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Cheng M, Liu Q, Gan H, Liu H, He M. Prevalence and Risk Factors of Cognitive Frailty in Patients Undergoing Maintenance Hemodialysis: A Systematic Review and Meta-Analysis. Semin Dial 2024. [PMID: 39120010 DOI: 10.1111/sdi.13220] [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: 03/07/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The purpose of this study is to investigate the prevalence and risk factor of cognitive frailty in patients undergoing maintenance hemodialysis. METHODS Systematically searched PubMed, EmBase, Web of Science, Cochrane Library, SinoMed, China Knowledge Resource Integrated Database, Wanfang Database, and Weipu Database from inception until January 1, 2024. Two researchers were independently screened and cross-checked. Stata 15.1 software was used to perform the meta-analysis. RESULTS A total of 15 articles were included, including 5398 patients. The results showed that the prevalence of cognitive frailty in patients undergoing maintenance hemodialysis was 24%. Among them, age (odds ratio [OR] = 1.33, 95% CI [1.16, 1.53]), waist circumference (OR = 1.05, 95% CI [1.03, 1.08]), malnutrition (OR = 2.91, 95% CI [1.94, 4.35]), comorbidities (OR = 1.93, 95% CI [1.47, 2.54]), stroke history (OR = 2.94, 95% CI [1.72, 5.03]), and depression (OR = 3.26, 95% CI [1.91, 5.57]) were the main risk factors for cognitive frailty in patients undergoing maintenance hemodialysis. Education level (OR = 0.48, 95% CI [0.31, 0.73]) was protective factors for cognitive frailty in patients undergoing maintenance hemodialysis. CONCLUSIONS Current evidence showed that the prevalence of cognitive frailty in patients undergoing maintenance hemodialysis was high, and there were many risk factors. Therefore, early identification and intervention of cognitive frailty in maintenance hemodialysis patients should be carried out, which may be helpful to reduce the prevalence rate and occurrence of adverse events and improve the prognosis of patients.
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Affiliation(s)
- Min Cheng
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital, School of Medicine Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Qin Liu
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital, School of Medicine Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Haoyue Gan
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital, School of Medicine Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Hangcheng Liu
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital, School of Medicine Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Mei He
- Nursing Department of Mianyang Central Hospital, School of Medicine Affiliated to University of Electronic Science and Technology of China, Mianyang, China
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Han JZ, Yang Y, Wang YF, Feng JH, Song CN, Wu WJ, Lin HB. Effectiveness and safety of Governor vessel acupuncture therapy for post-stroke cognitive impairment: A meta-analysis of randomized controlled trials. Ageing Res Rev 2024; 99:102355. [PMID: 38942201 DOI: 10.1016/j.arr.2024.102355] [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: 09/17/2023] [Accepted: 05/27/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of Governor vessel acupuncture (GV Ac) in treating post-stroke cognitive impairment (PSCI). METHODS There was a total of seven databases examined. Four English databases (Cochrane Library, PubMed, Embase, and Medline) and three Chinese databases (Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Databases (VIP), and Wan Fang Database) contain all randomized controlled trials (RCTs) comparing Governor vessel acupuncture to other treatments or none acupuncture for PSCI. The exact dates for the search period are from January 1, 2000, to January 1, 2023.Two researchers independently reviewed the literature, gathered RCT data, and performed statistical analysis. All data were analyzed using Review Manager software (Rev Man) 5.3. RESULTS This meta-analysis includes a total of 39 trials with 2044 patients. There were 1022 participants in each of the test and control groups. Following 12-120 days of acupuncture treatment, a meta-analysis revealed that the treatment groups (GV Ac combined with conventional treatment groups) significantly increased their scores on the Curative ratio (OR = 3.00, 95 %CI = 2.37-3.79, P = 0.98, I² = 0 %), Montreal Cognitive Assessment (MoCA)(MD = 1.82, 95 %CI = 1.60-2.03, P = 0.11, I² = 25 %), Mini-Mental State Examination (MMSE)(MD = 2.18, 95 %CI = 1.64-2.72, P<0.005, I² = 92 %), and Activity of Daily Living (ADL)(MD = 5.99, 95 %CI = 5.33-6.64, P = 0.19, I² = 26 %). CONCLUSION The results suggested that acupuncture on points of the Governor vessel enhanced cognitive function in stroke survivors.
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Affiliation(s)
- Ji-Ze Han
- Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen, China; Jinan University, Guangzhou, China
| | - Yang Yang
- Rehabilitation Department, Baoan Central Hospital of Shenzhen, Shenzhen, China
| | - Yi-Fan Wang
- Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen, China; Jinan University, Guangzhou, China
| | - Jia-Hao Feng
- Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen, China; Jinan University, Guangzhou, China
| | - Cheng-Ning Song
- Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen, China; Jinan University, Guangzhou, China
| | - Wei-Jie Wu
- Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen, China; Jinan University, Guangzhou, China
| | - Hai-Bo Lin
- Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen, China.
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Stasolla F, Di Gioia M, Messina I, Treglia F, Passaro A, Zullo A, Dragone M. Assessing and recovering Alzheimer's disease: a comparative analysis of standard neuropsychological approaches and virtual reality interventions with the use of digital storytelling. Front Psychol 2024; 15:1406167. [PMID: 39114597 PMCID: PMC11303320 DOI: 10.3389/fpsyg.2024.1406167] [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: 03/24/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Background Alzheimer's disease (AD), the most common form of dementia, is a progressive neurodegenerative disorder that predominantly affects the elderly population. Traditional assessment methods, including neuropsychological tests like the MMSE, have been the cornerstone of AD diagnosis for decades. These methods are grounded in a wealth of research and clinical experience, providing a robust framework for understanding the cognitive deficits of AD. The evolution of AD assessment and rehabilitation has recently been tackled with the introduction of Virtual Reality (VR) technologies. Objectives To evaluate the use of storytelling and reminiscence therapy in virtual reality programs as a complementary and enhancing modality alongside standard assessment and rehabilitation for Alzheimer's patients. To explore how regular interaction with VR narratives can slow cognitive decline or improve relevant features of cognitive functioning over the time. To propose a new assessment and rehabilitative tool based on the use of VR and digital storytelling. Method A comparative analysis of Standard Neuropsychological Approaches and Virtual Reality Interventions in patients with Alzheimer disorder was carried out. A literature overview on the empirical studies between 2019 and 2024 was conducted. Results We propose a new VR-based setup mediated by the use of storytelling for the assessment and recovery of AD. Conclusion The employment of storytelling within VR programs for the assessment and rehabilitation of Alzheimer's disease can positively impact both the cognitive and emotional realms of patients, with beneficial outcomes on caregivers' and families' burden. The successful implementation of this approach requires careful consideration of accessibility, data interpretation, and standard validation protocols.
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Affiliation(s)
| | | | | | - Francesco Treglia
- Academy of Mind Ecology-School of Specialization in Systemic Relational Psychotherapy, Rome, Italy
| | - Anna Passaro
- Faculty of Law, Giustino Fortunato University, Benevento, Italy
| | | | - Mirella Dragone
- Faculty of Law, Giustino Fortunato University, Benevento, Italy
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Yao S, Zhang Y, Chen J, Lu Q, Zhao Z. Enhancing identification performance of cognitive impairment high-risk based on a semi-supervised learning method. J Biomed Inform 2024; 157:104699. [PMID: 39033866 DOI: 10.1016/j.jbi.2024.104699] [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: 05/09/2024] [Revised: 06/21/2024] [Accepted: 07/18/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Cognitive assessment plays a pivotal role in the early detection of cognitive impairment, particularly in the prevention and management of cognitive diseases such as Alzheimer's and Lewy body dementia. Large-scale screening relies heavily on cognitive assessment scales as primary tools, with some low sensitivity and others expensive. Despite significant progress in machine learning for cognitive function assessment, its application in this particular screening domain remains underexplored, often requiring labor-intensive expert annotations. AIMS This paper introduces a semi-supervised learning algorithm based on pseudo-label with putback (SS-PP), aiming to enhance model efficiency in predicting the high risk of cognitive impairment (HR-CI) by utilizing the distribution of unlabeled samples. DATA The study involved 189 labeled samples and 215,078 unlabeled samples from real world. A semi-supervised classification algorithm was designed and evaluated by comparison with supervised methods composed by 14 traditional machine-learning methods and other advanced semi-supervised algorithms. RESULTS The optimal SS-PP model, based on GBDT, achieved an AUC of 0.947. Comparative analysis with supervised learning models and semi-supervised methods demonstrated an average AUC improvement of 8% and state-of-art performance, repectively. CONCLUSION This study pioneers the exploration of utilizing limited labeled data for HR-CI predictions and evaluates the benefits of incorporating physical examination data, holding significant implications for the development of cost-effective strategies in relevant healthcare domains.
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Affiliation(s)
- Sumei Yao
- Center for Studies of Information Resources, Wuhan University, Wuhan, China; School of Information Management, Wuhan University, Wuhan, China; Big Data Institute, Wuhan University, Wuhan, China.
| | - Yan Zhang
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jing Chen
- School of Information Management, Central China Normal University, Wuhan, China
| | - Quan Lu
- Center for Studies of Information Resources, Wuhan University, Wuhan, China; School of Information Management, Wuhan University, Wuhan, China; Big Data Institute, Wuhan University, Wuhan, China.
| | - Zhiguang Zhao
- Shenzhen Center for Chronic Disease Control, Shenzhen, China.
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Kitagawa K, Toi S, Hosoya M, Yoshizawa H. Small-Vessel Disease and Intracranial Large Artery Disease in Brain MRI Predict Dementia and Acute Coronary Syndrome, Respectively: A Prospective, Observational Study in the Population at High Vascular Risk. J Am Heart Assoc 2024; 13:e033512. [PMID: 38934848 PMCID: PMC11255692 DOI: 10.1161/jaha.123.033512] [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: 03/01/2024] [Accepted: 04/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND We aimed to clarify the predictive value of cerebral small-vessel disease and intracranial large artery disease (LAD) observed in magnetic resonance imaging of the brain and magnetic resonance angiography on future vascular events and cognitive impairment. METHODS AND RESULTS Data were derived from a Japanese cohort with evidence of cerebral vessel disease on magnetic resonance imaging. This study included 862 participants who underwent magnetic resonance angiography after excluding patients with a modified Rankin Scale score >1 and Mini-Mental State Examination score <24. We evaluated small-vessel disease such as white matter hyperintensities and lacunes in magnetic resonance imaging and LAD with magnetic resonance angiography. Outcomes were incident stroke, dementia, acute coronary syndrome, and all-cause death. Over a median follow-up period of 4.5 years, 54 incident stroke, 39 cases of dementia, and 27 cases of acute coronary syndrome were documented. Both small-vessel disease (white matter hyperintensities and lacunes) and LAD were associated with stroke; however, only white matter hyperintensities were related to dementia. In contrast, only LAD was associated with acute coronary syndrome. Among the 357 patients with no prior history of stroke, coronary or peripheral artery disease, or atrial fibrillation, white matter hyperintensities emerged as the sole predictor of future stroke and dementia, while LAD was the sole predictor of acute coronary syndrome. CONCLUSIONS Among cerebral vessels, small-vessel disease could underlie the cognitive impairment while LAD was associated with coronary artery disease as atherosclerotic vessel disease.
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Affiliation(s)
- Kazuo Kitagawa
- Department of NeurologyTokyo Women’s Medical University HospitalTokyoJapan
| | - Sono Toi
- Department of NeurologyTokyo Women’s Medical University HospitalTokyoJapan
| | - Megumi Hosoya
- Department of NeurologyTokyo Women’s Medical University HospitalTokyoJapan
| | - Hiroshi Yoshizawa
- Department of NeurologyTokyo Women’s Medical University HospitalTokyoJapan
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Fan H, Feng J, Ding Y, Gu P, Wang L, Chen X, Geng X. Performance of antisaccades in patients with cerebral small vessel disease accompanied by white matter hyperintensities. Neurol Res 2024:1-8. [PMID: 38888450 DOI: 10.1080/01616412.2024.2367934] [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: 05/03/2023] [Accepted: 06/09/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES The antisaccades (AS) task is considered a reliable indicator of inhibitory control of eye movements in humans. Achieving good AS performance requires efficient cognitive processes that are sensitive to changes in brain structure. White matter hyperintensities (WMH) can cause subcortical-cortical dysconnectivity, affecting diverse cognitive domains. Thus, the AS task was investigated in patients with WMH in cerebral small vessel disease (CSVD). METHODS In this retrospective study, 75 participants with WMH, determined by neuroimaging standards for CSVD research, were admitted to the Department of Neurology of Beijing Luhe Hospital, Capital Medical University from January 2021 to December 2022. All subjects underwent the AS task, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and 3.0T brain MRI. Additionally, 61 healthy subjects were recruited to characterize WMH profiles. RESULTS Compared to the control group, patients with WMH had a significantly increased AS error rate (49.81%, p = 0.001) and lower gain (76.00%, p = 0.042). The AS error rate was significantly higher in patients with WMH in the frontal lobe than in those without WMH (p = 0.004). After adjusting for confounders (age), a positive correlation was found between the AS error rate and MoCA scores for patients with WMH (coefficient = 0.262, p = 0.024). CONCLUSIONS Patients with WMH due to CSVD exhibited abnormal AS performances, particularly in the frontal lobe. The eye movement paradigms, the new diagnostic forms in neurology, can be utilized to investigate the distributed cortical and subcortical systems involved in cognitive control processes, offering simple, well-tolerated and highly sensitive advantages over traditional measures.
