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Menegon F, De Marchi F, Aprile D, Zanelli I, Decaroli G, Comi C, Tondo G. From Mild Cognitive Impairment to Dementia: The Impact of Comorbid Conditions on Disease Conversion. Biomedicines 2024; 12:1675. [PMID: 39200140 PMCID: PMC11351954 DOI: 10.3390/biomedicines12081675] [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: 05/29/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
The conversion from mild cognitive impairment (MCI) to dementia is influenced by several factors, including comorbid conditions such as metabolic and vascular diseases. Understanding the impact of these comorbidities can help in the disease management of patients with a higher risk of progressing to dementia, improving outcomes. In the current study, we aimed to analyze data from a large cohort of MCI (n = 188) by principal component analysis (PCA) and cluster analysis (CA) to classify patients into distinct groups based on their comorbidity profile and to predict the risk of conversion to dementia. From our analysis, four clusters emerged. CA showed a significantly higher rate of disease progression for Cluster 1, which was predominantly characterized by extremely high obesity and diabetes compared to other clusters. In contrast, Cluster 3, which was defined by a lower prevalence of all comorbidities, had a lower conversion rate. Cluster 2, mainly including subjects with traumatic brain injuries, showed the lowest rate of conversion. Lastly, Cluster 4, including a high load of hearing loss and depression, showed an intermediate risk of conversion. This study underscores the significant impact of specific comorbidity profiles on the progression from MCI to dementia, highlighting the need for targeted interventions and management strategies for individuals with these comorbidity profiles to potentially delay or prevent the onset of dementia.
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Affiliation(s)
- Federico Menegon
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (F.M.); (F.D.M.); (D.A.); (I.Z.)
| | - Fabiola De Marchi
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (F.M.); (F.D.M.); (D.A.); (I.Z.)
| | - Davide Aprile
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (F.M.); (F.D.M.); (D.A.); (I.Z.)
| | - Iacopo Zanelli
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (F.M.); (F.D.M.); (D.A.); (I.Z.)
| | - Greta Decaroli
- Neurology Unit, Department of Translational Medicine, Sant’Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.D.); (C.C.)
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, Sant’Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.D.); (C.C.)
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, 28100 Novara, Italy
| | - Giacomo Tondo
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (F.M.); (F.D.M.); (D.A.); (I.Z.)
- Neurology Unit, Department of Translational Medicine, Sant’Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.D.); (C.C.)
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De Luca SN, Vlahos R. Targeting accelerated pulmonary ageing to treat chronic obstructive pulmonary disease-induced neuropathological comorbidities. Br J Pharmacol 2024; 181:3-20. [PMID: 37828646 PMCID: PMC10952708 DOI: 10.1111/bph.16263] [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: 07/26/2023] [Revised: 09/06/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major incurable health burden, ranking as the third leading cause of death worldwide, mainly driven by cigarette smoking. COPD is characterised by persistent airway inflammation, lung function decline and premature ageing with the presence of pulmonary senescent cells. This review proposes that cellular senescence, a state of stable cell cycle arrest linked to ageing, induced by inflammation and oxidative stress in COPD, extends beyond the lungs and affects the systemic circulation. This pulmonary senescent profile will reach other organs via extracellular vesicles contributing to brain inflammation and damage, and increasing the risk of neurological comorbidities, such as stroke, cerebral small vessel disease and Alzheimer's disease. The review explores the role of cellular senescence in COPD-associated brain conditions and investigates the relationship between cellular senescence and circadian rhythm in COPD. Additionally, it discusses potential therapies, including senomorphic and senolytic treatments, as novel strategies to halt or improve the progression of COPD.
