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Karako K, Hata T, Inoue A, Oyama K, Ueda E, Sakatani K. Importance of serum albumin in machine learning-based prediction of cognitive function in the elderly using a basic blood test. Front Neurol 2024; 15:1362560. [PMID: 39114530 PMCID: PMC11303288 DOI: 10.3389/fneur.2024.1362560] [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: 12/28/2023] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction In this study, we investigated the correlation between serum albumin levels and cognitive function, and examined the impact of including serum albumin values in the input layer on the prediction accuracy when forecasting cognitive function using deep learning and other machine learning models. Methods We analyzed the electronic health record data from Osaka Medical and Pharmaceutical University Hospital between 2014 and 2021. The study included patients who underwent cognitive function tests during this period; however, patients from whom blood test data was not obtained up to 30 days before the cognitive function tests and those with values due to measurement error in blood test results were excluded. The Mini-Mental State Examination (MMSE) was used as the cognitive function test, and albumin levels were examined as the explanatory variable. Furthermore, we estimated MMSE scores from blood test data using deep learning models (DLM), linear regression models, support vector machines (SVM), decision trees, random forests, extreme gradient boosting (XGBoost), and light gradient boosting machines (LightGBM). Results Out of 5,017 patients who underwent cognitive function tests, 3,663 patients from whom blood test data had not been obtained recently and two patients with values due to measurement error were excluded. The final study population included 1,352 patients, with 114 patients (8.4%) aged below 65 and 1,238 patients (91.6%) aged 65 and above. In patients aged 65 and above, the age and male sex showed significant associations with MMSE scores of less than 24, while albumin and potassium levels showed negative associations with MMSE scores of less than 24. Comparing MMSE estimation performance, in those aged below 65, the mean squared error (MSE) of DLM was improved with the inclusion of albumin. Similarly, the MSE improved when using SVM, random forest and XGBoost. In those aged 65 and above, the MSE improved in all models. Discussion Our study results indicated a positive correlation between serum albumin levels and cognitive function, suggesting a positive correlation between nutritional status and cognitive function in the elderly. Serum albumin levels were shown to be an important explanatory variable in the estimation of cognitive function for individuals aged 65 and above.
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Affiliation(s)
- Kenji Karako
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Takeo Hata
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Atsushi Inoue
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Fukuoka, Japan
| | - Katsunori Oyama
- Department of Computer Science, College of Engineering, Nihon University, Tokyo, Japan
| | - Eiichiro Ueda
- Department of Hospital Quality and Safety Management, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Kaoru Sakatani
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
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Sideman AB, Harrison KL, Garrett SB, Paladino J, Naasan G, Ritchie CS. Dementia Specialty Care Clinicians' Perspectives on Their Role in the Dementia Diagnostic Process and Diagnostic Disclosure. J Geriatr Psychiatry Neurol 2024:8919887241254468. [PMID: 39046920 DOI: 10.1177/08919887241254468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Delivering a diagnosis of Alzheimer's disease and related dementias (ADRD) can be challenging not just for patients and families, but also for clinicians. Our objective was to understand dementia specialty care clinicians' perspectives on their role in diagnosis and diagnostic disclosure in dementia. METHODS Qualitative interviews with clinicians from a specialty tertiary dementia care center focused on practices, challenges, and opportunities addressing patient and caregiver needs in dementia. Data was analyzed by an interdisciplinary team using thematic analysis. RESULTS The 16 participants included behavioral neurologists, social workers, neuropsychologists, and nurses. Themes included the value of providing an accurate diagnosis, the timing and challenges of delivering a diagnosis, the central focus on diagnosis alongside the need for more education on care management, and the role of the interdisciplinary team. DISCUSSION We identified areas for improvement and strengths that can be built upon or adapted to other settings, including providing clinicians in specialty and primary care settings more guidance and support when diagnostic challenges arise, strengthening interdisciplinary teamwork, and making dementia diagnosis and care more accessible.