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Affiliation(s)
- Huimin Fan
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jing Feng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pan Gu
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Liying Wang
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaomeng Chen
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Tokaj A, Lehrner J. Drawing a line?-Visuo-constructive function as discriminator between healthy individuals, subjective cognitive decline, mild cognitive impairment and Alzheimer's disease and predictor of disease progress compared to a multimodal approach. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:71-81. [PMID: 36723802 PMCID: PMC11143003 DOI: 10.1007/s40211-022-00455-8] [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: 10/12/2022] [Accepted: 12/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE One cognitive domain impaired in Alzheimer's disease (AD) is visuo-construction. The Vienna Visuo-constructional Test 3.0 Screening (VVT 3.0 Screening) measures this cognitive domain. This study examines how it works in the differentiation of AD from healthy controls (HC) and the prodromal stages subjective cognitive decline (SCD) and mild cognitive impairment (MCI) and also how it performs in prediction of progress compared to the Mini Mental State Examination (MMSE) and the Sunderland Clock Drawing Test (CDT). METHODS Data from 622 patients (33 HC, 68 SCD, 301 MCI, 220 AD) who completed all three tests were obtained. Furthermore, 117 patients were examined in a follow-up. Data were analyzed in a retrospective analysis comparing the validity of tests in diagnosis and prediction using receiver operator characteristic (ROC) curves and multinominal logistic regression. RESULTS The VVT 3.0 Screening shows some ability to discriminate between AD and all other participants (sensitivity: 62.1%, specificity: 83.1%), while of the three examined tests none was able to predict membership to all experimental groups or to predict disease-progress adequately. As the VVT 3.0 Screening is short, easy to apply and largely language independent, it can be considered an alternative to the MMSE in certain situations. CONCLUSIONS The VVT 3.0 Screening is useful to discriminate between AD and all other participants and can be an alternative to the MMSE in certain situations.
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Affiliation(s)
- Amelie Tokaj
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria.
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Hong S, Choi Y, Lee MB, Rhee HY, Park S, Ryu CW, Cho AR, Kwon OI, Jahng GH. Increased extra-neurite conductivity of brain in patients with Alzheimer's disease: A pilot study. Psychiatry Res Neuroimaging 2024; 340:111807. [PMID: 38520873 DOI: 10.1016/j.pscychresns.2024.111807] [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: 09/14/2023] [Revised: 01/31/2024] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
The objectives of this study were to investigate how the extra-neurite conductivity (EC) and intra-neurite conductivity (IC) were reflected in Alzheimer's disease (AD) patients compared with old cognitively normal (CN) people and patients with amnestic mild cognitive impairment (MCI) and to evaluate the association between those conductivity values and cognitive decline. To do this, high-frequency conductivity (HFC) at the Larmor frequency was obtained using MRI-based electrical property tomography (MREPT) and was decomposed into EC and IC using information of multi-shell multi-gradient direction diffusion tensor images. This prospective single-center study included 20 patients with mild or moderate AD, 25 patients with amnestic MCI, and 21 old CN participants. After decomposing EC and IC from HFC for all participants, we performed voxel-based and regions-of-interest analyses to compare conductivity between the three participant groups and to evaluate the association with either age or the Mini-Mental State Examination (MMSE) scores. We found increased EC in AD compared to CN and MCI. EC was significantly negatively associated with MMSE scores in the insula, and middle temporal gyrus. EC might be used as an imaging biomarker for helping to monitor cognitive function.
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Affiliation(s)
- Seowon Hong
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea
| | - Yunjeong Choi
- Department of Biomedical Engineering, Undergraduate School, College of Electronics and Information, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin-si, Gyeonggi-do 17104, Republic of Korea
| | - Mun Bae Lee
- Department of Mathematics, College of Basic Science, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Hak Young Rhee
- Department of Neurology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Soonchan Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Ah Rang Cho
- Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea; Department of Psychiatry, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea
| | - Oh In Kwon
- Department of Mathematics, College of Basic Science, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea.
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Ajith M, Spence JS, Chapman SB, Calhoun VD. Multimodal Predictive Modeling: Scalable Imaging Informed Approaches to Predict Future Brain Health. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.29.596506. [PMID: 38854031 PMCID: PMC11160794 DOI: 10.1101/2024.05.29.596506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Predicting future brain health is a complex endeavor that often requires integrating diverse data sources. The neural patterns and interactions identified through neuroimaging serve as the fundamental basis and early indicators that precede the manifestation of observable behaviors or psychological states. New Method In this work, we introduce a multimodal predictive modeling approach that leverages an imaging-informed methodology to gain insights into future behavioral outcomes. We employed three methodologies for evaluation: an assessment-only approach using support vector regression (SVR), a neuroimaging-only approach using random forest (RF), and an image-assisted method integrating the static functional network connectivity (sFNC) matrix from resting-state functional magnetic resonance imaging (rs-fMRI) alongside assessments. The image-assisted approach utilized a partially conditional variational autoencoder (PCVAE) to predict brain health constructs in future visits from the behavioral data alone. Results Our performance evaluation indicates that the image-assisted method excels in handling conditional information to predict brain health constructs in subsequent visits and their longitudinal changes. These results suggest that during the training stage, the PCVAE model effectively captures relevant information from neuroimaging data, thereby potentially improving accuracy in making future predictions using only assessment data. Comparison with Existing Methods The proposed image-assisted method outperforms traditional assessment-only and neuroimaging-only approaches by effectively integrating neuroimaging data with assessment factors. Conclusion This study underscores the potential of neuroimaging-informed predictive modeling to advance our comprehension of the complex relationships between cognitive performance and neural connectivity.
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Affiliation(s)
- Meenu Ajith
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, 55 Park Pl NE, Atlanta, 30303, GA, USA
| | - Jeffrey S. Spence
- Center for BrainHealth, The University of Texas at Dallas, Dallas, 75235, TX, USA
| | - Sandra B. Chapman
- Center for BrainHealth, The University of Texas at Dallas, Dallas, 75235, TX, USA
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, 55 Park Pl NE, Atlanta, 30303, GA, USA
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Chen H, Liu W, Xu X, Xiao M, Yin Y. The Effects of a Nonpharmacological Intervention Practice for Older Adults with Mild Cognitive Impairment and Their Family Caregivers in China. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-20. [PMID: 38762891 DOI: 10.1080/01634372.2024.2355152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 05/10/2024] [Indexed: 05/21/2024]
Abstract
Mild cognitive impairment (MCI) marks a critical phase in the progression to dementia. In our study, social workers utilized the Multicomponent Nonpharmacological Intervention Approach (MCNIA) to aid MCI participants (N = 52) and their caregivers, dividing into intervention and control groups. The intervention group underwent an additional regimen of non-pharmacological therapies besides pharmacological treatment. Our findings highlighted that: 1) MCNIA significantly enhanced cognitive and daily living abilities in the intervention group; 2) Caregivers experienced reduced burdens and improved social support; 3) Correlation analyses involving biomarkers indicated that MCNIA was particularly effective in alleviating depression in those with slightly more severe cognitive impairment.
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Affiliation(s)
- Honglin Chen
- Department of Social Sciences, Faculty of Social Science and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Wenrui Liu
- Department of Social Work, School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Xian Xu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology, Sun Yat-Sen University and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Meng Xiao
- Department of social work, Tianjin Normal University, Tianjin, China
| | - You Yin
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, China
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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11
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Zuo F, Jing P, Sun J, Duan J, Ji Y, Liu Y. Deep Learning-Based Eye-Tracking Analysis for Diagnosis of Alzheimer's Disease Using 3D Comprehensive Visual Stimuli. IEEE J Biomed Health Inform 2024; 28:2781-2793. [PMID: 38349825 DOI: 10.1109/jbhi.2024.3365172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Alzheimer's Disease (AD) is a neurodegenerative disorder that causes a continuous decline in cognitive functions and eventually results in death. An early AD diagnosis is important for taking active measures to slow its deterioration. Traditional diagnoses are usually based on clinical experience, which is limited by several realistic factors. In this paper, we focus on exploiting deep learning techniques to diagnose AD based on eye-tracking behaviors. Visual attention, as a typical eye-tracking behavior, is of great clinical value in detecting cognitive abnormalities in AD patients. To better analyze the differences in visual attention between AD patients and normals, we first conducted a 3D comprehensive visual task on a noninvasive eye-tracking system to collect visual attention heatmaps. Then a multilayered comparison convolutional neural network (MC-CNN) is proposed to distinguish the visual attention differences between AD patients and normals. In MC-CNN, the multilayered feature representations of heatmaps were obtained by hierarchical residual blocks to better encode eye movement behaviors, which were further integrated into a distance vector to benefit the comprehensive visual task. From evaluation, MC-CNN can distinguish AD patients from normals with 0.84 accuracy, 0.86 recall, 0.82 precision, 0.83 F1-score and 0.90 area under the curve (AUC). The above results demonstrate the effectiveness of the proposed MC-CNN in AD diagnosis based on the comprehensive 3D visual task.
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Kudelka J, Ollenschläger M, Dodel R, Eskofier BM, Hobert MA, Jahn K, Klucken J, Labeit B, Polidori MC, Prell T, Warnecke T, von Arnim CAF, Maetzler W, Jacobs AH. Which Comprehensive Geriatric Assessment (CGA) instruments are currently used in Germany: a survey. BMC Geriatr 2024; 24:347. [PMID: 38627620 PMCID: PMC11022468 DOI: 10.1186/s12877-024-04913-6] [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: 03/24/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The Comprehensive Geriatric Assessment (CGA) records geriatric syndromes in a standardized manner, allowing individualized treatment tailored to the patient's needs and resources. Its use has shown a beneficial effect on the functional outcome and survival of geriatric patients. A recently published German S1 guideline for level 2 CGA provides recommendations for the use of a broad variety of different assessment instruments for each geriatric syndrome. However, the actual use of assessment instruments in routine geriatric clinical practice and its consistency with the guideline and the current state of literature has not been investigated to date. METHODS An online survey was developed by an expert group of geriatricians and sent to all licenced geriatricians (n = 569) within Germany. The survey included the following geriatric syndromes: motor function and self-help capability, cognition, depression, pain, dysphagia and nutrition, social status and comorbidity, pressure ulcers, language and speech, delirium, and frailty. Respondents were asked to report which geriatric assessment instruments are used to assess the respective syndromes. RESULTS A total of 122 clinicians participated in the survey (response rate: 21%); after data cleaning, 76 data sets remained for analysis. All participants regularly used assessment instruments in the following categories: motor function, self-help capability, cognition, depression, and pain. The most frequently used instruments in these categories were the Timed Up and Go (TUG), the Barthel Index (BI), the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Visual Analogue Scale (VAS). Limited or heterogenous assessments are used in the following categories: delirium, frailty and social status. CONCLUSIONS Our results show that the assessment of motor function, self-help capability, cognition, depression, pain, and dysphagia and nutrition is consistent with the recommendations of the S1 guideline for level 2 CGA. Instruments recommended for more frequent use include the Short Physical Performance Battery (SPPB), the Montreal Cognitive Assessment (MoCA), and the WHO-5 (depression). There is a particular need for standardized assessment of delirium, frailty and social status. The harmonization of assessment instruments throughout geriatric departments shall enable more effective treatment and prevention of age-related diseases and syndromes.
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Affiliation(s)
- Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany
| | - Malte Ollenschläger
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Richard Dodel
- Chair of Geriatric Medicine, University Duisburg-Essen, Essen, Germany
| | - Bjoern M Eskofier
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus A Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany
| | - Klaus Jahn
- Schön Klinik Bad Aibling, Neurology and Geriatrics, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University (LMU) of Munich, Munich, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Sur-Alzette, Luxembourg
- Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Bendix Labeit
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the University of Muenster, Osnabrueck, Germany
| | | | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany.
| | - Andreas H Jacobs
- Department of Geriatrics & Neurology, Johanniter Hospital Bonn, Johanniter Strasse 1-3, Bonn, 53113, Germany.
- Centre for Integrated Oncology (CIO) of the University of Bonn, Bonn, Germany.
- European Institute for Molecular Imaging (EIMI) of the Westfälische Wilhelms University (WWU), Münster, Germany.
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Pomiersky R, Matting L, Haigis D, Eschweiler GW, Frahsa A, Niess A, Thiel A, Sudeck G. Physical Activity, Sedentary Behavior, and Their Predictors Among Nursing Home Residents-Cross-Sectional Results of the BaSAlt Study. J Aging Phys Act 2024:1-10. [PMID: 38589013 DOI: 10.1123/japa.2023-0088] [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: 03/27/2023] [Revised: 12/04/2023] [Accepted: 02/23/2024] [Indexed: 04/10/2024]
Abstract
Little is known about physical activity (PA) and sedentary behavior (SB) among nursing home residents although PA is known as a health promoter. This study examined PA, SB, and their predictors among nursing home residents (n = 63). Dependent variables were accelerometry-based PA and SB. Predictor variables included in a path analysis were age, sex, body mass index, Barthel Index, cognitive status (Mini-Mental State Examination), physical performance (hand grip strength and habitual walking speed), and well-being (World Health Organization-5 well-being index). PA was very low (M steps per day = 2,433) and SB was high (M percentage of sedentary time = 89.4%). PA was significantly predicted by age (β = -0.27, p = .008), body mass index (β = -0.29, p = .002), Barthel Index (β = 0.24, p = .040), and hand grip strength (β = 0.30, p = .048). SB was significantly predicted by body mass index (β = 0.27, p = .008) and Barthel Index (β = -0.30, p = .012). Results might be helpful for everyday practice to identify individuals at high risk for low PA and high SB.
