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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Aravena JM, Chen X, Levy BR. Association between experiencing low healthcare quality and developing dementia. J Am Geriatr Soc 2024; 72:2126-2132. [PMID: 38415796 PMCID: PMC11226361 DOI: 10.1111/jgs.18842] [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: 06/17/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older. METHODS Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors. RESULTS Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk. CONCLUSIONS As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.
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Affiliation(s)
- José M. Aravena
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, 06510, USA
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile
| | - Xi Chen
- Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Becca R. Levy
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, 06510, USA
- Department of Psychology, Yale University, New Haven, CT, 06510, USA
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11
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Morrison L, Dyer AH, Dolphin H, Killane I, Bourke NM, Widdowson M, Woods CP, Gibney J, Reilly RB, Kennelly SP. Discrete Relationships between Spatiotemporal Gait Characteristics and Domain-Specific Neuropsychological Performance in Midlife. SENSORS (BASEL, SWITZERLAND) 2024; 24:3903. [PMID: 38931687 PMCID: PMC11207228 DOI: 10.3390/s24123903] [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: 05/08/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Midlife risk factors such as type 2 diabetes mellitus (T2DM) confer a significantly increased risk of cognitive impairment in later life with executive function, memory, and attention domains often affected first. Spatiotemporal gait characteristics are emerging as important integrative biomarkers of neurocognitive function and of later dementia risk. We examined 24 spatiotemporal gait parameters across five domains of gait previously linked to cognitive function on usual-pace, maximal-pace, and cognitive dual-task gait conditions in 102 middle-aged adults with (57.5 ± 8.0 years; 40% female) and without (57.0 ± 8.3 years; 62.1% female) T2DM. Neurocognitive function was measured using a neuropsychological assessment battery. T2DM was associated with significant changes in gait phases and rhythm domains at usual pace, and greater gait variability observed during maximal pace and dual tasks. In the overall cohort, both the gait pace and rhythm domains were associated with memory and executive function during usual pace. At maximal pace, gait pace parameters were associated with reaction time and delayed memory. During the cognitive dual task, associations between gait variability and both delayed memory/executive function were observed. Associations persisted following covariate adjustment and did not differ by T2DM status. Principal components analysis identified a consistent association of slower gait pace (step/stride length) and increased gait variability during maximal-pace walking with poorer memory and executive function performance. These data support the use of spatiotemporal gait as an integrative biomarker of neurocognitive function in otherwise healthy middle-aged individuals and reveal discrete associations between both differing gait tasks and gait domains with domain-specific neuropsychological performance. Employing both maximal-pace and dual-task paradigms may be important in cognitively unimpaired populations with risk factors for later cognitive decline-with the aim of identifying individuals who may benefit from potential preventative interventions.
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Affiliation(s)
- Laura Morrison
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Adam H. Dyer
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Helena Dolphin
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Isabelle Killane
- Department of Engineering, Technological University Dublin, D07 EWV4 Dublin, Ireland
| | - Nollaig M. Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Matthew Widdowson
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Robert Graves Institute of Endocrinology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Conor P. Woods
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Robert Graves Institute of Endocrinology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - James Gibney
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Robert Graves Institute of Endocrinology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Richard B. Reilly
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Sean P. Kennelly
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
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12
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Ornish D, Madison C, Kivipelto M, Kemp C, McCulloch CE, Galasko D, Artz J, Rentz D, Lin J, Norman K, Ornish A, Tranter S, DeLamarter N, Wingers N, Richling C, Kaddurah-Daouk R, Knight R, McDonald D, Patel L, Verdin E, E Tanzi R, Arnold SE. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: a randomized, controlled clinical trial. Alzheimers Res Ther 2024; 16:122. [PMID: 38849944 PMCID: PMC11157928 DOI: 10.1186/s13195-024-01482-z] [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: 02/21/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Evidence links lifestyle factors with Alzheimer's disease (AD). We report the first randomized, controlled clinical trial to determine if intensive lifestyle changes may beneficially affect the progression of mild cognitive impairment (MCI) or early dementia due to AD. METHODS A 1:1 multicenter randomized controlled phase 2 trial, ages 45-90 with MCI or early dementia due to AD and a Montreal Cognitive Assessment (MoCA) score of 18 or higher. The primary outcome measures were changes in cognition and function tests: Clinical Global Impression of Change (CGIC), Alzheimer's Disease Assessment Scale (ADAS-Cog), Clinical Dementia Rating-Sum of Boxes (CDR-SB), and Clinical Dementia Rating Global (CDR-G) after 20 weeks of an intensive multidomain lifestyle intervention compared to a wait-list usual care control group. ADAS-Cog, CDR-SB, and