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Affiliation(s)
- Alissa B Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - Krista L Harrison
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Sarah B Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - Joanna Paladino
- Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine S Ritchie
- Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
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Jeyagurunathan A, Yuan Q, Samari E, Zhang Y, Goveas R, Ng LL, Subramaniam M. Facilitators and barriers of help-seeking for persons with dementia in Asia-findings from a qualitative study of informal caregivers. Front Public Health 2024; 12:1396056. [PMID: 39071142 PMCID: PMC11282579 DOI: 10.3389/fpubh.2024.1396056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
Background and aim The deterioration in cognition of persons with dementia (PWD) makes their caregivers key players in their help-seeking process. This study aimed to identify the facilitators and barriers of help-seeking for persons with dementia in Asia from the perspective of their informal caregivers. Methods A qualitative methodology was adopted in the current study. Twenty-nine informal caregivers of PWD in Singapore were interviewed between April 2019 and December 2020. All interviews were audio-recorded and transcribed verbatim for the analysis. Results The transcripts were analyzed using inductive thematic analysis. The results revealed four major themes with 12 sub-themes, including (1) Barriers to diagnosis-seeking (i.e., lack of knowledge and awareness of dementia, emotional denial, resistance from PWD, and delays in the healthcare system); (2) Facilitators of diagnosis-seeking (i.e., synergy between awareness of dementia and an active diagnosis-seeking intention and incidental diagnosis resulting from seeking treatment for comorbid conditions); (3) Barriers to treatment-seeking (i.e., challenges from PWD and disease, challenges faced by caregivers when seeking treatment for PWD, and challenges imposed by the COVID-19 pandemic); (4) Facilitators of treatment-seeking (i.e., caregivers' capabilities of handling PWD, cooperation/compliance from PWD, and an integrated care plan for PWD). Conclusion The findings highlight the importance of raising public awareness, enabling health professionals to tailor psychosocial interventions better, and improving community support through dementia awareness and education.
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Affiliation(s)
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Richard Goveas
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
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Orimaye SO, Schmidtke KA. Combining artificial neural networks and a marginal structural model to predict the progression from depression to Alzheimer's disease. FRONTIERS IN DEMENTIA 2024; 3:1362230. [PMID: 39081615 PMCID: PMC11285640 DOI: 10.3389/frdem.2024.1362230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/21/2024] [Indexed: 08/02/2024]
Abstract
Introduction Decades of research in population health have established depression as a likely precursor to Alzheimer's disease. A combination of causal estimates and machine learning methods in artificial intelligence could identify internal and external mediating mechanisms that contribute to the likelihood of progression from depression to Alzheimer's disease. Methods We developed an integrated predictive model, combining the marginal structural model and an artificial intelligence predictive model, distinguishing between patients likely to progress from depressive states to Alzheimer's disease better than each model alone. Results The integrated predictive model achieved substantial clinical relevance when using the area under the curve measure. It performed better than the traditional statistical method or a single artificial intelligence method alone. Discussion The integrated predictive model could form a part of a clinical screening tool that identifies patients who are likely to progress from depression to Alzheimer's disease for early behavioral health interventions. Given the high costs of treating Alzheimer's disease, our model could serve as a cost-effective intervention for the early detection of depression before it progresses to Alzheimer's disease.
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Affiliation(s)
- Sylvester O. Orimaye
- College of Global Population Health, University of Health Sciences and Pharmacy, St. Louis, MO, United States
| | - Kelly A. Schmidtke
- College of Arts and Sciences, University of Health Sciences and Pharmacy, St. Louis, MO, United States
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Rühl J, Brinkmann ST, Schaufler D, Gräßel E, Walker BB, Kolominsky-Rabas P. [Travel time to memory clinics in Bavaria: A geographical analyses within the framework of digiDEM Bayern]. DAS GESUNDHEITSWESEN 2024; 86:263-273. [PMID: 38579731 PMCID: PMC11003252 DOI: 10.1055/a-2233-6168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria. METHODS We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data. RESULTS The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas. CONCLUSION In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.
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Affiliation(s)
- Jana Rühl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisziplinäres
Zentrum für Health Technology Assessment (HTA) und Public Health (IZPH),
Erlangen, Germany
| | - Sebastian T. Brinkmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Dominik Schaufler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Elmar Gräßel
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische und
Psychotherapeutische Klinik, Universitätsklinikum Erlangen,
Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen,
Germany
| | - Blake Byron Walker
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Peter Kolominsky-Rabas
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisziplinäres
Zentrum für Health Technology Assessment (HTA) und Public Health (IZPH),
Erlangen, Germany
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Amano T, Halvorsen CJ, Kim S, Reynolds A, Scher C, Jia Y. An outcome-wide analysis of the effects of diagnostic labeling of Alzheimer's disease and related dementias on social relationships. Alzheimers Dement 2024; 20:1614-1626. [PMID: 38053452 PMCID: PMC10984499 DOI: 10.1002/alz.13574] [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: 04/05/2023] [Revised: 09/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study examines how receiving a dementia diagnosis influences social relationships by race and ethnicity. METHODS Using data from the Health and Retirement Study (10 waves; 7,159 observations) of adults 70 years and older predicted to have dementia using Gianattasio-Power scores (91% accuracy), this study assessed changes in social support, engagement, and networks after a dementia diagnosis. We utilized quasi-experimental methods to estimate treatment effects and subgroup analyses by race/ethnicity. RESULTS A diagnostic label significantly increased the likelihood of gaining social support but reduced social engagement and one measure of social networks. With some exceptions, the results were similar by race and ethnicity. DISCUSSION Results suggest that among older adults with assumed dementia, being diagnosed by a doctor may influence social relationships in both support-seeking and socially withdrawn ways. This suggests that discussing services and supports at the time of diagnosis is important for healthcare professionals.