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Affiliation(s)
- Rebekka Pomiersky
- Institute of Sports Science, University of Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
| | - Leon Matting
- Institute of Sports Science, University of Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
| | - Daniel Haigis
- Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
- Department of Sports Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Gerhard W Eschweiler
- Center for Geriatric Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andreas Niess
- Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
- Department of Sports Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Ansgar Thiel
- Institute of Sports Science, University of Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
| | - Gordon Sudeck
- Institute of Sports Science, University of Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
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Mora-Traverso M, Prieto-Moreno R, Molina-Garcia P, Salas-Fariña Z, Martín-Martín L, Martín-Matillas M, Ariza-Vega P. Effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients with hip fracture. J Telemed Telecare 2024; 30:549-558. [PMID: 35060784 DOI: 10.1177/1357633x211073256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Telerehabilitation has emerged in the last decade as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. METHODS The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients' quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale. RESULTS The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow-up (medium effect size: 0.66 SDs; p = 0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: -0.50 SDs; p = 0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). DISCUSSION The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e. anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level.
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Affiliation(s)
- Marta Mora-Traverso
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Rafael Prieto-Moreno
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Pablo Molina-Garcia
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Zeus Salas-Fariña
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
- Sport and Health University Research Institute (iMUDS), Universtity of Granada, Granada, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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15
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Simpkins C, Khalili SM, Yang F. Meta-Analysis-Based Comparison of Annual Fall Risk between Older Adults with Alzheimer's Disease and Mild Cognitive Impairment. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240002. [PMID: 38725433 PMCID: PMC11081206 DOI: 10.20900/agmr20240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Background Falls are a primary cause of injuries and hospitalization in older adults. It has been reported that cognitive impairments and dementia can increase fall risk in the older population; however, it remains unknown if fall risk differs among subgroups of dementia. This meta-analysis summarized previous studies reporting the annual fall risk of people with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and compared the fall risk between these two groups of people with dementia. Methods Thirty-five studies enrolling 7844 older adults with AD or MCI were included. The annual fall prevalence and average number of falls of the included studies were meta-analyzed and compared by random-effects models with inverse variance weights. Results The annual fall prevalence in people with AD (43.55%) was significantly higher than MCI (35.26%, p < 0.001). A χ2 test indicated that the pooled fall prevalence is significantly higher in people with AD than MCI χ2 = 158.403, p < 0.001). Additionally, the yearly average number of falls in AD was higher than in MCI (1.30 vs 0.77 falls/person). Conclusions The results showed that older people with AD experience a higher annual fall prevalence with a larger number of falls than older adults with MCI. The results suggested that the fall risk measurements should be reported separately between people with AD and MCI. The findings could provide preliminary guidance for the identification of individuals with dementia who experience a high fall risk.
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Affiliation(s)
- Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
- These authors contributed equally
| | - Sara Mahmoudzadeh Khalili
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
- These authors contributed equally
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
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16
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Kossowska M, Olejniczak S, Karbowiak M, Mosiej W, Zielińska D, Brzezicka A. The Interplay between Gut Microbiota and Cognitive Functioning in the Healthy Aging Population: A Systematic Review. Nutrients 2024; 16:852. [PMID: 38542764 PMCID: PMC10974508 DOI: 10.3390/nu16060852] [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: 02/12/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The gut microbiota in healthy older individuals typically show a decrease in beneficial bacteria like Bifidobacterium and Lactobacillus, alongside an increase in pro-inflammatory microbes such as Enterobacteriaceae and Clostridia. These changes contrast with younger and middle-aged individuals and appear to correlate with cognitive status. Although there is extensive research on gut microbiota and cognitive functions in cognitively impaired elderly individuals, its impact on cognitively healthy elderly populations has not been extensively studied. METHOD A comprehensive literature search was conducted across PubMed, EBSCO, Web of Science, and Scopus databases to identify studies exploring the relationship between gut microbiota composition and cognitive functioning in healthy older adults. During the literature screening process, each record was initially assessed by its title, abstract, and keywords to exclude articles that did not align with the scope of this review. Three authors independently screened and retrieved the records. The inclusion criteria included: (1) publication in peer-reviewed journals; (2) studies involving neurologically, cognitively, and medically healthy populations; (3) participants identified as older adults, defined for this review as individuals aged 45 years and older due to the limited number of records; (4) analysis of gut microbiota; and (5) assessment of cognitive function. Subsequently, full texts were analyzed to determine eligibility. The exclusion criteria encompassed: (1) incorrect publication type; (2) inappropriate sample population; (3) unsuitable study design; (4) absence of one or more inclusion criteria; and (5) studies based on animal research. A risk of bias assessment was performed for each included study using the Joanna Briggs Institute (JBI) checklist, ensuring all selected studies met established quality standards. RESULTS A total of 6 eligible research articles from a possible 1752 published until March 2024 were identified and included. We categorized the included studies into two groups based on their focus: the taxonomic composition of gut microbiota and the alpha diversity, which is the variety of organisms within a sample. Additionally, two methods were identified for assessing cognition: neuropsychological tests and physiological measurements, notably electroencephalography (EEG). The studies show varying results regarding the abundance of specific bacterial taxa and their cognitive associations. Notably, the relationship between certain bacteria and cognition may vary when analyzed at different taxonomic levels, such as phylum versus family. CONCLUSIONS Changes in gut microbiota composition in the elderly, even without a cognitive impairment diagnosis, could potentially serve as early biological markers for Alzheimer's disease or other dementias before mild cognitive impairment appears.
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Affiliation(s)
- Maria Kossowska
- Institute of Psychology, SWPS University, 03-815 Warsaw, Poland; (M.K.); (S.O.)
| | - Sylwia Olejniczak
- Institute of Psychology, SWPS University, 03-815 Warsaw, Poland; (M.K.); (S.O.)
| | - Marcelina Karbowiak
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159c, 02-776 Warsaw, Poland; (M.K.); (W.M.); (D.Z.)
| | - Wioletta Mosiej
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159c, 02-776 Warsaw, Poland; (M.K.); (W.M.); (D.Z.)
| | - Dorota Zielińska
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159c, 02-776 Warsaw, Poland; (M.K.); (W.M.); (D.Z.)
| | - Aneta Brzezicka
- Institute of Psychology, SWPS University, 03-815 Warsaw, Poland; (M.K.); (S.O.)
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Padrela B, Mahroo A, Tee M, Sneve MH, Moyaert P, Geier O, Kuijer JPA, Beun S, Nordhøy W, Zhu YD, Buck MA, Hoinkiss DC, Konstandin S, Huber J, Wiersinga J, Rikken R, de Leeuw D, Grydeland H, Tippett L, Cawston EE, Ozturk-Isik E, Linn J, Brandt M, Tijms BM, van de Giessen EM, Muller M, Fjell A, Walhovd K, Bjørnerud A, Pålhaugen L, Selnes P, Clement P, Achten E, Anazodo U, Barkhof F, Hilal S, Fladby T, Eickel K, Morgan C, Thomas DL, Petr J, Günther M, Mutsaerts HJMM. Developing blood-brain barrier arterial spin labelling as a non-invasive early biomarker of Alzheimer's disease (DEBBIE-AD): a prospective observational multicohort study protocol. BMJ Open 2024; 14:e081635. [PMID: 38458785 DOI: 10.1136/bmjopen-2023-081635] [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] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Loss of blood-brain barrier (BBB) integrity is hypothesised to be one of the earliest microvascular signs of Alzheimer's disease (AD). Existing BBB integrity imaging methods involve contrast agents or ionising radiation, and pose limitations in terms of cost and logistics. Arterial spin labelling (ASL) perfusion MRI has been recently adapted to map the BBB permeability non-invasively. The DEveloping BBB-ASL as a non-Invasive Early biomarker (DEBBIE) consortium aims to develop this modified ASL-MRI technique for patient-specific and robust BBB permeability assessments. This article outlines the study design of the DEBBIE cohorts focused on investigating the potential of BBB-ASL as an early biomarker for AD (DEBBIE-AD). METHODS AND ANALYSIS DEBBIE-AD consists of a multicohort study enrolling participants with subjective cognitive decline, mild cognitive impairment and AD, as well as age-matched healthy controls, from 13 cohorts. The precision and accuracy of BBB-ASL will be evaluated in healthy participants. The clinical value of BBB-ASL will be evaluated by comparing results with both established and novel AD biomarkers. The DEBBIE-AD study aims to provide evidence of the ability of BBB-ASL to measure BBB permeability and demonstrate its utility in AD and AD-related pathologies. ETHICS AND DISSEMINATION Ethics approval was obtained for 10 cohorts, and is pending for 3 cohorts. The results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Beatriz Padrela
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Amnah Mahroo
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Mervin Tee
- National University Health System, Singapore
| | - Markus H Sneve
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
| | - Paulien Moyaert
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Diagnostic Sciences, University Hospital Ghent, Gent, Belgium
| | - Oliver Geier
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Joost P A Kuijer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Soetkin Beun
- Department of Diagnostic Sciences, University Hospital Ghent, Gent, Belgium
| | - Wibeke Nordhøy
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Yufei David Zhu
- Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Mareike A Buck
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- University of Bremen, Bremen, Germany
| | | | - Simon Konstandin
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Jörn Huber
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Julia Wiersinga
- Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Roos Rikken
- Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | | | - Håkon Grydeland
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
| | - Lynette Tippett
- The University of Auckland School of Psychology, Auckland, New Zealand
| | - Erin E Cawston
- The University of Auckland Department of Pharmacology and Clinical Pharmacology, Auckland, New Zealand
| | - Esin Ozturk-Isik
- Bogazici University Institute of Biomedical Engineering, Istanbul, Turkey
| | - Jennifer Linn
- Department of Neurology, Faculty of Medicine, Babylon, Iraq
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Moritz Brandt
- Department of Neurology, Faculty of Medicine, Babylon, Iraq
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Betty M Tijms
- Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | | | - Majon Muller
- Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Anders Fjell
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Kristine Walhovd
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Atle Bjørnerud
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Lene Pålhaugen
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
- University of Oslo, Oslo, Norway
| | - Per Selnes
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Patricia Clement
- Department of Diagnostic Sciences, University Hospital Ghent, Gent, Belgium
| | - Eric Achten
- Department of Diagnostic Sciences, University Hospital Ghent, Gent, Belgium
| | - Udunna Anazodo
- Lawson Health Research Institute, London, Ontario, Canada
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
- University College London, London, UK
| | - Saima Hilal
- National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
- University of Oslo, Oslo, Norway
| | - Klaus Eickel
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- University of Applied Sciences Bremerhaven, Bremerhaven, Germany
| | - Catherine Morgan
- The University of Auckland School of Psychology, Auckland, New Zealand
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, University College London, London, UK
| | - Jan Petr
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Matthias Günther
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- University of Bremen, Bremen, Germany
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
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18
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Tu L, Lv X, Yuan C, Chen H, Yu X, Wang H, Zhang Q. Sex differences in cognitive function trajectories and their determinants in older adults: Evidence from the Chinese longitudinal healthy longevity survey. Int J Geriatr Psychiatry 2024; 39:e6072. [PMID: 38488836 DOI: 10.1002/gps.6072] [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: 08/24/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To examine sex differences in the cognitive trajectories of a nationally representative sample of older people living in China and to explore potential determinants of these trajectories. METHODS The study included 2230 women and 2171 men who were cognitively healthy and aged over 60 at the first observation from the Chinese Longitudinal Healthy Longevity Survey based on the 2008-2018 cohort. Cognitive function was measured using the Chinese version of the Mini-Mental State Examination (MMSE). Group-based trajectory modeling was used to identify potential heterogeneity of longitudinal changes over the 10 years in each gender. Logistic regression was used to investigate associations between baseline characteristics (age, education, fertility history, sleep length, physical activity, and health status and behaviors) and trajectory classes. RESULTS Three trajectories (labeled stable, slow decline, and rapid decline) were identified according to the changes in MMSE scores for both women and men. For the women, both the slow and rapid decline groups accounted for a larger proportion (14.7% and 11.0%, respectively) than the male decline groups (8.1% and 6.6%, respectively), and the women had a lower baseline MMSE score with a faster decline. In the multivariable logistic regression analyses, older age, less education, older age at first birth, poorer functional abilities, hearing impairment, and lower baseline MMSE scores were significantly associated with cognitive decline in both the female and male groups compared to the stable group. For the women, sleeping over 9 h was also associated with a rapid cognitive decline trajectory, while current exercise and being overweight/obese were protective factors against cognitive decline. CONCLUSIONS The women had an overall more serious cognitive decline than men. The potential determinants of cognitive decline identified in this study could be considered for developing specific intervention strategies aimed at promoting a healthy brain and preventing cognitive decline in different sexes, especially in low-income and developing countries.
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Affiliation(s)
- Lihui Tu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiaozhen Lv
- Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hui Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xin Yu
- Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Huali Wang
- Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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19
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Yang Y, Yan Z, Chang W, Ding J, Xu H. Effect of different modalities of transcranial magnetic stimulation on Parkinson's patients cognitive impairment and long-term effectiveness: a systematic review and network meta-analysis. Front Neurosci 2024; 18:1354864. [PMID: 38495111 PMCID: PMC10940328 DOI: 10.3389/fnins.2024.1354864] [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: 12/13/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Objective This study used network Meta-analysis to compare the effects of different transcranial magnetic stimulation (TMS) modalities on the effectiveness and long-term validity of improving cognitive function in Parkinson's patients. Methods Computer searches of the Cochrane Library, PubMed, Web of Science, Embass, CNKI and Wanfang Data were conducted to collect randomized controlled clinical studies on TMS to improve cognitive function in Parkinson's patients published from the time of library construction to December 2023. Results A total of 22 studies and 1,473 patients were included, comprising 5 interventions: high frequency repetitive transcranial magnetic stimulation (HF-rTMS), low frequency repetitive transcranial magnetic stimulation (LF-rTMS), intermittent theta burst stimulation (iTBS), sham stimulation and conventional rehabilitation therapy (CRT). Network Meta-analysis showed that the ranking results of different TMS intervention modalities in terms of MoCA scores were: HF-rTMS > LF-rTMS > iTBS > sham > CRT, the ranking results of different TMS intervention modalities in terms of MMSE scores were: HF-rTMS > LF-rTMS > sham > CRT. The effect of TMS on improving Parkinsonian cognitive function lasted for 1 month compared to the no-stimulation group. Conclusion TMS has some long-term sustained effects on improving cognitive function in Parkinson's patients. HF-rTMS is more effective in improving cognitive function in Parkinson's patients.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023463958.