CDR-Global scales were compared using a Mann-Whitney-Wilcoxon rank-sum test, and CGIC was compared using Fisher's exact test. Secondary outcomes included plasma Aβ42/40 ratio, other biomarkers, and correlating lifestyle with the degree of change in these measures. RESULTS Fifty-one AD patients enrolled, mean age 73.5. No significant differences in any measures at baseline. Only two patients withdrew. All patients had plasma Aβ42/40 ratios <0.0672 at baseline, strongly supporting AD diagnosis. After 20 weeks, significant between-group differences in the CGIC (p= 0.001), CDR-SB (p= 0.032), and CDR Global (p= 0.037) tests and borderline significance in the ADAS-Cog test (p= 0.053). CGIC, CDR Global, and ADAS-Cog showed improvement in cognition and function and CDR-SB showed significantly less progression, compared to the control group which worsened in all four measures. Aβ42/40 ratio increased in the intervention group and decreased in the control group (p = 0.003). There was a significant correlation between lifestyle and both cognitive function and the plasma Aβ42/40 ratio. The microbiome improved only in the intervention group (p <0.0001). CONCLUSIONS Comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with MCI or early dementia due to AD. TRIAL REGISTRATION Approved by Western Institutional Review Board on 12/31/2017 (#20172897) and by Institutional Review Boards of all sites. This study was registered retrospectively with clinicaltrials.gov on October 8, 2020 (NCT04606420, ID: 20172897).
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Affiliation(s)
- Dean Ornish
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA.
- University of California, San Francisco and University of California, San Diego, USA.
| | - Catherine Madison
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
- Ray Dolby Brain Health Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska vägen 37 A, SE-171 64, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska vägen 37 A, SE-171 64, Stockholm, Solna, Sweden
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, United Kingdom
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Colleen Kemp
- Clinical Services, Preventive Medicine Research Institute, Bridgeway, Sausalito, CA, 900, USA
| | - Charles E McCulloch
- Division of Biostatistics, Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | | | - Jon Artz
- Clinical Neurology, School of Medicine, University of Nevada, Reno, USA
- Renown Health Institute of Neurosciences, Reno, NV, USA
| | - Dorene Rentz
- Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Boston, MA, USA
- Mass General Brigham Alzheimer Disease Research Center, Boston, MA, USA
| | - Jue Lin
- Elizabeth Blackburn Lab, UCSF, San Francisco, CA, USA
| | | | - Anne Ornish
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Sarah Tranter
- Clinical Services, Preventive Medicine Research Institute, Bridgeway, Sausalito, CA, 900, USA
| | - Nancy DeLamarter
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Noel Wingers
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Carra Richling
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Rima Kaddurah-Daouk
- Departments of Medicine and Psychiatry, Duke University Medical Center and Member, Duke Institute of Brain Sciences, Durham, NC, USA
| | - Rob Knight
- Department of Pediatrics; Department of Computer Science & Engineering; Department of Bioengineering; Center for Microbiome Innovation, Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics and Scientific Director, American Gut Project and The Microsetta Initiative, University of California San Diego, La Jolla, CA, USA
| | - Lucas Patel
- Bioinformatics and Systems Biology Program; Rob Knight Lab; Medical Scientist Training Program, University of California, San Diego, La Jolla, CA, USA
| | - Eric Verdin
- Buck Institute for Research on Aging, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Rudolph E Tanzi
- Harvard Medical School, Boston, MA, USA
- Genetics and Aging Research Unit, Boston, MA, USA
- McCance Center for Brain Health, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Steven E Arnold
- Harvard Medical School, Boston, MA, USA
- Interdisciplinary Brain Center, Massachusetts General Hospital, Boston, MA, USA
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13
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Sakurai T, Sugimoto T, Akatsu H, Doi T, Fujiwara Y, Hirakawa A, Kinoshita F, Kuzuya M, Lee S, Matsumoto N, Matsuo K, Michikawa M, Nakamura A, Ogawa S, Otsuka R, Sato K, Shimada H, Suzuki H, Suzuki H, Takechi H, Takeda S, Uchida K, Umegaki H, Wakayama S, Arai H. Japan-Multimodal Intervention Trial for the Prevention of Dementia: A randomized controlled trial. Alzheimers Dement 2024; 20:3918-3930. [PMID: 38646854 PMCID: PMC11180858 DOI: 10.1002/alz.13838] [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: 12/07/2023] [Revised: 03/01/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild cognitive impairment (MCI). METHODS Participants aged 65-85 years with MCI were randomized into intervention (management of vascular risk factors, exercise, nutritional counseling, and cognitive training) and control groups. The primary outcome was changes in the cognitive composite score over a period of 18 months. RESULTS Of 531 participants, 406 completed the trial. The between-group difference in composite score changes was 0.047 (95% CI: -0.029 to 0.124). Secondary analyses indicated positive impacts of interventions on several secondary health outcomes. The interventions appeared to be particularly effective for individuals with high attendance during exercise sessions and those with the apolipoprotein E ε4 allele and elevated plasma glial fibrillary acidic protein levels. DISCUSSION The multidomain intervention showed no efficacy in preventing cognitive decline. Further research on more efficient strategies and suitable target populations is required. HIGHLIGHTS This trial evaluated the efficacy of multidomain intervention in individuals with MCI. The trial did not show a significant difference in preplanned cognitive outcomes. Interventions had positive effects on a wide range of secondary health outcomes. Those with adequate adherence or high risk of dementia benefited from interventions.