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Affiliation(s)
- Simone N. De Luca
- Centre for Respiratory Science and Health, School of Health & Biomedical SciencesRMIT UniversityMelbourneVictoriaAustralia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical SciencesRMIT UniversityMelbourneVictoriaAustralia
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Wang M, Wang Y, Wang Z, Ren Q. The Abnormal Alternations of Brain Imaging in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review. J Alzheimers Dis Rep 2023; 7:901-919. [PMID: 37662615 PMCID: PMC10473125 DOI: 10.3233/adr-220083] [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: 10/12/2022] [Accepted: 07/11/2023] [Indexed: 09/05/2023] Open
Abstract
Background Cognitive impairment (CI) is an important extrapulmonary complication in patients with chronic obstructive pulmonary disease (COPD). Multimodal Neuroimaging Examination can display changes in brain structure and functions in patients with COPD. Objective The purpose of this systematic review is to provide an overview of the variations in brain imaging in patients with COPD and their potential relationship with CI. Furthermore, we aim to provide new ideas and directions for future research. Methods Literature searches were performed using the electronic databases PubMed, Scopus, and ScienceDirect. All articles published between January 2000 and November 2021 that met the eligibility criteria were included. Results Twenty of the 23 studies focused on changes in brain structure and function. Alterations in the brain's macrostructure are manifested in the bilateral frontal lobe, hippocampus, right temporal lobe, motor cortex, and supplementary motor area. The white matter microstructural changes initially appear in the bilateral frontal subcortical region. Regarding brain function, patients with COPD exhibited reduced frontal cerebral perfusion and abnormal alterations in intrinsic brain activity in the bilateral posterior cingulate cortex, precuneus, right lingual gyrus, and left anterior central gyrus. Currently, there is limited research related to brain networks. Conclusion CI in patients with COPD may present as a type of dementia different from Alzheimer's disease, which tends to manifest as frontal cognitive decline early in the disease. Further studies are required to clarify the neurobiological pathways of CI in patients with COPD from the perspective of brain connectomics based on the whole-brain system in the future.
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Affiliation(s)
- Mengxue Wang
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Nanjing, China
| | - Yanjuan Wang
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Nanjing, China
| | - Zan Wang
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Nanjing, China
| | - Qingguo Ren
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Nanjing, China
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Tondo G, Aprile D, De Marchi F, Sarasso B, Serra P, Borasio G, Rojo E, Arenillas JF, Comi C. Investigating the Prognostic Role of Peripheral Inflammatory Markers in Mild Cognitive Impairment. J Clin Med 2023; 12:4298. [PMID: 37445333 DOI: 10.3390/jcm12134298] [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: 06/09/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Growing evidence suggests that neuroinflammation plays a critical role in the pathogenesis of neurodegenerative diseases. Peripheral markers of inflammation, including blood cell counts and their ratios, such as the neutrophil-to-lymphocyte ratio (NLR), have been reported as an easily accessible and reliable proxy of central nervous system inflammation. However, the role of peripheral inflammation in dementia and Mild Cognitive Impairment (MCI) still needs to be clarified. In the current study, we aimed to assess the prognostic role of the NLR and other peripheral markers of inflammation in a sample of 130 amnestic MCI, followed up for two to five years. The Mini-Mental state examination (MMSE) score at baseline and follow-up visits was used to assess global cognitive status at each visit and the degree of cognitive decline over time. Baseline peripheral markers of inflammation included blood cell counts and ratios, specifically the NLR, the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), and the systemic immune inflammation index (SII). After classifying subjects into CONVERTERS and non-CONVERTERS (respectively, patients converting to dementia and subjects showing stability at the last available follow-up), we compared peripheral markers of inflammation among groups ed correlated them with cognitive measures, testing the ability of significant factors to predict conversion to dementia. In our cohort, CONVERTERS showed lower baseline MMSE scores (p-value = 0.004) than non-CONVERTERS. In addition, CONVERTERS had statistically elevated NLR (p-value = 0.005), PLR (p-value = 0.002), and SII levels (p-value = 0.015), besides a lower number of lymphocytes (p-value = 0.004) compared with non-CONVERTERS. In a logistic regression analysis, baseline MMSE scores and NLR predicted conversion to dementia. Tertiles analysis showed that MCI with the highest NLR values had a higher conversion risk. Our study supports the hypothesis that a dysregulation of peripheral inflammation involving both lymphocytes and neutrophils may play a role in the pathogenesis of dementia, even at the early stages of neurodegeneration, as in the MCI condition.