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Affiliation(s)
- Yulin Yang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhenyang Yan
- Weifang Hospital of Traditional Chinese Medicine, Weifang, China
| | - Wanpeng Chang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiangtao Ding
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongli Xu
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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20
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Rajendrakumar AL, Arbeev KG, Bagley O, Yashin AI, Ukraintseva S. The SNP rs6859 in NECTIN2 gene is associated with underlying heterogeneous trajectories of cognitive changes in older adults. BMC Neurol 2024; 24:78. [PMID: 38408961 PMCID: PMC10898142 DOI: 10.1186/s12883-024-03577-4] [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: 09/05/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Functional decline associated with dementia, including in Alzheimer's disease (AD), is not uniform across individuals, and respective heterogeneity is not yet fully explained. Such heterogeneity may in part be related to genetic variability among individuals. In this study, we investigated whether the SNP rs6859 in nectin cell adhesion molecule 2 (NECTIN2) gene (a major risk factor for AD) influences trajectories of cognitive decline in older participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI). METHODS We retrospectively analyzed records on 1310 participants from the ADNI database for the multivariate analysis. We used longitudinal measures of Mini-Mental State Examination (MMSE) scores in participants, who were cognitively normal, or having AD, or other cognitive deficits to investigate the trajectories of cognitive changes. Multiple linear regression, linear mixed models and latent class analyses were conducted to investigate the association of the SNP rs6859 with MMSE. RESULTS The regression coefficient per one allele dose of the SNP rs6859 was independently associated with MMSE in both cross-sectional (-2.23, p < 0.01) and linear mixed models (-2.26, p < 0.01) analyses. The latent class model with three distinct subgroups (class 1: stable and gradual decline, class 2: intermediate and late decline, and class 3: lowest and irregular) performed best in the posterior classification, 42.67% (n = 559), 21.45% (n = 281), 35.88% (n = 470) were classified as class 1, class 2, and class 3. In the heterogeneous linear mixed model, the regression coefficient per one allele dose of rs6859 - A risk allele was significantly associated with MMSE class 1 and class 2 memberships and related decline; Class 1 (-2.28, 95% CI: -4.05, -0.50, p < 0.05), Class 2 (-5.56, 95% CI: -9.61, -1.51, p < 0.01) and Class 3 (-0.37, 95% CI: -1.62, 0.87, p = 0.55). CONCLUSIONS This study found statistical evidence supporting the classification of three latent subclass groups representing complex MMSE trajectories in the ADNI cohort. The SNP rs6859 can be suggested as a candidate genetic predictor of variation in modeling MMSE trajectory, as well as for identifying latent classes with higher baseline MMSE. Functional studies may help further elucidate this relationship.
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Affiliation(s)
- Aravind Lathika Rajendrakumar
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, 27708-0408, USA
| | - Konstantin G Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, 27708-0408, USA.
| | - Olivia Bagley
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, 27708-0408, USA
| | - Anatoliy I Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, 27708-0408, USA
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, 27708-0408, USA
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21
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Lee A, Shah S, Atha K, Indoe P, Mahmoud N, Niblett G, Pradhan V, Roberts N, Malouf RS, Topiwala A. Brain health measurement: a scoping review. BMJ Open 2024; 14:e080334. [PMID: 38341202 PMCID: PMC10862273 DOI: 10.1136/bmjopen-2023-080334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Preservation of brain health is an urgent priority for the world's ageing population. The evidence base for brain health optimisation strategies is rapidly expanding, but clear recommendations have been limited by heterogeneity in measurement of brain health outcomes. We performed a scoping review to systematically evaluate brain health measurement in the scientific literature to date, informing development of a core outcome set. DESIGN Scoping review. DATA SOURCES Medline, APA PsycArticles and Embase were searched through until 25 January 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they described brain health evaluation methods in sufficient detail in human adults and were in English language. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data using Covidence software. RESULTS From 6987 articles identified by the search, 727 studies met inclusion criteria. Study publication increased by 22 times in the last decade. Cohort study was the most common study design (n=609, 84%). 479 unique methods of measuring brain health were identified, comprising imaging, cognitive, mental health, biological and clinical categories. Seven of the top 10 most frequently used brain health measurement methods were imaging based, including structural imaging of grey matter and hippocampal volumes and white matter hyperintensities. Cognitive tests such as the trail making test accounted for 286 (59.7%) of all brain health measurement methods. CONCLUSIONS The scientific literature surrounding brain health has increased exponentially, yet measurement methods are highly heterogeneous across studies which may explain the lack of clinical translation. Future studies should aim to develop a selected group of measures that should be included in all brain health studies to aid interstudy comparison (core outcome set), and broaden from the current focus on neuroimaging outcomes to include a range of outcomes.
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Affiliation(s)
- Angeline Lee
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Peter Indoe
- Health Education Thames Valley (HETV), Oxford, UK
| | | | - Guy Niblett
- Health Education Thames Valley (HETV), Oxford, UK
| | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Reem Saleem Malouf
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Oxford, UK
| | - Anya Topiwala
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Ciesla M, Pobst J, Gomes-Osman J, Lamar M, Barnes LL, Banks R, Jannati A, Libon D, Swenson R, Tobyne S, Bates D, Showalter J, Pascual-Leone A. Estimating dementia risk in an African American population using the DCTclock. Front Aging Neurosci 2024; 15:1328333. [PMID: 38274984 PMCID: PMC10810014 DOI: 10.3389/fnagi.2023.1328333] [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: 10/26/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The prevalence of Alzheimer's disease (AD) and related dementias (ADRD) is increasing. African Americans are twice as likely to develop dementia than other ethnic populations. Traditional cognitive screening solutions lack the sensitivity to independently identify individuals at risk for cognitive decline. The DCTclock is a 3-min AI-enabled adaptation of the well-established clock drawing test. The DCTclock can estimate dementia risk for both general cognitive impairment and the presence of AD pathology. Here we performed a retrospective analysis to assess the performance of the DCTclock to estimate future conversion to ADRD in African American participants from the Rush Alzheimer's Disease Research Center Minority Aging Research Study (MARS) and African American Clinical Core (AACORE). We assessed baseline DCTclock scores in 646 participants (baseline median age = 78.0 ± 6.4, median years of education = 14.0 ± 3.2, 78% female) and found significantly lower baseline DCTclock scores in those who received a dementia diagnosis within 3 years. We also found that 16.4% of participants with a baseline DCTclock score less than 60 were significantly more likely to develop dementia in 5 years vs. those with the highest DCTclock scores (75-100). This research demonstrates the DCTclock's ability to estimate the 5-year risk of developing dementia in an African American population. Early detection of elevated dementia risk using the DCTclock could provide patients, caregivers, and clinicians opportunities to plan and intervene early to improve cognitive health trajectories. Early detection of dementia risk can also enhance participant selection in clinical trials while reducing screening costs.
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Affiliation(s)
| | | | - Joyce Gomes-Osman
- Linus Health, Boston, MA, United States
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Russell Banks
- Linus Health, Boston, MA, United States
- Department of Communicative Sciences and Disorders, College of Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - Ali Jannati
- Linus Health, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - David Libon
- Linus Health, Boston, MA, United States
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States
| | - Rodney Swenson
- Linus Health, Boston, MA, United States
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | | | | | | | - Alvaro Pascual-Leone
- Linus Health, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
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23
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Yondjo J, Siette J. "VR is the future": perspectives of healthcare professionals on virtual reality as a diagnostic tool for dementia status in primary care. BMC Med Inform Decis Mak 2024; 24:9. [PMID: 38178165 PMCID: PMC10765843 DOI: 10.1186/s12911-023-02413-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Healthcare professionals (HPs) hold critical perspectives on the barriers and facilitating factors for the implementation of virtual reality (VR) dementia diagnosis tools in the clinical setting. This study aims to explore HP perspectives regarding the clinical implementation of dementia diagnosis tools using VR platforms. METHODS An exploratory qualitative interview study was carried out between July and September 2022. In-depth semi-structured interviews were conducted with HPs (n = 7) with clinical expertise in dementia diagnoses drawn from medicine, nursing and allied health practices. A hermeneutic phenomenological approach was used to frame the interview data across the dementia diagnosis pathway and application of new technology. RESULTS HPs were on average 36.29 years old (SD = 11.56) with 11.85 years of experience (SD = 12.80, range:4-42). Analyses identified three main themes related to the contemporary methods of dementia diagnosis, dementia diagnosis and the medical landscape and HP perspectives on the usefulness and barriers of VR implementation. VR was considered an innovative prospect, with improved ecological validity compared to commonplace, current cognitive assessments. Concerns of time commitments, monetary costs and the validity of the new technology were identified as key barriers to implementation. Overall, implementation of a new diagnostic tool was considered a complex process. CONCLUSIONS Our insight into general practice and nursing clinics can be supported to embed and integrate virtual reality platforms in primary care settings. Primary healthcare organizations require more funding and time related resources to produce a context in which VR tools could be implemented in a beneficial manner.
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Affiliation(s)
- Joshua Yondjo
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia.
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24
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Wang S, Wong LLN. An Exploration of the Memory Performance in Older Adult Hearing Aid Users on the Integrated Digit-in-Noise Test. Trends Hear 2024; 28:23312165241253653. [PMID: 38715401 PMCID: PMC11080745 DOI: 10.1177/23312165241253653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
This study aimed to preliminarily investigate the associations between performance on the integrated Digit-in-Noise Test (iDIN) and performance on measures of general cognition and working memory (WM). The study recruited 81 older adult hearing aid users between 60 and 95 years of age with bilateral moderate to severe hearing loss. The Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) was used to screen older adults for mild cognitive impairment. Speech reception thresholds (SRTs) were measured using 2- to 5-digit sequences of the Mandarin iDIN. The differences in SRT between five-digit and two-digit sequences (SRT5-2), and between five-digit and three-digit sequences (SRT5-3), were used as indicators of memory performance. The results were compared to those from the Digit Span Test and Corsi Blocks Tapping Test, which evaluate WM and attention capacity. SRT5-2 and SRT5-3 demonstrated significant correlations with the three cognitive function tests (rs ranging from -.705 to -.528). Furthermore, SRT5-2 and SRT5-3 were significantly higher in participants who failed the MoCA-BC screening compared to those who passed. The findings show associations between performance on the iDIN and performance on memory tests. However, further validation and exploration are needed to fully establish its effectiveness and efficacy.
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Affiliation(s)
- Shangqiguo Wang
- Unit of Human Communication, Development, and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, SAR, China
| | - Lena L. N. Wong
- Unit of Human Communication, Development, and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, SAR, China
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25
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Flyborg J, Renvert S, Anderberg P, Larsson T, Sanmartin-Berglund J. Results of objective brushing data recorded from a powered toothbrush used by elderly individuals with mild cognitive impairment related to values for oral health. Clin Oral Investig 2023; 28:8. [PMID: 38123762 PMCID: PMC10733217 DOI: 10.1007/s00784-023-05407-2] [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: 07/15/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The study aimed to investigate how the objective use of a powered toothbrush in frequency and duration affects plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm in elderly individuals with MCI. A second aim was to compare the objective results with the participants' self-estimated brush use. MATERIALS AND METHODS Objective brush usage data was extracted from the participants' powered toothbrushes and related to the oral health variables plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm. Furthermore, the objective usage data was compared with the participants' self-reported brush usage reported in a questionnaire at baseline and 6- and 12-month examination. RESULTS Out of a screened sample of 213 individuals, 170 fulfilled the 12-month visit. The principal findings are that despite the objective values registered for frequency and duration being lower than the recommended and less than the instructed, using powered toothbrushes after instruction and information led to improved values for PI, BOP, and PPD ≥ 4 mm in the group of elderly with MIC. CONCLUSIONS Despite lower brush frequency and duration than the generally recommended, using a powered toothbrush improved oral health. The objective brush data recorded from the powered toothbrush correlates poorly with the self-estimated brush use. CLINICAL RELEVANCE Using objective brush data can become one of the factors in the collaboration to preserve and improve oral health in older people with mild cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05941611, retrospectively registered 11/07/2023.
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Affiliation(s)
- Johan Flyborg
- Department of Health, Blekinge Institute of Technology, 37179, Karlskrona, Sweden.
| | - Stefan Renvert
- Department of Health, Blekinge Institute of Technology, 37179, Karlskrona, Sweden
- Faculty of Health Sciences, Kristianstad University, 29188, Kristianstad, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, 37179, Karlskrona, Sweden
- School of Health Sciences, University of Skövde, 54128, Skövde, Sweden
| | - Tobias Larsson
- Department of Health, Blekinge Institute of Technology, 37179, Karlskrona, Sweden
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Brito DVC, Esteves F, Rajado AT, Silva N, Araújo I, Bragança J, Castelo-Branco P, Nóbrega C. Assessing cognitive decline in the aging brain: lessons from rodent and human studies. NPJ AGING 2023; 9:23. [PMID: 37857723 PMCID: PMC10587123 DOI: 10.1038/s41514-023-00120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
As life expectancy continues to increase worldwide, age-related dysfunction will largely impact our societies in the future. Aging is well established to promote the deterioration of cognitive function and is the primary risk factor for the development of prevalent neurological disorders. Even in the absence of dementia, age-related cognitive decline impacts specific types of memories and brain structures in humans and animal models. Despite this, preclinical and clinical studies that investigate age-related changes in brain physiology often use largely different methods, which hinders the translational potential of findings. This review seeks to integrate what is known about age-related changes in the brain with analogue cognitive tests used in humans and rodent studies, ranging from "pen and paper" tests to virtual-reality-based paradigms. Finally, we draw parallels between the behavior paradigms used in research compared to the enrollment into clinical trials that aim to study age-related cognitive decline.