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Affiliation(s)
- Takashi Sakurai
- Research InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of Prevention and Care ScienceResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of Cognition and Behavior ScienceNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Taiki Sugimoto
- Department of Prevention and Care ScienceResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Hiroyasu Akatsu
- Department of General Medicine and General Internal MedicineNagoya City University Graduate School of MedicineNagoyaAichiJapan
| | - Takehiko Doi
- Department of Preventive GerontologyResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Yoshinori Fujiwara
- Tokyo Metropolitan Institute for Geriatrics and GerontologyItabashi‐kuTokyoJapan
| | - Akihiro Hirakawa
- Department of Clinical BiostatisticsGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityBunkyo‐kuTokyoJapan
| | - Fumie Kinoshita
- Department of Advanced MedicineNagoya University HospitalNagoyaAichiJapan
| | | | - Sangyoon Lee
- Department of Preventive GerontologyResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of ResearchObu Center for Dementia Care Research and PracticeObuAichiJapan
| | - Nanae Matsumoto
- Department of Prevention and Care ScienceResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Koichiro Matsuo
- Department of Oral Health Sciences for Community WelfareGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityBunkyo‐kuTokyoJapan
| | - Makoto Michikawa
- Department of Geriatric MedicineSchool of Life Dentistry at NiigataThe Nippon Dental UniversityNiigataJapan
| | - Akinori Nakamura
- Department of Biomarker ResearchResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Susumu Ogawa
- Research Team for Social Participation and Healthy AgingTokyo Metropolitan Institute for Geriatrics and GerontologyItabashi‐kuTokyoJapan
| | - Rei Otsuka
- Department of Epidemiology of AgingResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Kenji Sato
- Department of Rehabilitation MedicineHospital, National Center for Geriatrics and GerontologyObuAichiJapan
| | - Hiroyuki Shimada
- Center for Gerontology and Social ScienceResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Hiroko Suzuki
- Well Aging DivisionSompo Care Inc.Shinagawa‐kuTokyoJapan
| | - Hiroyuki Suzuki
- Research Team for Social Participation and Healthy AgingTokyo Metropolitan Institute for Geriatrics and GerontologyItabashi‐kuTokyoJapan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive DisordersSchool of MedicineFujita Health UniversityToyoakeAichiJapan
| | - Shinya Takeda
- Department of Clinical PsychologyTottori University Graduate School of Medical SciencesYonagoTottoriJapan
| | - Kazuaki Uchida
- Department of Prevention and Care ScienceResearch InstituteNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and GeriatricsNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Satomu Wakayama
- Department of Rehabilitation MedicineHospital, National Center for Geriatrics and GerontologyObuAichiJapan
- Innovation for Aging & Wellness DepartmentSompo Holdings, Inc.Shinagawa‐KuTokyoJapan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuAichiJapan
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14
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Reuben DB, Kremen S, Maust DT. Dementia Prevention and Treatment: A Narrative Review. JAMA Intern Med 2024; 184:563-572. [PMID: 38436963 DOI: 10.1001/jamainternmed.2023.8522] [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] [Indexed: 03/05/2024]
Abstract
Importance Dementia affects 10% of those 65 years or older and 35% of those 90 years or older, often with profound cognitive, behavioral, and functional consequences. As the baby boomers and subsequent generations age, effective preventive and treatment strategies will assume increasing importance. Observations Preventive measures are aimed at modifiable risk factors, many of which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions of any kind can prevent dementia. Nevertheless, addressing risk factors may have other health benefits and should be considered. Alzheimer disease can be treated with cholinesterase inhibitors, memantine, and antiamyloid immunomodulators, with the last modestly slowing cognitive and functional decline in people with mild cognitive impairment or mild dementia due to Alzheimer disease. Cholinesterase inhibitors and memantine may benefit persons with other types of dementia, including dementia with Lewy bodies, Parkinson disease dementia, vascular dementia, and dementia due to traumatic brain injury. Behavioral and psychological symptoms of dementia are best treated with nonpharmacologic management, including identifying and mitigating the underlying causes and individually tailored behavioral approaches. Psychotropic medications have minimal evidence of efficacy for treating these symptoms and are associated with increased mortality and clinically meaningful risks of falls and cognitive decline. Several emerging prevention and treatment strategies hold promise to improve dementia care in the future. Conclusions and Relevance Although current prevention and treatment approaches to dementia have been less than optimally successful, substantial investments in dementia research will undoubtedly provide new answers to reducing the burden of dementia worldwide.