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Affiliation(s)
- Giacomo Tondo
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Davide Aprile
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Fabiola De Marchi
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy
| | - Barbara Sarasso
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Paola Serra
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Giordana Borasio
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Esther Rojo
- Department of Neurology and Medicine, Hospital Clínico Universitario, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Juan Francisco Arenillas
- Department of Neurology and Medicine, Hospital Clínico Universitario, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, 28100 Novara, Italy
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Yao K, Wang J, Ma B, He L, Zhao T, Zou X, Weng Z, Yao R. A nomogram for predicting risk of death during hospitalization in elderly patients with Alzheimer's disease at the time of admission. Front Neurol 2023; 14:1093154. [PMID: 36873432 PMCID: PMC9978216 DOI: 10.3389/fneur.2023.1093154] [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: 11/08/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Background and objectives Elderly patients with Alzheimer's disease (AD) often have multiple underlying disorders that lead to frequent hospital admissions and are associated with adverse outcomes such as in-hospital mortality. The aim of our study was to develop a nomogram to be used at hospital admission for predicting the risk of death in patients with AD during hospitalization. Methods We established a prediction model based on a dataset of 328 patients hospitalized with AD -who were admitted and discharged from January 2015 to December 2020. A multivariate logistic regression analysis method combined with a minimum absolute contraction and selection operator regression model was used to establish the prediction model. The identification, calibration, and clinical usefulness of the predictive model were evaluated using the C-index, calibration diagram, and decision curve analysis. Internal validation was evaluated using bootstrapping. Results The independent risk factors included in our nomogram were diabetes, coronary heart disease (CHD), heart failure, hypotension, chronic obstructive pulmonary disease (COPD), cerebral infarction, chronic kidney disease (CKD), anemia, activities of daily living (ADL) and systolic blood pressure (SBP). The C-index and AUC of the model were both 0.954 (95% CI: 0.929-0.978), suggesting that the model had accurate discrimination ability and calibration. Internal validation achieved a good C-index of 0.940. Conclusion The nomogram including the comorbidities (i.e., diabetes, CHD, heart failure, hypotension, COPD, cerebral infarction, anemia and CKD), ADL and SBP can be conveniently used to facilitate individualized identification of risk of death during hospitalization in patients with AD.
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Affiliation(s)
- Kecheng Yao
- Department of Geriatrics, The People's Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Junpeng Wang
- Department of Geriatrics, The People's Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Baohua Ma
- Department of Medical Record, The People's Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Ling He
- Department of General Practice, The People's Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Tianming Zhao
- Department of Respiratory and Critical Care Medicine, The People's Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Xiulan Zou
- Department of Geriatrics, The People's Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Zean Weng
- Department of Neurology, The First College of Clinical Medical Sciences, Three Gorges University, Yichang, Hubei, China
| | - Rucheng Yao
- Department of Hepatopancreatobilary Surgery, The First College of Clinical Medical Sciences, Three Gorges University, Yichang, Hubei, China
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Alastalo A, Tolppanen A, Nietola M, Haapea M, Miettunen J, Hartikainen S, Jääskeläinen E. Prevalence and characteristics of psychiatric morbidity treated in specialized health care in a nationwide cohort of people with newly diagnosed Alzheimer's disease. Acta Psychiatr Scand 2022; 145:507-516. [PMID: 35266140 PMCID: PMC9311732 DOI: 10.1111/acps.13423] [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: 11/11/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Psychiatric disorders have been implied as both risk factors and prodromal symptoms of Alzheimer's disease (AD). A better understanding of the history of psychiatric morbidity in people with AD may aid with understanding this relationship and highlight challenges in diagnosing AD in people with concomitant psychiatric disorders. METHODS Medication use and Alzheimer's disease (MEDALZ) study is a nationwide register-based cohort of people (n = 70,718) who received a clinically verified AD diagnosis in Finland in 2005-2011 and were community-dwelling at the time of diagnosis. The study population was divided into four groups based on psychiatric morbidity treated in specialized health care. We characterized the groups using data of psychiatric and somatic illnesses, psychotropic drug use, and socioeconomic factors and investigated factors associated with prodromal AD. RESULTS Altogether, 4.3% of cohort members had a psychiatric diagnosis at least five years before AD diagnosis, 3.1% had a psychiatric diagnosis only up to five years before AD diagnosis, and 1.1% had a psychiatric diagnosis both less and more than 5 years before AD. Belonging to the Prodromal group (psychiatric diagnosis within 5 years before AD diagnosis) was most strongly associated with substance abuse (RR 65.06, 95%CI 55.54-76.22). Other associated factors with the Prodromal group were female gender, use of psychotropics, stroke, and asthma/COPD. CONCLUSION Substance abuse and psychotropic drug use are common five years before AD diagnosis. These can be potential markers of possible prodromal symptoms of AD and should be acknowledged in clinical work.