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Affiliation(s)
- D V C Brito
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - F Esteves
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - A T Rajado
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - N Silva
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - I Araújo
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - J Bragança
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - P Castelo-Branco
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - C Nóbrega
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal.
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal.
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal.
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal.
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Yao X, Yang G, Fang T, Tian Z, Lu Y, Chen F, Che P, Chen J, Zhang N. Brain-derived neurotrophic factor gene polymorphism affects cognitive function and neurofilament light chain level in patients with subcortical ischaemic vascular dementia. Front Aging Neurosci 2023; 15:1244191. [PMID: 37876876 PMCID: PMC10590892 DOI: 10.3389/fnagi.2023.1244191] [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: 06/22/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Objective To investigate the effects of brain-derived neurotrophic factor (BDNF) gene polymorphism on cognitive function, neuroimaging and blood biological markers in patients with subcortical ischaemic vascular dementia (SIVD). Methods A total of 81 patients with SIVD were included. According to their BDNF gene polymorphism, the participants were divided into the Val/Val (n = 26), Val/Met (n = 35), and Met/Met (n = 20) groups. A comprehensive neuropsychological evaluation and multimodal brain MRI scan were performed. MRI markers for small vessel disease were visually rated or quantitatively analysed. Moreover, 52 patients were further evaluated with blood marker assays, including amyloid beta (Aβ), phosphorylated tau at threonine-181 (P-tau181), glial fibrillary acidic protein (GFAP), total tau (T-tau) and neurofilament light chain (NfL). Results There were no significant differences in demographics, disease duration or MRI markers of small vessel disease between the three groups. Compared with the Val/Val and Val/Met groups, the Met/Met group showed worse performance in the verbal fluency test and higher levels of plasma NfL. Conclusion The rs6265 polymorphism of the BDNF gene is associated with semantic language fluency in patients with SIVD. The Met genotype may be a risk factor for cognitive impairment and neuronal injury.
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Affiliation(s)
- Xiaojuan Yao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Guotao Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Tingting Fang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhuo Tian
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yunyao Lu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Feifan Chen
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ping Che
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingshan Chen
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Nan Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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Pittara M, Matsangidou M, Pattichis CS. Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review. JMIR Rehabil Assist Technol 2023; 10:e47114. [PMID: 37782529 PMCID: PMC10580136 DOI: 10.2196/47114] [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: 03/09/2023] [Revised: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is a vital component of comprehensive care for patients with respiratory conditions, such as lung cancer, chronic obstructive pulmonary disease, and asthma, and those recovering from respiratory diseases like COVID-19. It aims to enhance patients' functional ability and quality of life, and reduce symptoms, such as stress, anxiety, and chronic pain. Virtual reality is a novel technology that offers new opportunities for customized implementation and self-control of pulmonary rehabilitation through patient engagement. OBJECTIVE This review focused on all types of virtual reality technologies (nonimmersive, semi-immersive, and fully immersive) that witnessed significant development and were released in the field of pulmonary rehabilitation, including breathing exercises, biofeedback systems, virtual environments for exercise, and educational models. METHODS The review screened 7 electronic libraries from 2010 to 2023. The libraries were ACM Digital Library, Google Scholar, IEEE Xplore, MEDLINE, PubMed, Sage, and ScienceDirect. Thematic analysis was used as an additional methodology to classify our findings based on themes. The themes were virtual reality training, interaction, types of virtual environments, effectiveness, feasibility, design strategies, limitations, and future directions. RESULTS A total of 2319 articles were identified, and after a detailed screening process, 32 studies were reviewed. Based on the findings of all the studies that were reviewed (29 with a positive label and 3 with a neutral label), virtual reality can be an effective solution for pulmonary rehabilitation in patients with lung cancer, chronic obstructive pulmonary disease, and asthma, and in individuals and children who are dealing with mental health-related disorders, such as anxiety. The outcomes indicated that virtual reality is a reliable and feasible solution for pulmonary rehabilitation. Interventions can provide immersive experiences to patients and offer tailored and engaging rehabilitation that promotes improved functional outcomes of pulmonary rehabilitation, breathing body awareness, and relaxation breathing techniques. CONCLUSIONS The identified studies on virtual reality in pulmonary rehabilitation showed that virtual reality holds great promise for improving the outcomes and experiences of patients. The immersive and interactive nature of virtual reality interventions offers a new dimension to traditional rehabilitation approaches, providing personalized exercises and addressing psychological well-being. However, additional research is needed to establish standardized protocols, identify the most effective strategies, and evaluate long-term benefits. As virtual reality technology continues to advance, it has the potential to revolutionize pulmonary rehabilitation and significantly improve the lives of patients with chronic lung diseases.
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Affiliation(s)
- Melpo Pittara
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, Groningen, Netherlands
| | | | - Constantinos S Pattichis
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus
- Biomedical Engineering Research Centre, University of Cyprus, Nicosia, Cyprus
- HealthXR Smart, Ubiquitous, and Participatory Technologies for Healthcare Innovation, CYENS-Centre of Excellence, Nicosia, Cyprus
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Li S, Chen X, Gao M, Zhang X, Han P, Cao L, Gao J, Tao Q, Zhai J, Liang D, Guo Q. The neutrophil-to-lymphocyte ratio is associated with mild cognitive impairment in community-dwelling older women aged over 70 years: a population-based cross-sectional study. Front Aging Neurosci 2023; 15:1261026. [PMID: 37781103 PMCID: PMC10539551 DOI: 10.3389/fnagi.2023.1261026] [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: 07/18/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation that can be obtained quickly, conveniently, and cheaply from blood samples. However, there is no research to explore the effects of sex and age on the relationship between the NLR and mild cognitive impairment (MCI) in community-dwelling older adults. Methods A total of 3,126 individuals aged over 60 years in Shanghai were recruited for face-to-face interviews, and blood samples were collected. MCI was assessed by the Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale, and neutrophil count and lymphocyte counts were measured in fasting blood samples. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Results In females, the NLR in the MCI group was significantly higher than that in the cognitively normal group (2.13 ± 0.94 vs. 1.85 ± 0.83, p < 0.001) but not in men. Logistic regression showed that a higher NLR was an independent risk factor for MCI in women [odds ratio (OR) = 1.33; 95% confidence interval (CI) = 1.14-1.55]. In addition, the elevated NLR quartile was associated with an increased risk of MCI, especially in women older than 70 years (p value for trend = 0.012). Conclusion Compared with males, female MCI patients had a significantly higher NLR than cognitively normal controls. In addition, elevated NLR was found to be significantly associated with MCI risk in women older than 70 years. Therefore, elderly Chinese women with a higher NLR value may be the target population for effective prevention of MCI.
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Affiliation(s)
- Shengjie Li
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- School of Sports and Health, Tianjin University of Sport, Tianjin, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Mengze Gao
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- School of Sports and Health, Tianjin University of Sport, Tianjin, China
| | - Xingyu Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- School of Sports and Health, Tianjin University of Sport, Tianjin, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Liou Cao
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Gao
- General Practice Clinic, Pujiang Community Health Service Center in Minhang District, Shanghai, China
| | - Qiongying Tao
- Jiading Subdistrict Community Health Center, Shanghai, China
| | - Jiayi Zhai
- Jiading Subdistrict Community Health Center, Shanghai, China
| | - Dongyu Liang
- Clinical Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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Das SS, Gopal PM, Thomas JV, Mohan MC, Thomas SC, Maliakel BP, Krishnakumar IM, Pulikkaparambil Sasidharan BC. Influence of CurQfen ®-curcumin on cognitive impairment: a randomized, double-blinded, placebo-controlled, 3-arm, 3-sequence comparative study. FRONTIERS IN DEMENTIA 2023; 2:1222708. [PMID: 39081970 PMCID: PMC11285547 DOI: 10.3389/frdem.2023.1222708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2024]
Abstract
Background Although curcumin is a blood-brain-barrier permeable molecule with the ability to bind and segregate β-amyloid plaques and neurofibrillary tangles of hyperphosphorylated tau proteins, its poor oral bioavailability, rapid biotransformation to inactive metabolites, fast elimination from the systemic circulation, and hence the poor neuronal uptake has been limiting its clinical efficacy under neurodegenerative conditions. Objective We hypothesized that the highly bioavailable CurQfen-curcumin (CGM), which has been shown to possess significant blood-brain-barrier permeability and brain bioavailability, would ameliorate dementia in neurodegenerative conditions. Methods In the present double-blinded placebo-controlled 3-arm 3-sequence comparative study, 48 subjects characterized with moderate dementia due to the onset of Alzheimer's disease were randomized into three groups (N = 16/group) and supplemented with 400 mg × 2/day of either placebo (MCC), unformulated standard curcumin complex with 95% purity (USC), or CGM as a sachet for six months. The relative changes in cognitive and locomotor functions and biochemical markers were compared. Results Supplementation with CGM produced significant (P < 0.05) improvement in the Mini-Mental State Examination (MMSE) and the Geriatric Locomotive Function Scale (GLFS) scores in both intra- and inter-group comparison by 2 × 2 repeated measures (RM) ANOVA. Further, analysis of the serum levels of specific biomarkers (BDNF, Aβ42, tau protein, IL-6, and TNF-α) also revealed a significant (P < 0.05) improvement among CGM subjects as compared to placebo and the USC groups. Conclusion Supplementation with CGM as sachet was found to offer significant delay in the progress of Alzheimer's disease, as evident from the improvements in locomotive and cognitive functions related to dementia. Clinical trial registration http://ctri.nic.in, identifier: CTRI/2018/03/012410.
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Affiliation(s)
- S. Syam Das
- Akay Natural Ingredients, Kochi, Kerala, India
| | - Prasad M. Gopal
- Alzheimer's and Related Disorders Society of India, Kochi, Kerala, India
- Centre for Neuroscience, Cochin University of Science and Technology, Kochi, Kerala, India
| | - Jestin V. Thomas
- Leads Clinical Research & Bio Services Private Limited, Bengaluru, India
| | - Mohind C. Mohan
- Centre for Neuroscience, Cochin University of Science and Technology, Kochi, Kerala, India
- Department of Biotechnology, Cochin University of Science and Technology, Kochi, Kerala, India
| | - Siju C. Thomas
- Alzheimer's and Related Disorders Society of India, Kochi, Kerala, India
| | | | | | - Baby Chakrapani Pulikkaparambil Sasidharan
- Centre for Neuroscience, Cochin University of Science and Technology, Kochi, Kerala, India
- Department of Biotechnology, Cochin University of Science and Technology, Kochi, Kerala, India
- Centre for Excellence in Neurodegeneration and Brain Health, Kochi, Kerala, India
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Dai Y, Yu-Chun H, Fernandes BS, Zhang K, Xiaoyang L, Enduru N, Liu A, Manuel AM, Jiang X, Zhao Z. Disentangling accelerated cognitive decline from the normal aging process and unraveling its genetic components: A neuroimaging-based deep learning approach. RESEARCH SQUARE 2023:rs.3.rs-3328861. [PMID: 37720047 PMCID: PMC10503860 DOI: 10.21203/rs.3.rs-3328861/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background The progressive cognitive decline that is an integral component of AD unfolds in tandem with the natural aging process. Neuroimaging features have demonstrated the capacity to distinguish cognitive decline changes stemming from typical brain aging and Alzheimer's disease between different chronological points. Methods We developed a deep-learning framework based on dual-loss Siamese ResNet network to extract fine-grained information from the longitudinal structural magnetic resonance imaging (MRI) data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. We then conducted genome-wide association studies (GWAS) and post-GWAS analyses to reveal the genetic basis of AD-related accelerated cognitive decline. Results We used our model to process data from 1,313 individuals, training it on 414 cognitively normal people and predicting cognitive assessment for all participants. In our analysis of accelerated cognitive decline GWAS, we identified two genome-wide significant loci: APOE locus (chromosome 19 p13.32) and rs144614292 (chromosome 11 p15.1). Variant rs144614292 (G>T) has not been reported in previous AD GWA studies. It is within the intronic region of NELL1, which is expressed in neuron and plays a role in controlling cell growth and differentiation. In addition, MUC7 and PROL1/OPRPNon chromosome 4 were significant at the gene level. The cell-type-specific enrichment analysis and functional enrichment of GWAS signals highlighted the microglia and immune-response pathways. Furthermore, we found that the cognitive decline slope GWAS was positively correlated with previous AD GWAS. Conclusion Our deep learning model was demonstrated effective on extracting relevant neuroimaging features and predicting individual cognitive decline. We reported a novel variant (rs144614292) within the NELL1 gene. Our approach has the potential to disentangle accelerated cognitive decline from the normal aging process and to determine its related genetic factors, leveraging opportunities for early intervention.