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Affiliation(s)
- Takashi Amano
- Department of Social WorkSchool of Arts and SciencesRutgers University NewarkNewarkUSA
| | | | - Seoyoun Kim
- Department of SociologyTexas State UniversitySan MarcosUSA
| | - Addam Reynolds
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesUSA
| | - Clara Scher
- School of Social WorkRutgers UniversityNew BrunswickUSA
| | - Yuane Jia
- Department of Interdisciplinary StudiesSchool of Health ProfessionsRutgers Biomedical and Health SciencesNewarkUSA
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Stimmel MB, Orkaby AR, Ayers E, Verghese J, Nsubayi CK, Weiss EF. Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx. J Am Geriatr Soc 2024; 72:850-857. [PMID: 38196332 PMCID: PMC10947962 DOI: 10.1111/jgs.18705] [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: 08/11/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Efficacy and validity of the MoCA for cognitive screening in ethnoculturally and linguistically diverse settings is unclear. We sought to examine the utility and discriminative validity of the Spanish and English MoCA versions to identify cognitive impairment among diverse community-dwelling older adults. METHODS Participants aged ≥65 with cognitive concerns attending outpatient primary care in Bronx, NY, were recruited. MoCA and neuropsychological measures were administered in Spanish or English, and a neuropsychologist determined cognitive status (normal with subjective cognitive concerns [SCC], mild cognitive impairment [MCI], and dementia). One-way ANOVA compared cognitive statuses. ROC analyses identified optimal MoCA cutpoints for discriminating possible cognitive impairment. RESULTS There were 231 participants, with mean age 73, 72% women, 43% Hispanic; 39% Black/African American; 113 (49%) completed testing in English and 118 (51%) in Spanish. Overall MoCA mean was 17.7 (SD = 4.3). Neuropsychological assessment identified 90 as cognitively normal/SCC, average MoCA 19.9 (SD = 4.1), 133 with MCI, average MoCA 16.6 (SD = 3.7), and 8 with dementia, average MoCA 10.6 (SD = 3.1). Mean English MoCA average was 18.6 (SD = 4.1) versus Spanish 16.7 (SD = 4.3). The published cutpoint ≤23 for MCI yielded a high false-positive rate (79%). ROC analyses identified ≤18.5 as the score to identify MCI or dementia using the English MoCA (65% sensitivity; 77% specificity) and ≤16.5 for the Spanish MoCA (64% sensitivity;73% specificity) in this sample of older adults with cognitive concerns. CONCLUSIONS Current MoCA cutpoints were inappropriately high in a culturally/linguistically diverse urban setting, leading to a high false-positive rate. Lower Spanish and English MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group, highlighting the need for the creation and validation of accurate cognitive screeners for ethnoculturally and linguistically diverse older adults.
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Affiliation(s)
- Marnina B Stimmel
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ariela R Orkaby
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emmeline Ayers
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joe Verghese
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Celeste K Nsubayi
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Erica F Weiss
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Ávila-Jiménez JL, Cantón-Habas V, Carrera-González MDP, Rich-Ruiz M, Ventura S. A deep learning model for Alzheimer's disease diagnosis based on patient clinical records. Comput Biol Med 2024; 169:107814. [PMID: 38113682 DOI: 10.1016/j.compbiomed.2023.107814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Dementia, with Alzheimer's disease (AD) being the most common type of this neurodegenerative disease, is an under-diagnosed health problem in older people. The creation of classification models based on AD risk factors using Deep Learning is a promising tool to minimize the impact of under-diagnosis. OBJECTIVE To develop a Deep Learning model that uses clinical data from patients with dementia to classify whether they have AD. METHODS A Deep Learning model to identify AD in clinical records is proposed. In addition, several rebalancing methods have been used to preprocess the dataset and several studies have been carried out to tune up the model. RESULTS Model has been tested against other well-established machine learning techniques, having better results than these in terms of AUC with alpha less than 0.05. CONCLUSIONS The developed Neural Network Model has a good performance and can be an accurate assisting tool for AD diagnosis.