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Affiliation(s)
- David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles
| | - Sarah Kremen
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
- Jona Goldrich Center for Alzheimer's and Memory Disorders, Cedars-Sinai Medical Center, Los Angeles, California
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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15
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Andrews SJ, Jonson C, Fulton-Howard B, Renton AE, Yokoyama JS, Yaffe K. The Role of Genomic-Informed Risk Assessments in Predicting Dementia Outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.27.24306488. [PMID: 38903124 PMCID: PMC11188112 DOI: 10.1101/2024.04.27.24306488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Importance By integrating genetic and clinical risk factors into genomic-informed dementia risk reports, healthcare providers can offer patients detailed risk profiles to facilitate understanding of individual risk and support the implementation of personalized strategies for promoting brain health. Objective To develop a genomic-informed risk assessment composed of family history, genetic, and clinical risk factors and, in turn, evaluate how the risk assessment predicted incident dementia. Design This longitudinal study included data from two clinical case-control cohorts with an average of 6.6 visits. Secondary analyses were conducted from July 2023 - March 2024. Setting Data were previously collected across multiple US locations from 1994 to 2023. Participants Older adults aged 55+ with whole-genome sequencing and dementia-free at baseline. Exposures An additive score comprising the modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia Risk Score (mCAIDE), family history of dementia, APOE genotype, and an AD polygenic risk score. Main Outcomes and Measures The risk of progression to all-cause dementia was evaluated using Cox-proportional hazard models (hazard ratios with 95% confidence intervals [OR 9%CI]). Results A total of 3,429 older adults were included (aged 75 ± 7 years; 59% female; 75% non-Latino White, 15% Black, 5.2% Latino, 3.6% other, and 0.4% Asian; 27% MCI), with 751 participants progressing to dementia. The most common high-risk indicator was a family history of dementia (56%), followed by APOE*ε4 genotype (36%), high mCAIDE score (34%), and high AD-PRS (11%). Most participants had at least one high-risk indicator, with 39% having one, 32% two, 9.8% three, and 1% four. The presence of 1, 2, 3, or 4 risk indicators was associated with a doubling (HR = 1.72, CI: 1.34-2.22, p = 2.5e-05), tripling (HR = 3.09, CI: 2.41-3.95, p = 4.4e-19), quadrupling (HR = 4.46, CI: 3.34-5.94, p = 2.2e-24), and a twelvefold increase (HR = 12.15, CI: 7.33-20.14, p = 3.2e-22) in dementia risk. Conclusion & Relevance We found that most participants in memory and aging clinics had at least one high-risk indicator for dementia. Furthermore, we observed a dose-response relationship where a greater number of risk indicators was associated with an increased risk of incident dementia.
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Affiliation(s)
- Shea J. Andrews
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, USA
| | - Caroline Jonson
- Department of Neurology, University of California San Francisco, San Francisco, USA
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- DataTecnica LLC, Washington, DC USA 20037
| | - Brian Fulton-Howard
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alan E Renton
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jennifer S Yokoyama
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, USA
- Department of Neurology, University of California San Francisco, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California
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16
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Leng Y, Yaffe K. Harnessing Brain Pathology for Dementia Prevention. JAMA Neurol 2024; 81:229-231. [PMID: 38315478 DOI: 10.1001/jamaneurol.2023.5490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
- Departments of Neurology and Epidemiology, University of California, San Francisco, San Francisco
- San Francisco VA Health Care System, San Francisco, California
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