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Affiliation(s)
- Yulin Dai
- The University of Texas Health Science Center at Houston
| | - Hsu Yu-Chun
- The University of Texas Health Science Center at Houston
| | | | - Kai Zhang
- The University of Texas Health Science Center at Houston
| | - Li Xiaoyang
- The University of Texas Health Science Center at Houston
| | - Nitesh Enduru
- The University of Texas Health Science Center at Houston
| | - Andi Liu
- The University of Texas Health Science Center at Houston
| | | | - Xiaoqian Jiang
- The University of Texas Health Science Center at Houston
| | - Zhongming Zhao
- The University of Texas Health Science Center at Houston
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Doan DNT, Kim K, Ku B, Lee KH, Kim JU. Reduced body cell mass and functions in lower extremities are associated with mild cognitive impairment and Alzheimer's dementia. Sci Rep 2023; 13:13389. [PMID: 37591966 PMCID: PMC10435546 DOI: 10.1038/s41598-023-39110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
This study examined the alterations of segmental body composition in individuals with Alzheimer's pathology (AD), including mild cognitive impairment (MCI) and dementia. A multifrequency bioimpedance analysis (BIA) was used to provide segmental water and impedance variables from 365 cognitively normal (CN), 123 MCI due to AD, and 30 AD dementia participants. We compared the BIA variables between the three groups, examined their correlations with neuropsychological screening test scores, and illustrate their 95% confidence RXc graphs. AD dementia participants were older, more depressive, and had worse cognitive abilities than MCI due to AD and CN participants. Although the BIA variables showed weak partial correlations with the cognitive test scores, we found patterns of an increasing water content in lean mass, increasing extra to intracellular water ratio, and decreasing reactance and phase angle in the lower extremities with effect sizes ranging from 0.26 to 0.51 in the groups of MCI and dementia due to AD compared with CN individuals. The RXc graphs upheld the findings with a significant displacement downward and toward the right, dominantly in the lower extremities. Individuals with AD pathology exhibit a reduced body cell mass or cell strength, an abnormal cellular water distribution, and an overhydration status in lean mass, especially in the lower extremities.
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Affiliation(s)
- Dieu Ni Thi Doan
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- School of Korean Convergence Medical Science, University of Science and Technology, Daejeon, South Korea
| | - Kahye Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Boncho Ku
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Kun Ho Lee
- Gwangju Alzheimer's Disease and Related Dementias (GARD) Cohort Research Center, Chosun University, Gwangju, South Korea
- Department of Biomedical Science, Chosun University, Gwangju, South Korea
- Dementia Research Group, Korea Brain Research Institute, Daegu, South Korea
| | - Jaeuk U Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.
- School of Korean Convergence Medical Science, University of Science and Technology, Daejeon, South Korea.
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Yu J, Lu SR, Wang Z, Yang Y, Zhang BS, Xu Q, Kan H. Role of comprehensive geriatric assessment in screening for mild cognitive disorders. World J Psychiatry 2023; 13:478-485. [PMID: 37547738 PMCID: PMC10401506 DOI: 10.5498/wjp.v13.i7.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The role of comprehensive geriatric assessment (CGA) in screening for mild cognitive disorders was not known.
AIM To evaluate the role of CGA in screening for mild cognitive disorders.
METHODS A total of 100 elderly people who underwent health examinations in our hospital and community between January 2020 and December 2021 were included for analysis. Using Petersen as the diagnostic gold standard, healthy individuals were included in the control group and patients with mild cognitive impairment were assigned to the study group. The correlation between the cognitive function of the patients and their baseline clinical profiles was analyzed. Patients' Montreal Cognitive Assessment (MoCA) and CGA screening results were compared, and the sensitivity and specificity were calculated to assess the screening role of CGA.
RESULTS CGA assessment yielded higher diagnostic accuracy than MoCA. The results of the multivariate regression analysis showed no correlation of gender, age, body mass index and literacy with cognitive function. Patients with mild cognitive impairment obtained significantly lower MoCA scores than healthy individuals (P < 0.05). In the CGA scale, patients with mild cognitive impairment showed significantly lower Mini-mental State Examination, Miniature Nutritional Assessment and Berg Balance Scale scores, and higher Activity of Daily Living, Instrumental Activities of Daily Living Scale and Frailty Screening Inventory scores than healthy individuals (P < 0.05), whereas the other assessment scales showed no significant differences (P > 0.05). The CGA provides higher diagnostic sensitivity and specificity than the MoCA (P < 0.05).
CONCLUSION CGA allows accurate identification of mild cognitive impairment with high sensitivity and specificity, facilitating timely and effective intervention, and is thus recommended for clinical use.
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Affiliation(s)
- Jie Yu
- Department of Geriatrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Shou-Rong Lu
- Department of Geriatrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Zhuo Wang
- Department of Geriatrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Yin Yang
- Department of Geriatrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Bin-Shan Zhang
- Department of Geriatrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Qiao Xu
- Department of Geriatrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
| | - Hong Kan
- Department of Geriatrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
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Zwart L, Germans T, Vogels R, Simsek S, Hemels M, Jansen R. Frail patients who fall and their risk on major bleeding and intracranial haemorrhage. Outcomes from the Fall and Syncope Registry. BMC Geriatr 2023; 23:422. [PMID: 37430207 DOI: 10.1186/s12877-023-04120-9] [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: 09/17/2022] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Major bleeding, and intracranial bleeding specifically, are severe complications related to the use of anticoagulation. To what extent the risk for major bleeding is elevated among frail older people is not well known because they are underrepresented in the randomized clinical trials (RCTs). This study investigates the risk for major bleeding (MB) and intra cranial haemorrhage (ICH) in frail older people who fall. METHODS All patients 65 years and older visiting the Fall and Syncope Clinic, between November 2011 and January 2020, and underwent a MRI of the brain were eligible. Frailty was assessed with a Frailty Index, based on the accumulation of deficits model. Cerebral small vessel disease was described and evaluated as proposed in the position paper of Wardlaw and colleagues in 2013. RESULTS 479 patients were included in this analysis. Mean follow-up was 7 years per patient (ranging from 1 month to 8 years and 5 months). 368 patients (77%) were frail. A total of 81 patients used oral anticoagulation (OAC). 17 extracranial MB of which 3 were traumatic and 14 gastrointestinal, and 16 ICH occurred. There was a total of 603.4 treatment years with OAC, and 8 MBs occurred among patients on OAC (bleeding rate 1.32 per 100 treatment years), of which 2 ICHs (bleeding rate 0.33 per 100 treatment years). The risk for extracranial MB was increased by the use of antiplatelet agents (APA) (adjusted OR 6.9, CI 95% 1.2-38.3), and by the use of OAC (adjusted OR 9.8, CI 95% 1.7-56.1). The risk for ICH was only heightened by white matter hyperintensities (WMH) (adjusted OR 3.8, CI 95% 1.0-13.4). The use of APA (adjusted OR 0.9, CI 95% 0.3-3.3) or OAC (adjusted OR 0.6, CI 95% 0.1-3.3) did not elevate the risk for ICH. CONCLUSION In contrast to common belief, frail patients on OAC with repeated falls show a comparable bleeding rate as in the large RCTs, and the use of OAC did not increase the risk for ICH. However, the number of MBs was low, and of ICHs very low, despite extensive follow-up in this registry.
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Affiliation(s)
- Lar Zwart
- Department of Geriatric Medicine, Northwest Clinics, Alkmaar, The Netherlands.
- Aging and Public Health department, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
- Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands.
| | - T Germans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R Vogels
- Department of Neurology, Northwest Clinics, Alkmaar, The Netherlands
| | - S Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
- Department of Internal Medicine/Endocrinology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Mew Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rwmm Jansen
- Department of Geriatric Medicine, Northwest Clinics, Alkmaar, The Netherlands
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Pillai JA, Bena J, Maly EF, Leverenz JB. Initial non-amnestic symptoms relate to faster rate of functional and cognitive decline compared to amnestic symptoms in neuropathologically confirmed dementias. Alzheimers Dement 2023; 19:2956-2965. [PMID: 36648159 PMCID: PMC10350479 DOI: 10.1002/alz.12922] [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: 09/20/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The relationship between initial cognitive symptoms and subsequent rate of clinical decline is important in clinical care and the design of dementia clinical trials. METHODS This retrospective longitudinal, autopsy-confirmed, cohort study among 2426 participants in the National Alzheimer's Coordinating Center database included Alzheimer's disease (AD) pathology, n = 1187; Lewy body pathology (LBP), n = 331; and mixed pathology (AD-LBP), n = 904. The predominant initial cognitive symptom was assessed clinically. Linear mixed models evaluated the longitudinal outcome of the Clinical Dementia Rating-Sum of Boxes (CDR-SB) score. RESULTS Non-amnestic initial symptoms had a faster rate of decline than amnestic symptoms in all three groups. Language symptoms had a faster rate of decline in all three groups. Executive symptoms had a faster rate of decline than amnestic in AD and AD-LBP. There was a similar trend for visuospatial symptoms in AD-LBP. DISCUSSION Initial cognitive symptoms, despite varied underlying pathology, are a predictor of longitudinal functional outcomes among dementias. HIGHLIGHTS Initial non-amnestic symptoms had a faster rate of longitudinal cognitive and functional decline on the Clinical Dementia Rating-Sum of Boxes (CDR-SB) scores than amnestic symptoms among Alzheimer's disease, Lewy body pathology, and mixed neuropathology. Given the relative size of CDR-SB changes in Alzheimer's disease clinical trials, clarifying the nature of initial symptoms could be an important variable in ensuring appropriately designed clinical trials.
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Affiliation(s)
- Jagan A Pillai
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH 44195
- Neurological Institute ,Cleveland Clinic, Cleveland, OH 44195
- Department of Neurology, Cleveland Clinic, Cleveland, OH 44195
| | - James Bena
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195
| | - Emily F Maly
- Department of Neurology, Cleveland Clinic, Cleveland, OH 44195
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH 44195
- Neurological Institute ,Cleveland Clinic, Cleveland, OH 44195
- Department of Neurology, Cleveland Clinic, Cleveland, OH 44195
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Zhang J, Jia D, Li W, Li X, Ma Q, Chen X. General anesthesia with S-ketamine improves the early recovery and cognitive function in patients undergoing modified radical mastectomy: a prospective randomized controlled trial. BMC Anesthesiol 2023; 23:214. [PMID: 37340359 DOI: 10.1186/s12871-023-02161-6] [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: 01/12/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common postoperative disorder that is frequently observed after general anesthesia, which seriously threatens the quality of patients' life. Existing studies have demonstrated that S-ketamine plays an important role in improving neuroinflammation. This trial aimed to explore the effects of S-ketamine on quality of recovery and cognitive function in patients following modified radical mastectomy (MRM). METHODS Ninety patients aged 45 to 70 years with ASA grades of I or II, who underwent MRM, were selected. Patients were randomly assigned to the S-ketamine or control group. In the S-ketamine group, patients were induced with S-ketamine instead of sufentanil and maintained with S-ketamine and remifentanil. In the control group, patients were induced with sufentanil and maintained with remifentanil. The primary outcome was the Mini-Mental State Examination (MMSE) and Quality of Recovery-15 (QoR-15) score. Secondary outcomes including visual analog scale (VAS) score, cumulative propofol and opioids consumption, post anesthesia care unit (PACU) recovery time, occurrence of remedial analgesia, postoperative nausea and vomiting (PONV), other adverse events, as well as patient satisfaction. RESULTS The global QoR-15 scores at postoperative day 1 (POD1) were significantly higher in the S-ketamine group than in the control group (124 [119.5-128.0] vs. 119 [114.0-123.5], P = 0.002), with a median difference of 5 points (95% confidence interval [CI] [-8 to -2]). Similarly, the global QoR-15 scores at postoperative day 2 (POD2) in the S-ketamine group were significantly higher than in the control group (140.0 [133.0-145.0] vs. 132.0 [126.5-141.5], P = 0.004). In addition, among the five subcomponents of the 15-item scale, S-ketamine group had a higher score in terms of physical comfort, pain, and emotional state both at POD1 and POD2. In terms of MMSE score, S-ketamine could promote the recovery of postoperative cognitive function at POD1, but not at POD2. Furthermore, the consumption of opioids, VAS score, and remedial analgesia in the S-ketamine group decreased significantly. CONCLUSIONS Collectively, our findings support that general anesthesia with S-ketamine as a potential strategy showed high safety and could not only improve the quality of recovery mainly through improving pain, physical comfort, and emotional state but also promote the recovery of cognitive function on POD1 in patients undergoing MRM. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (registration No:ChiCTR2200057226, Date of registration: 04/03/2022).
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Affiliation(s)
- Junxia Zhang
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Danting Jia
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Wenbin Li
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Xiaohui Li
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Qian Ma
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Xuexin Chen
- Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China.
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Wang Q, Zhou S, Zhang J, Wang Q, Hou F, Han X, Shen G, Zhang Y. Risk assessment and stratification of mild cognitive impairment among the Chinese elderly: attention to modifiable risk factors. J Epidemiol Community Health 2023:jech-2022-219952. [PMID: 37321832 DOI: 10.1136/jech-2022-219952] [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: 10/14/2022] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The early identification of individuals at risk of mild cognitive impairment (MCI) has major public health implications for Alzheimer's disease prevention. OBJECTIVE This study aims to develop and validate a risk assessment tool for MCI with a focus on modifiable factors and a suggested risk stratification strategy. METHODS Modifiable risk factors were selected from recent reviews, and risk scores were obtained from the literature or calculated based on the Rothman-Keller model. Simulated data of 10 000 subjects with the exposure rates of the selected factors were generated, and the risk stratifications were determined by the theoretical incidences of MCI. The performance of the tool was verified using cross-sectional and longitudinal datasets from a population-based Chinese elderly cohort. RESULTS Nine modifiable risk factors (social isolation, less education, hypertension, hyperlipidaemia, diabetes, smoking, drinking, physical inactivity and depression) were selected for the predictive model. The area under the curve (AUC) was 0.71 in the training set and 0.72 in the validation set for the cross-sectional dataset. The AUCs were 0.70 and 0.64 in the training and validation sets, respectively, for the longitudinal dataset. A combined risk score of 0.95 and 1.86 was used as the threshold to categorise MCI risk as 'low', 'moderate' and 'high'. CONCLUSION A risk assessment tool for MCI with appropriate accuracy was developed in this study, and risk stratification thresholds were also suggested. The tool might have significant public health implications for the primary prevention of MCI in elderly individuals in China.