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Affiliation(s)
- Aleksi Alastalo
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | | | - Miika Nietola
- Department of PsychiatryUniversity of Turku and Turku University HospitalTurkuFinland
| | - Marianne Haapea
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of PsychiatryOulu University HospitalOuluFinland
| | - Jouko Miettunen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | | | - Erika Jääskeläinen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of PsychiatryOulu University HospitalOuluFinland
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Tondo G, Aprile D, Tesser F, Comi C. Increased Prevalence of Neuropsychiatric Disorders during COVID-19 Pandemic in People Needing a Non-Deferrable Neurological Evaluation. J Clin Med 2021; 10:jcm10215169. [PMID: 34768689 PMCID: PMC8585111 DOI: 10.3390/jcm10215169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The novel coronavirus disease of 2019 (COVID-19) outbreak provoked a profound healthcare system reorganization. This study aimed to compare the reasons for requesting a non-deferrable neurological evaluation before the COVID-19 pandemic and during the lockdown. Methods: Retrospective observational study including non-deferrable neurological outpatients before the pandemic (pre-COVID-19 group, n = 223) and during the Italian second wave of the COVID-19 pandemic (LOCKDOWN group, n = 318). Results: The number of patients sent for cerebrovascular disorders, headache, and vertigo significantly dropped between the pre-COVID-19 era and the lockdown period. While in the pre-COVID-19 group, the most frequent diagnosis was cerebrovascular disorder; neuropsychiatric disorders ranked first in the LOCKDOWN group. Moreover, the percentage of appropriate non-deferrable neurological evaluations significantly increased in the LOCKDOWN group compared with the pre-COVID-19 group. Discussion: Our study shows a significant increase of neuropsychiatric disorders in non-deferrable neurologic evaluations during the Italian second wave of the COVID-19. Overall, cases were more severe and required a more complex management during the lockdown compared with the pre-COVID era. These findings confirm that a careful approach to prevent the psychological consequences of the pandemic is needed, and long-term rearrangements of the healthcare system are desirable to guarantee appropriate management.
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Affiliation(s)
- Giacomo Tondo
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (F.T.)
- School of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Davide Aprile
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Fabiana Tesser
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (F.T.)
| | - Cristoforo Comi
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (F.T.)
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy;
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, 28100 Novara, Italy
- Correspondence:
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Jia J, Xu J, Liu J, Wang Y, Wang Y, Cao Y, Guo Q, Qu Q, Wei C, Wei W, Zhang J, Yu E. Comprehensive Management of Daily Living Activities, behavioral and Psychological Symptoms, and Cognitive Function in Patients with Alzheimer's Disease: A Chinese Consensus on the Comprehensive Management of Alzheimer's Disease. Neurosci Bull 2021; 37:1025-1038. [PMID: 34050523 PMCID: PMC8275730 DOI: 10.1007/s12264-021-00701-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
Alzheimer's disease (AD) is the most common cognitive disorder in the elderly. Its main clinical manifestations are cognitive decline (C), behavioral and psychological symptoms (B), and a decline in the activities of daily living (A), also known as ABC symptoms. Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis, comprehensive treatment, and prognosis of AD. To guide Chinese clinical practice for optimization of the comprehensive management of AD, in 2018, The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD. Based on a review of the evidence, the consensus summarizes the pathogenesis, pathological changes, clinical manifestations, evaluation, diagnosis, drug and non-drug treatment, and patient care for AD. Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients. The new consensus provides a feasible AD management process for clinicians.