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Affiliation(s)
- Qiong Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Shuai Zhou
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Jingya Zhang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Qing Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Fangfang Hou
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Xiao Han
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Guodong Shen
- Department of Geriatrics, University of Science and Technology of China, Hefei, Anhui, China
| | - Yan Zhang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
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Chad Chew EY, Prem P, Jasmine K, Nav V, Arthi B. Comparison of DBFS with MoCA and MMSE tools for MCI screening. Bioinformation 2023; 19:522-524. [PMID: 37886151 PMCID: PMC10599673 DOI: 10.6026/97320630019522] [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: 05/01/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 10/28/2023] Open
Abstract
Mild cognitive impairment (MCI) has been associated with many diseases. The MCI could be a marker for the early diagnosis of certain diseases. Early detection of MCI could be beneficial for restoration of cognitive reserves. One hundred and five subjects were included in the study, underwent the Digital Brain Function Screen (DBFS) test as well as the Montreal Cognitive Assessment (MoCA) test and 73 subjects took the Mini-Mental State Examination (MMSE) test. DBFS test and retest was taken by 16 subjects. The test scores of DBFS tool showed significant positive correlation with MoCA and MMSE test scores. In conclusion, the DBFS tool could be an effective digital tool which can overcome the disadvantages of traditional tools of screening MCI like MoCA and MMSE.
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Affiliation(s)
| | - Pillay Prem
- Neurowyzr Pte. Ltd., 6 Raffles Quay, 11-07, Singapore-048580
| | - Kuah Jasmine
- Neurowyzr Pte. Ltd., 6 Raffles Quay, 11-07, Singapore-048580
| | - Vij Nav
- Neurowyzr Pte. Ltd., 6 Raffles Quay, 11-07, Singapore-048580
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Ganhão-Arranhado S, Poínhos R, Pinhão S. Determinants of Nutritional Risk among Community-Dwelling Older Adults with Social Support. Nutrients 2023; 15:nu15112506. [PMID: 37299469 DOI: 10.3390/nu15112506] [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: 04/28/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND It is well established that older adults are at risk for malnutrition due to several social and non-social determinants, namely physiological, psychosocial, dietary and environmental determinants. The progression to malnutrition is often insidious and undetected. Thus, nutritional assessment should consider a complex web of factors that can impact nutritional status (NS). The primary objective of this study was to assess the NS of older adults attending senior centres (SCs) and to identify its predictors. METHODS This cross-sectional study enrolled a sample of community-dwelling older adults in Lisbon. NS was assessed using Mini Nutritional Assessment (MNA®). Malnutrition or malnutrition risk (recategorised into a single group) was predicted using binary logistic regression models, considering those participants classified as having a normal NS as the reference group. Data were collected through face-to-face interviews and anthropometric indices were measured according to Isak procedures. RESULTS A sample of 337 older adults, with an average age of 78.4 years old (range 66-99), mostly women (n = 210; 62.3%), were enrolled. Older adults at risk of malnutrition accounted for 40.7% of the sample. Being older (OR = 1.045, CI 95% [1.003-1.089], p = 0.037), having a worse perception of health status (OR = 3.395, CI 95% [1.182-9.746], p = 0.023), having or having had depression (OR = 5.138, CI 95% [2.869-9.201], p < 0.001), and not having or having had respiratory tract problems (OR = 0.477, CI 95% [0.246-0.925], p = 0.028) were independent predictors of malnutrition or malnutrition risk. An intermediate time of SC attendance was associated with a lower probability of malnutrition or risk (OR = 0.367, CI 95% [0.191-0.705], p = 0.003). CONCLUSIONS NS among older adults has a multifactorial aetiology, with a strongly social component and is related to health circumstances. Further research is needed to timely identify and understand nutritional risk among this population.
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Affiliation(s)
- Susana Ganhão-Arranhado
- CINTESIS, Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
- Atlântica, Instituto Universitário, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
| | - Rui Poínhos
- Faculty of Nutrition and Food Sciences, Universidade do Porto, 4150-180 Porto, Portugal
| | - Sílvia Pinhão
- Faculty of Nutrition and Food Sciences, Universidade do Porto, 4150-180 Porto, Portugal
- Serviço de Nutrição do Centro Hospitalar Universitário de São João, E.P.E, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Puaschitz NGS, Jacobsen FF, Berge LI, Husebo BS. Access to, use of, and experiences with social alarms in home-living people with dementia: results from the LIVE@Home.Path trial. Front Aging Neurosci 2023; 15:1167616. [PMID: 37284020 PMCID: PMC10239917 DOI: 10.3389/fnagi.2023.1167616] [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: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Abstract
Background Social alarms are considered an appropriate technology to ensure the safety and independence of older adults, but limited research has been conducted on their actual use. We, therefore, explored the access, experiences, and use of social alarms among home-bound people with dementia and their informal caregivers (dyads). Methods From May 2019 to October 2021, the LIVE@Home.Path mixed-method intervention trial collected data from semi-quantitative questionnaires and qualitative interviews conducted among home-dwelling people with dementia and their informal caregivers in Norway. The study focused on data from the final assessment at 24 months. Results A total of 278 dyads were included, and 82 participants reached the final assessment. The mean age of the patients was 83 years; 74.6% were female; 50% lived alone; and 58% had their child as a caregiver. A total of 62.2% of subjects had access to a social alarm. Caregivers were more likely to answer that the device was not in use (23.6%) compared to patients (14%). Qualitative data revealed that approximately 50% of the patients were not aware of having such an alarm. Regression analyses assessed that access to a social alarm was associated with increasing age (86-97 years, p = 0.005) and living alone (p < 0.001). Compared to their caregivers, people with dementia were more likely to answer that the device gave them a false sense of security (28% vs. 9.9%), while caregivers were more likely to answer that the social alarm was of no value (31.4% vs.14.0%). The number of social alarms installed increased from 39.5% at baseline to 68% at 24 months. The frequency of unused social alarms increased from 12 months (17.7%) to 24 months (23.5%), and patients were less likely to feel safe during this period (60.8% vs. 70%). Conclusion Depending on their living situation, patients and family members experienced the installed social alarm differently. There is a gap between access to and the use of social alarms. The results indicate an urgent need for better routines in municipalities with regard to the provision and follow-up of existing social alarms. To meet the users' changing needs and abilities, passive monitoring may help them adapt to declining cognitive abilities and increase their safety.Clinical Trial Registration: https://ClinicalTrials.gov, NCT04043364.
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Affiliation(s)
- Nathalie Genevieve Søyland Puaschitz
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, Center for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| | - Frode Fadnes Jacobsen
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| | - Line Iden Berge
- Department of Global Public Health and Primary Care, Faculty of Medicine, Center for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Norske Kvinners Sanitetsforening (NKS) Olaviken Gerontopsychiatric Hospital, Askøy, Norway
| | - Bettina Sandgathe Husebo
- Department of Global Public Health and Primary Care, Faculty of Medicine, Center for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
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Castano CR, Lee LD, Huang HJ. Speeding up: Discrete mediolateral perturbations increased self-paced walking speed in young and older adults. Gait Posture 2023; 102:198-204. [PMID: 37043989 DOI: 10.1016/j.gaitpost.2023.04.003] [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: 10/24/2022] [Revised: 02/16/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND In uncertain environments and with increasing age, humans often walk, slower while taking shorter, quicker, and wider steps, reflective of a cautious gait., Understanding when humans opt to use a cautious gait and the differences in gait, strategies used as people age could be examined with perturbations on a self-paced, treadmill that allows participants to adjust their walking speed. Adding varying degrees, of unpredictability, an inherent element of real-world walking, could also improve, understanding of when specific gait strategies are used RESEARCH QUESTION: We investigated how healthy young and older adults adjust their, gait strategies when responding to perturbations of varying unpredictability. We, hypothesized that more unpredictable perturbations would produce more cautious gait, strategies and be more pronounced in older adults than young adults METHODS: Ten young and ten older adults walked on a self-paced treadmill with, discrete mediolateral treadmill shift perturbations. We changed the shift magnitude, and/or the timing of the perturbations during the gait cycle to vary perturbation, unpredictability. We analyzed walking speed and step kinematics from treadmill and, motion capture data RESULTS: Surprisingly, participants walked faster, not slower, for the conditions with, perturbations. Even more surprising, older adults walked faster overall than young, adults. As expected, participants took faster and wider steps for the most unpredictable, perturbation but also took longer steps, which was not expected. Step kinematic, variability and average step width also increased as perturbation unpredictability, increased, suggesting that the more unpredictable conditions demanded greater, balance control. Additionally, older adults had greater step kinematic variability, highlighted further using detrended step length variability, compared to young adults SIGNIFICANCE: Overall, these findings provide new insights about gait strategies and, suggest that perturbations such as discrete mediolateral treadmill shifts can potentially, be designed to encourage participants to walk faster, if it is beneficial.
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Affiliation(s)
- Cesar R Castano
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States.
| | - Lindsey D Lee
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
| | - Helen J Huang
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States; Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, United States; BiionixTM (Bionic Materials, Implants & Interfaces) Cluster, University of Central Florida, Orlando, FL, United States
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Li Y, Chen J, Yu H, Ye J, Wang C, Kong L. Serum brain-derived neurotrophic factor as diagnosis clue for Alzheimer's disease: A cross-sectional observational study in the elderly. Front Psychiatry 2023; 14:1127658. [PMID: 37009109 PMCID: PMC10060560 DOI: 10.3389/fpsyt.2023.1127658] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveBrain-derived neurotrophic factor (BDNF) has not been validated as a diagnostic marker for Alzheimer's disease (AD). To provide a different perspective, this study aimed to evaluate the relationship between serum levels of mature BDNF (mBDNF) and precursor BDNF (proBDNF) in AD and to investigate whether serum BDNF levels or the ratio of mBDNF levels to proBDNF levels (M/P) could be a valuable biomarker for determining the risk of AD in elderly individuals.MethodA total of 126 subjects who met the inclusion criteria were assigned to either the AD group (n = 62) or the healthy control group (HC, n = 64) in this cross-sectional observationl study. Serum levels of mBDNF and proBDNF were measured using enzyme immunoassay kits. We analyzed the Mini-Mental State Examination (MMSE) scores from the two groups and examined the associations between AD and BDNF metabolism.ResultsThe serum concentration of proBDNF was significantly higher in ADs (4140.937 pg/ml) than in HCs (2606.943 pg/ml; p < 0.01). The MMSE significantly correlated with proBDNF (p < 0.01, r = −0.686) and M/P (p < 0.01, r = 0.595) in all subjects. To determine the risk for AD, the area under the receiver operating characteristic curve was calculated, which was 0.896 (95% confidence interval 0.844–0.949) for proBDNF and 0.901 (95% 0.850–0.953) for proBDNF and M/P combined.ConclusionWe observed a correlation between low serum proBDNF levels and higher MMSE scores in AD. The most effective diagnostic strategy was the combination of proBDNF and M/P, whereas mBDNF levels performed poorly when we evaluated the predictive model.
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Affiliation(s)
- Yuanyuan Li
- Medical Department, Qingdao University, Qingdao, China
| | - Jiao Chen
- Department of Geriatric Psychiatry, Qingdao Mental Health Center, Qingdao, Shandong, China
| | - Hui Yu
- Department of Geriatric Psychiatry, Qingdao Mental Health Center, Qingdao, Shandong, China
| | - Jiayu Ye
- School of Mental Health, Jining Medical University, Jining, Shandong, China
| | - Chunxia Wang
- Department of Geriatric Psychiatry, Qingdao Mental Health Center, Qingdao, Shandong, China
- *Correspondence: Chunxia Wang
| | - Lingli Kong
- Department of Geriatric Psychiatry, Qingdao Mental Health Center, Qingdao, Shandong, China
- Lingli Kong
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Roy A, Choudhury S, Banerjee R, Basu P, Mondal B, Sarkar S, Anand SS, Dey S, Kumar H. Dietary and Environmental Risk Factors in Parkinson's and Alzheimer's Disease: A Semi-Quantitative Pilot Study. Ann Indian Acad Neurol 2023; 26:174-181. [PMID: 37179670 PMCID: PMC10171008 DOI: 10.4103/aian.aian_823_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Environmental influence and dietary variations are well-known risk factors for various diseases including neurodegenerative disorders. Preliminary evidence suggests that diet in early-life and living environment might influence the incidence of Parkinson's disease (PD) in later phase of life. There have been limited epidemiologic studies on this aspect especially in India. In this hospital-based case-control study, we intended to identify dietary and environmental risk factors of PD. Methods Patients with PD (n = 105), Alzheimer's disease (AD) (n = 53) and healthy individuals (n = 81) were recruited. Dietary intake and environmental exposures were assessed using a validated Food-Frequency and Environmental Hazard Questionnaire. Their demographic details and living environment were also recorded using the same questionnaire. Results Pre-morbid consumption of carbohydrate and fat was significantly higher whereas dietary fiber and fruit content was significantly lesser in PD as compared to AD and healthy age-matched controls. Meat and milk intake was the highest among all the food groups in PD patients. Rural living and their habitation near water bodies were significantly more frequent in PD patients. Conclusion We found that past intake of carbohydrate, fat, milk, and meat are associated with increased risk of PD. On the other hand, rural living and habitat near water bodies might be associated with incidence and severity of PD. Hence, preventive strategies related to dietary and environmental modulators in PD might be clinically useful in the future.
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Affiliation(s)
- Akash Roy
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
| | - Supriyo Choudhury
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Rebecca Banerjee
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Purba Basu
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Banashree Mondal
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Swagata Sarkar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Sidharth Shankar Anand
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Sanjit Dey
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
- UGC Centre for Nanoscience and Nanotechnology and UGC Centre with Potential for Excellence in Particular Area (CPEPA), University of Calcutta, Kolkata, West Bengal, India
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
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Fearn-Smith EM, Scanlan JN, Hancock N. Exploring and Mapping Screening Tools for Cognitive Impairment and Traumatic Brain Injury in the Homelessness Context: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3440. [PMID: 36834133 PMCID: PMC9966671 DOI: 10.3390/ijerph20043440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.