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Affiliation(s)
- Jianjun Jia
- Department of Neurology, The Second Medical Center, People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yongjun Wang
- Cognitive Impairment Department, Shenzhen Kangning Hospital, Shenzhen, 518118, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yunpeng Cao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, 210112, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Qiuming Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Cuibai Wei
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Enyan Yu
- Department of Psychology, Chinese Academy of Sciences Cancer Hospital of the University of the Chinese Academy of Sciences, Hangzhou, 310022, China
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Lampela P, Tolppanen AM, Koponen M, Tanskanen A, Tiihonen J, Hartikainen S, Taipale H. Asthma and Chronic Obstructive Pulmonary Disease as a Comorbidity and Association with the Choice of Antidementia Medication Among Persons with Alzheimer's Disease. J Alzheimers Dis 2021; 73:1243-1251. [PMID: 31929157 DOI: 10.3233/jad-190850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are common comorbidities in persons with Alzheimer's disease (AD). However, pharmacotherapy of these diseases may have opposite mechanisms of action; anticholinergics in asthma/COPD and acetylcholinesterase inhibitors (AChEI) in AD. OBJECTIVE To investigate whether existing asthma/COPD affects the choice of AD medication, and the survival of the patients with AD. METHODS In this retrospective cohort study, data from the MEDALZ-study, which includes all community-dwelling persons with AD during 2005-2011 in Finland (n = 70718) was utilized. Persons with asthma/COPD (N = 7211) were defined as having a special reimbursement for asthma/COPD, or long-term use (≥250 days) of inhaled anticholinergics, inhaled corticosteroids, or leukotriene antagonists during the year before AD diagnosis. We compared persons with and without asthma/COPD regarding the choice of the initial antidementia medication (AChEI versus memantine) with logistic regression and mortality with Cox regression model during the follow-up (up to end of 2015). RESULTS Memantine was favored over AChEIs as first-line treatment to AD in persons with asthma/COPD compared to those without asthma/COPD (odds ratio 1.23, 95% confidence interval (CI) 1.15-1.31). Memantine was also more commonly used among those who used multiple asthma/COPD medications (7.9% of memantine initiators used ≥3 asthma/COPD medications compared with 5.5% of those who initiated with AChEI). Mortality was higher in persons with asthma/COPD compared to those without asthma/COPD (adjusted hazard ratio 1.10, 95% CI 1.07-1.13). CONCLUSION More frequent use of memantine instead of AChEI may result from an attempt to prevent possible worsening of asthma/COPD by AChEIs. Vulnerable persons with both AD and asthma/COPD need individually assessed pharmacotherapy for their medical conditions.
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Affiliation(s)
- Pasi Lampela
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, VIC, Australia
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
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Shaughnessy KA, Hackney KJ, Clark BC, Kraemer WJ, Terbizan DJ, Bailey RR, McGrath R. A Narrative Review of Handgrip Strength and Cognitive Functioning: Bringing a New Characteristic to Muscle Memory. J Alzheimers Dis 2021; 73:1265-1278. [PMID: 31929158 DOI: 10.3233/jad-190856] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Measures of handgrip strength have not only emerged as a clinically viable screening tool for determining risk for morbidity, functional disability, and early mortality, but also for helping to identify cognitive deficits. However, the phenomena that links low handgrip strength with cognitive decline remains unclear. The role of the muscular and neural systems, and their adaptations to muscle strengthening activities over the life course, may provide important information for how age-related changes to muscle mass, strength, and neural capacity influence cognition. Moreover, disentangling how handgrip strength and cognitive function are associated may help to inform healthcare providers working with aging adults and guide targeted interventions aiming to preserve muscle and cognitive functioning. OBJECTIVE To 1) highlight and summarize evidence examining the associations of handgrip strength and cognitive functioning, and 2) provide directions for future research in this area. METHODS Articles from the PubMed database were searched from November 2018-May 2019. The search term algorithm, inclusion and exclusion criteria were pre-specified by investigators. RESULTS Several cross-sectional and longitudinal studies have revealed that measures of handgrip strength were associated with cognitive declines regardless of age demographics and the presence of comorbidities. CONCLUSION Handgrip strength can be used in clinical and epidemiological settings for helping to determine the onset and progression of cognitive impairment. Future research should continue to examine how handgrip strength and cognitive function are linked.
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Affiliation(s)
- Keith A Shaughnessy
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Kyle J Hackney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, USA.,Division of Geriatric Medicine, Ohio University, Athens, OH, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Donna J Terbizan
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Ryan R Bailey
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
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11
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Tondo G, Sarasso B, Serra P, Tesser F, Comi C. The Impact of the COVID-19 Pandemic on the Cognition of People with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4285. [PMID: 33919491 PMCID: PMC8073614 DOI: 10.3390/ijerph18084285] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 01/07/2023]
Abstract
(1) Background: To limit the COVID-19 outbreak, the Italian government implemented social restrictions that may have had psychological and cognitive repercussions on people with dementia. We aimed to analyze cognitive decline during the pandemic year in people evaluated in a memory clinic in northern Italy, the epicenter of COVID-19 spread. (2) Methods: A single-center retrospective study was carried out, including individuals with annual follow-up evaluated in three different years (2020-GROUP, 2019-GROUP, 2018-GROUP). We performed an intergroup comparison of cognitive decline over a one-year follow-up, and an intragroup comparison in the 2020-GROUP to analyze the five-year cognitive decline trajectory, as measured by the MMSE. (3) Results: The 2020-GROUP showed a significant loss of MMSE points per year in the considered follow-up period compared with the 2019-GROUP and 2018-GROUP (p = 0.021). Demographics, clinical features, and the other analyzed variables, including rate of diagnosis, therapy, and comorbidities, did not significantly differ between groups. The five-year cognitive decline trajectory confirmed a significant worsening of cognitive decline between 2019 and 2020 (p < 0.001), while the decrease in MMSE scores was not statistically significant between previous time points. (4) Conclusions: COVID-19 pandemic measures have induced a significant worsening of cognitive decline in people with dementia, needing more careful assistance to minimize the adverse effects of social isolation in case of future lockdowns.
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Affiliation(s)
- Giacomo Tondo
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (B.S.); (P.S.); (F.T.)
- School of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Barbara Sarasso
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (B.S.); (P.S.); (F.T.)
| | - Paola Serra
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (B.S.); (P.S.); (F.T.)
| | - Fabiana Tesser
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (B.S.); (P.S.); (F.T.)
| | - Cristoforo Comi
- Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy; (G.T.); (B.S.); (P.S.); (F.T.)