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Affiliation(s)
- Erin M. Fearn-Smith
- Faculty of Medicine and Health, Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2050, Australia
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Matsangidou M, Solomou T, Frangoudes F, Ioannou K, Theofanous P, Papayianni E, Pattichis CS. Affective Out-World Experience via Virtual Reality for Older Adults Living with Mild Cognitive Impairments or Mild Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2919. [PMID: 36833616 PMCID: PMC9957279 DOI: 10.3390/ijerph20042919] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Older adults with cognitive impairments may face barriers to accessing experiences beyond their physical premises. Previous research has suggested that missing out on emotional experiences may affect mental health and impact cognitive abilities. In recent years, there has been growing research interest in designing non-pharmacological interventions to improve the health-related quality of life of older adults. With virtual reality offering endless opportunities for health support, we must consider how virtual reality can be sensitively designed to provide comfortable, enriching out-world experiences to older adults to enhance their emotional regulation. Thirty older adults living with mild cognitive impairment or mild dementia participated in the study. Affect and emotional behavior were measured. The usability and the sense of presence were also assessed. Finally, we assessed the virtual reality experiences based on physiological responses and eye-tracking data. The results indicated that virtual reality can positively enhance the mental health of this population by eliciting a positive affective state and enhancing their emotional regulation. Overall, this paper raises awareness of the role of virtual reality in emotion elicitation, regulation, and expression and enhances our understanding of the use of virtual reality by older adults living with mild cognitive impairments or mild dementia.
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Affiliation(s)
| | - Theodoros Solomou
- Department of Computer Science, School of Natural & Applied Sciences, University of Cyprus, Nicosia 1678, Cyprus
| | | | - Konstantinos Ioannou
- Department of Computer Science, School of Natural & Applied Sciences, University of Cyprus, Nicosia 1678, Cyprus
| | - Panagiotis Theofanous
- Department of Computer Science, School of Natural & Applied Sciences, University of Cyprus, Nicosia 1678, Cyprus
| | - Ersi Papayianni
- Archangelos Michael Elderly People Nursing Home/Rehabilitation Centre for Patients with Alzheimer (AMEN), Nicosia 1022, Cyprus
| | - Constantinos S. Pattichis
- CYENS Center of Excellence, Nicosia 1016, Cyprus
- Department of Computer Science, School of Natural & Applied Sciences, University of Cyprus, Nicosia 1678, Cyprus
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Naharci MI, Kayahan Satis N, Ozsurekci C, Tasci I. Assessment of clinical features and coexisting geriatric syndromes in newly diagnosed dementia with Lewy bodies: a retrospective study in a tertiary geriatrics setting in Turkey. Eur Geriatr Med 2023; 14:19-27. [PMID: 36512254 DOI: 10.1007/s41999-022-00727-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Identifying the associated clinical conditions in patients with newly diagnosed dementia with Lewy bodies (DLB) may contribute to the disease management. This study aimed to examine the clinical features and coexisting geriatric syndromes of patients with newly diagnosed DLB. METHOD This cross-sectional study included newly diagnosed DLB participants who were admitted to a tertiary geriatric outpatient clinic. Of the 857 patients with dementia, 116 DLB diagnoses were eligible for analysis. The core and supportive clinical features of DLB were recorded. Geriatric syndromes including polypharmacy, depression, insomnia, dependency, a history of delirium, falls, malnutrition, urinary incontinence, functional impairment, and living alone, were assessed and recorded at baseline. RESULTS The mean age was 79.0 ± 6.9 years, and 50.9% of the participants were female. The majority (63.8%) had mild dementia, 31.9% had moderate, and 4.3% had severe disease. Cognitive fluctuations (78.4%), visual hallucinations (77.6%), and Parkinsonism (73.3%) were the most common clinical features. Functional impairment (59.5%) and urinary incontinence (59.5%) were the leading geriatric syndromes, followed by polypharmacy (56.9%), depressive symptoms (54.7%), falls (52.6%), insomnia (49.1%), malnutrition (24.3%), and delirium (6.0%). Women had more functional impairment and depressive symptoms than men. CONCLUSION Although most patients had mild dementia, three-quarters of the DLB cohort had hallucinations, and nearly two-thirds were functionally impaired. The proportion of other serious health conditions also increased, indicating a high comorbidity and geriatric syndrome burden. Comprehensive geriatric assessment is strongly recommended for DLB patients from the time of diagnosis until death to reduce disability and comorbidities. THE CLINICAL TRIAL REGISTRATION NUMBER NCT05052450.
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Affiliation(s)
- Mehmet Ilkin Naharci
- Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, 06010, Ankara, Turkey
| | - Neslihan Kayahan Satis
- Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, 06010, Ankara, Turkey
| | - Cemile Ozsurekci
- Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Division of Geriatrics, University of Health Sciences, 06010, Ankara, Turkey.
| | - Ilker Tasci
- Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Internal Medicine, University of Health Sciences, 06010, Ankara, Turkey
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Bhattarai K, Das T, Kim Y, Chen Y, Dai Q, Li X, Jiang X, Zong N. Using Artificial Intelligence to Learn Optimal Regimen Plan for Alzheimer's Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.26.23285064. [PMID: 36747733 PMCID: PMC9901063 DOI: 10.1101/2023.01.26.23285064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Alzheimer's Disease (AD) is a progressive neurological disorder with no specific curative medications. While only a few medications are approved by FDA (i.e., donepezil, galantamine, rivastigmine, and memantine) to relieve symptoms (e.g., cognitive decline), sophisticated clinical skills are crucial to optimize the appropriate regimens given the multiple coexisting comorbidities in this patient population. Objective Here, we propose a study to leverage reinforcement learning (RL) to learn the clinicians' decisions for AD patients based on the longitude records from Electronic Health Records (EHR). Methods In this study, we withdraw 1,736 patients fulfilling our criteria, from the Alzheimer's Disease Neuroimaging Initiative(ADNI) database. We focused on the two most frequent concomitant diseases, depression, and hypertension, thus resulting in five main cohorts, 1) whole data, 2) AD-only, 3) AD-hypertension, 4) AD-depression, and 5) AD-hypertension-depression. We modeled the treatment learning into an RL problem by defining the three factors (i.e., states, action, and reward) in RL in multiple strategies, where a regression model and a decision tree are developed to generate states, six main medications extracted (i.e., no drugs, cholinesterase inhibitors, memantine, hypertension drugs, a combination of cholinesterase inhibitors and memantine, and supplements or other drugs) are for action, and Mini-Mental State Exam (MMSE) scores are for reward. Results Given the proper dataset, the RL model can generate an optimal policy (regimen plan) that outperforms the clinician's treatment regimen. With the smallest data samples, the optimal-policy (i.e., policy iteration and Q-learning) gained a lesser reward than the clinician's policy (mean -2.68 and -2.76 vs . -2.66, respectively), but it gained more reward once the data size increased (mean -3.56 and -2.48 vs . -3.57, respectively). Conclusions Our results highlight the potential of using RL to generate the optimal treatment based on the patients' longitude records. Our work can lead the path toward the development of RL-based decision support systems which could facilitate the daily practice to manage Alzheimer's disease with comorbidities.
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Affiliation(s)
- Kritib Bhattarai
- Department of Computer Science, Luther College Decorah, IA, United States
| | - Trisha Das
- Department of Computer Science, University of Illinois Urbana-Champaign Champaign, Champaign, IL, United States
| | - Yejin Kim
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, United States
| | | | - Qiying Dai
- Mayo Clinic Rochester, MN, United States
| | | | - Xiaoqian Jiang
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, United States
| | - Nansu Zong
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, United States
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Ho SYC, Chien TW, Lin ML, Tsai KT. An app for predicting patient dementia classes using convolutional neural networks (CNN) and artificial neural networks (ANN): Comparison of prediction accuracy in Microsoft Excel. Medicine (Baltimore) 2023; 102:e32670. [PMID: 36705387 PMCID: PMC9875960 DOI: 10.1097/md.0000000000032670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Dementia is a progressive disease that worsens over time as cognitive abilities deteriorate. Effective preventive interventions require early detection. However, there are no reports in the literature concerning apps that have been developed and designed to predict patient dementia classes (DCs). This study aimed to develop an app that could predict DC automatically and accurately for patients responding to the clinical dementia rating (CDR) instrument. METHODS A CDR was applied to 366 outpatients in a hospital in Taiwan, with assessments on 25 and 49 items endorsed by patients and family members, respectively. The 2 models of convolutional neural networks (CNN) and artificial neural networks (ANN) were applied to examine the prediction accuracy based on 5 classes (i.e., no cognitive decline, very mild, mild, moderate, and severe) in 4 scenarios, consisting of 74 (items) in total, 25 in patients, 49 in family, and a combination strategy to select the best in the aforementioned scenarios using the forest plot. Using CDR scores in patients and their families on both axes, patients were dispersed on a radar plot. An app was developed to predict patient DC. RESULTS We found that ANN had higher accuracy rates than CNN with a ratio of 3:1 in the 4 scenarios. The highest accuracy rate (=93.72%) was shown in the combination scenario of ANN. A significant difference was observed between the CNN and ANN in terms of the accuracy rate. An available ANN-based app for predicting DC in patients was successfully developed and demonstrated in this study. CONCLUSION On the basis of a combination strategy and a decision rule, a 74-item ANN model with 285 estimated parameters was developed and included. The development of an app that will assist clinicians in predicting DC in clinical settings is required in the near future.
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Affiliation(s)
- Sam Yu-Chieh Ho
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Geriatrics and Gerontology, Chi Mei Medical Center, Tainan, Taiwan
| | - Tsair-Wei Chien
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Mei-Lien Lin
- Department of Examination Room, Chi Mei Medical Center, Tainan, Taiwan
| | - Kang-Ting Tsai
- Department of Geriatrics and Gerontology, Chi Mei Medical Center, Tainan, Taiwan
- Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan.*
- * Correspondence: Kang-Ting Tsai, Department of Geriatrics and Gerontology, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kung Dist., Tainan 710, Taiwan (e-mail: )
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Comparison of Cognitive Functions Between Patients with Alzheimer Disease, Patients with Mild Cognitive Impairment, and Healthy People. ARCHIVES OF NEUROSCIENCE 2023. [DOI: 10.5812/ans-131408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: There is a growing need for predicting Alzheimer disease (AD) based on emerging neurocognitive dysfunction before the onset of the disease. Objectives: According to neuropathological changes in the mesial temporal lobe (MTL) before the onset of clinical symptoms and the relationship between the function of these structures and cognitive functions (such as visual memory, working memory, and new learning), we aimed to investigate the possibility of these cognitive functions as markers of transition from mild cognitive impairment (MCI) to AD. Methods: In this case-control study, 15 patients with AD, 18 patients with MCI (from memory clinics of Tehran University of Medical Sciences), and 15 healthy people were compared using the 3 subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB), including spatial working memory (SWM), pattern recognition memory (PRM), and paired-associate learning (PAL). The tests were performed between 9 AM and 12 noon. The scores were compared by a 1-way analysis of variance (ANOVA). Results: The mean ages of AD, MCI, and healthy groups were 68.66, 68.22, and 64.26 years, respectively. In terms of the SWM test, in 2 of 3 variables, there were significant differences between the 3 groups (P = 0.000 and P = 0.001). Regarding the PRM test, there were significant differences between the 3 groups in accuracy and response time (P = 0.000 and P = 0.004, respectively). Regarding PAL, there were significant differences between the 3 groups in all 3 variables (P = 0.000). The Mini-mental State Examination (MMSE) scores were associated with almost all variable scores (P = 0.000). Conclusions: Dysfunction in new learning and recognition memory can be indicators of MCI and its progression to AD, whereas the assessment of SWM can only be used to assess the progression of MCI to AD.
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Jönsson L, Tate A, Frisell O, Wimo A. The Costs of Dementia in Europe: An Updated Review and Meta-analysis. PHARMACOECONOMICS 2023; 41:59-75. [PMID: 36376775 PMCID: PMC9813179 DOI: 10.1007/s40273-022-01212-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of dementia is increasing, while new opportunities for diagnosing, treating and possibly preventing Alzheimer's disease and other dementia disorders are placing focus on the need for accurate estimates of costs in dementia. Considerable methodological heterogeneity creates challenges for synthesising the existing literature. This study aimed to estimate the costs for persons with dementia in Europe, disaggregated into cost components and informative patient subgroups. METHODS We conducted an updated literature review searching PubMed, Embase and Web of Science for studies published from 2008 to July 2021 reporting empirically based cost estimates for persons with dementia in European countries. We excluded highly selective or otherwise biased reports, and used a random-effects meta-analysis to produce estimates of mean costs of care across five European regions. RESULTS Based on 113 studies from 17 European countries, the estimated mean costs for all patients by region were highest in the British Isles (73,712 EUR), followed by the Nordics (43,767 EUR), Southern (35,866 EUR), Western (38,249 EUR), and Eastern Europe and Baltics (7938 EUR). Costs increased with disease severity, and the distribution of costs over informal and formal care followed a North-South gradient with Southern Europe being most reliant on informal care. CONCLUSIONS To our knowledge, this study represents the most extensive meta-analysis of the cost for persons with dementia in Europe to date. Though there is considerable heterogeneity across studies, much of this is explained by identifiable factors. Further standardisation of methodology for capturing resource utilisation data may further improve comparability of future studies. The cost estimates presented here may be of value for cost-of-illness studies and economic evaluations of novel diagnostic technologies and therapies for Alzheimer's disease.
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Affiliation(s)
- Linus Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
| | - Ashley Tate
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Oskar Frisell
- Institute of Health Economics (IHE), Stockholm, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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