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, 28100 Novara, Italy
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12
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Puteikis K, Mameniškienė R, Jurevičienė E. Neurological and Psychiatric Comorbidities in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:553-562. [PMID: 33688180 PMCID: PMC7937394 DOI: 10.2147/copd.s290363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose Chronic obstructive pulmonary disease (COPD) is often accompanied by different neurological and psychiatric comorbidities. The purpose of this study was to examine which of them are the most frequent and to explore whether their manifestation can be explained by underlying latent variables. Methods Data about patients with COPD and their neurological and psychiatric comorbidities were extracted from an electronic database of the National Health Insurance Fund of Lithuania for the period between January 1, 2012, and June 30, 2014. Exploratory factor analysis (EFA) was used to investigate comorbidity patterns. Results A study sample of 4834 patients with COPD was obtained from the database, 3338 (69.1%) of who were male. The most frequent neurological and psychiatric comorbidities were nerve, nerve root and plexus disorders (n=1439, 29.8%), sleep disorders (n=666, 13.8%), transient ischemic attack (n=545, 11.3%), depression (n=364, 7.5%) and ischemic stroke (n=349, 7.2%). The prevalence of ischemic stroke, transient ischemic attack, Parkinson’s disease, dementia and sleep disorders increased with age. One latent variable outlined during EFA grouped neurological disorders, namely ischemic stroke, transient ischemic attack, epilepsy, dementia and Parkinson’s disease. The second encompassed depression, anxiety, somatoform and sleep disorders. While similar patterns emerged in data from male patients, no clear comorbidity profiles among women with COPD were obtained. Conclusion Our study provides novel insights into the neurological and psychiatric comorbidities in COPD by outlining an association among cerebrovascular, neurodegenerative disorders and epilepsy, and psychiatric and sleep disorders. Future studies could substantiate the discrete pathological mechanism that underlie these comorbidity groups.
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Affiliation(s)
| | | | - Elena Jurevičienė
- Vilnius University, Center for Pulmonology and Allergology, Vilnius, Lithuania
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13
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Changes in Spatial Working Memory in Stable Chronic Obstructive Pulmonary Disease: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7363712. [PMID: 32775438 PMCID: PMC7396050 DOI: 10.1155/2020/7363712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 12/02/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and is often accompanied by cognitive impairment. Little is known about the working memory of COPD patients. The aim of the study is to evaluate the spatial working memory of COPD patients using the classical visuospatial working memory neuropsychological paradigms. This was a retrospective study of patients with COPD who were evaluated for neurocognitive functions between February and December 2018 at Hefei Second People's Hospital. Healthy controls (HC) were included. The neuropsychological tests included the Beijing Version of the Montreal Cognitive Assessment Test (MoCA), digit span test (DS), Chinese Auditory Verbal Learning Test (CAVLT), Stroop test, and Verbal Fluency Test (VFT). The COPD group performed worse in MoCA (22.3 ± 4.5 vs. 26.1 ± 2.9, P < 0.001), Stroop interference test (44.2 ± 16.9 vs. 36.8 ± 10.3, P = 0.038), and VFT (12.9 ± 2.8 vs. 15.3 ± 4.7, P = 0.021) vs. the HC group. Compared with the HC group, COPD patients had statistically significant differences with respect to 0-back RT (657 ± 46 vs. 578 ± 107, P = 0.001), 1-back accuracy (41.8 ± 12.1% vs. 81.5 ± 18.1%, P < 0.001), 1-back RT (592 ± 75 vs. 431 ± 138, P < 0.001), 2-back accuracy (31.4 ± 9.9% vs. 68.1 ± 16.6%, P < 0.001), and 2-back RT (563 ± 79 vs. 455 ± 153, P = 0.002). Only PaO2 was independently associated with 0-back RT (B = 0.992 ± 0.428, P = 0.028) and 1-back ACC (B = 0.003 ± 0.001, P = 0.004). COPD patients exhibit impairment in working memory and executive function, but not in short- or long-term memory. The impairment of working memory in a patient with COPD may be more due to integrate memory information rather than to memory information storage. COPD patients exhibit a frontal-type cognitive decline.
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14
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Lim KH, Yang S, Kim SH, Joo JY. Elevation of ACE2 as a SARS-CoV-2 entry receptor gene expression in Alzheimer's disease. J Infect 2020; 81:e33-e34. [PMID: 32619698 PMCID: PMC7834154 DOI: 10.1016/j.jinf.2020.06.072] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Key-Hwan Lim
- Neurodegenerative Disease Research Group, Korea Brain Research Institute, Daegu 41062, Republic of Korea
| | - Sumin Yang
- Neurodegenerative Disease Research Group, Korea Brain Research Institute, Daegu 41062, Republic of Korea
| | - Sung-Hyun Kim
- Neurodegenerative Disease Research Group, Korea Brain Research Institute, Daegu 41062, Republic of Korea
| | - Jae-Yeol Joo
- Neurodegenerative Disease Research Group, Korea Brain Research Institute, Daegu 41062, Republic of Korea.
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15
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Cao Y, Qian L, Yu W, Li T, Mao S, Han G. Donepezil plus memantine versus donepezil alone for treatment of concomitant Alzheimer's disease and chronic obstructive pulmonary disease: a retrospective observational study. J Int Med Res 2020; 48:300060520902895. [PMID: 32046559 PMCID: PMC7111061 DOI: 10.1177/0300060520902895] [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: 05/16/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the clinical outcomes of donepezil plus memantine (DM) and donepezil (DO) alone in Asian patients with a concomitant diagnosis of moderate-to-severe Alzheimer’s disease and mild-to-moderate chronic obstructive pulmonary disease (AD-COPD). Methods We conducted a retrospective analysis of patients with AD-COPD who received either DM or DO for 6 months, or until the occurrence of unacceptable adverse events or disease progression, between June 2012 and May 2016. The primary endpoint was the score on the Standardized Mini-Mental State Examination (SMMSE). Secondary endpoints were scores on the caregiver-rated Bristol Activities of Daily Living Scale, Neuropsychiatric Inventory, Dementia Quality of Life (DEMQOL)-Proxy, and General Health Questionnaire 12. Results In total, 154 eligible patients received DM, whereas 156 received DO. Compared with patients who received DO, patients who received DM had significantly higher mean scores on the SMMSE by 2.1 points (95% confidence interval, 1.3–2.5). Significant between-group heterogeneity was not detected in outcomes over time. The benefits of treatment with DM were greater than those of treatment with DO, in terms of the primary endpoint. Significant differences were also detected in terms of secondary endpoints. Conclusion DM is more effective than DO alone for Asian patients with AD-COPD.
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Affiliation(s)
- Yangyi Cao
- Department of Treatment Center For Traumatic Injuries, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Liang Qian
- Department of Anesthesiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Weiguang Yu
- Department of Orthopeadics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuai Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guowei Han
- Department of Orthopeadics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Kim SY, Min C, Oh DJ, Choi HG. Risk of neurodegenerative dementia in asthma patients: a nested case-control study using a national sample cohort. BMJ Open 2019; 9:e030227. [PMID: 31597651 PMCID: PMC6797318 DOI: 10.1136/bmjopen-2019-030227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study investigated the risk of neurodegenerative dementia following asthma. DESIGN A nested case-control study SETTING: The ≥60-year-old population was selected from the Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2013. PARTICIPANTS AND INTERVENTIONS The 11 442 dementia cases were matched with 45 768 control cases for age, sex, income, region of residence, hypertension, diabetes and dyslipidaemia. Asthma was classified using International Classification of Disease-10 (ICD-10) codes (J45 and J46) and medication history. Dementia was identified based on ICD-10 codes (G30 and F00). PRIMARY AND SECONDARY OUTCOME MEASURES The ORs of a previous history of asthma in patients with dementia were analysed using conditional logistic regression analysis stratified for age, sex, income, region of residence, hypertension, diabetes and dyslipidaemia. Subgroup analysis was performed according to age and sex. RESULTS Overall, 22.6% (2587/11 442) and 22.3% (10 229/45 768) of the cases in the dementia and control groups, respectively, had a previous history of asthma. The OR for asthma in the dementia group was not higher than that in the control group (adjusted OR=0.97, 95% CI 0.92 to 1.02, p=0.207). All age and sex subgroups demonstrated consistent results. CONCLUSIONS Asthma was not related to an increased risk of dementia.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA University, Seongnam, Korea (the Republic of)
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang-si, Korea (the Republic of)
| | - Dong Jun Oh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul-si, Korea (the Republic of)
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head & Neck Surgery, Hallym University, Anyang-si, Korea (the Republic of)
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