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Affiliation(s)
- J L Ávila-Jiménez
- Departament of Electronic and Computer Engineering. Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Cordoba, Córdoba, Spain
| | - Vanesa Cantón-Habas
- Maimonides Institute for Biomedical Research, Reina Sofia University Hospital, University of Córdoba, Spain.
| | - María Del Pilar Carrera-González
- Maimonides Institute for Biomedical Research, Reina Sofia University Hospital, University of Córdoba, Spain; Experimental and Clinical Physiopathology Research Group CTS-1039; Department of Health Sciences, Faculty of Health Sciences; University of Jaén, Campus Universitario Las Lagunillas, Jaén, Spain
| | - Manuel Rich-Ruiz
- Maimonides Institute for Biomedical Research, Reina Sofia University Hospital, University of Córdoba, Spain; CIBER on Fragility and Healthy Aging (CIBERFES), Madrid, Spain; Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
| | - Sebastián Ventura
- Department of Computer Science and Numerical Analysis, Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Cordoba, Córdoba, Spain
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Pham BD, Kim BG, Esterman A, Brodaty H, Kurrle S, Nguyen TB, Nguyen TH, Roughead E, Hinton L, Dang TH, Nguyen TDH, Tran K, Crotty M, Du D, Nguyen TA. Knowledge, attitudes and self-confidence with skills required for providing dementia care in physicians at primary healthcare settings in Vietnam. BMC Health Serv Res 2024; 24:86. [PMID: 38233921 PMCID: PMC10792887 DOI: 10.1186/s12913-023-10460-4] [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: 02/22/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Dementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam. METHODS A cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam. RESULTS The results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management. CONCLUSIONS The results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnam's population ages.
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Affiliation(s)
- Bich Diep Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Bao Giang Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
| | - Adrian Esterman
- UniSA: Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Kurrle
- The University of Sydney, Sydney, NSW, Australia
| | | | | | - Elizabeth Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ladson Hinton
- University of California, Davis, Sacramento, CA, USA
| | - Thu Ha Dang
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Thi Diem Huong Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kham Tran
- National Ageing Research Institute, Melbourne, VIC, Australia
- Flinders University, Adelaide, SA, Australia
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Duc Du
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tuan Anh Nguyen
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Perneczky R, Hansen N, Hofmann A, Laske C, Priller J, Grimmer T, Frölich L, Düzel E, Jessen F, Wiltfang J. Blood-Based Biomarkers for Early Alzheimer's Disease Diagnosis in Real-World Settings. Methods Mol Biol 2024; 2785:3-14. [PMID: 38427184 DOI: 10.1007/978-1-0716-3774-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
As our knowledge about the biology of Alzheimer's disease (AD) expands and we recognize the significance of early intervention for effective treatment, there is a shift in focus toward detecting the disease at an early stage. AD is characterized by the accumulation of misfolded amyloid-β (Aβ) and phosphorylated tau proteins in the brain, leading to the formation of senile plaques and neurofibrillary tangles. While a definitive diagnosis of AD can only be confirmed through autopsy by examining these pathological features, there are now reliable methods available for diagnosing the disease in living individuals. These methods involve analyzing cerebrospinal fluid and using positron emission tomography to accurately assess the presence of Aβ and tau proteins. While these diagnostic markers have shown high accuracy in memory-clinic populations, they do have limitations such as the requirement for invasive lumbar puncture or exposure to ionizing radiation. Additionally, they are not easily accessible outside of specialized healthcare settings. Blood-based biomarkers of the core pathological features of AD are being developed, showing promise for less invasive, scalable identification of AD cases in the community. The advantages for the healthcare systems of this development are obvious, but the diagnostic performance of blood-based biomarkers in broader, non-selected populations outside of retrospective analyses and research cohorts still requires further investigation, including the combination with more effective neuropsychological assessments such as digital cognitive test solutions.
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Affiliation(s)
- Robert Perneczky
- Department of Psychiatry and Psychotherapy, LMU Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK.
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK.
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Anna Hofmann
- Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany
- German Center for Neurodegenerative Diseases (DZNE) Tuebingen, Tuebingen, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE) Tuebingen, Tuebingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charite University Medicine, Berlin, Germany
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Emrah Düzel
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Magdeburg, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Medical Faculty, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE) Bonn, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE) Goettingen, Goettingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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Ogbuagu C, Ogbuagu E, Emelumadu O, Okereke U, Okeke I, Chigbo G, Javendal S, Miller B, Valcour V, Allen IE, Goode C, Possin KL, Uwakwe R. Feasibility and Determinants of Performance for a Tablet-Based Cognitive Assessment Tool in Rural and Urban Southeast Nigeria. J Alzheimers Dis 2024; 101:175-182. [PMID: 39150829 DOI: 10.3233/jad-240518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
Background Cognitive assessment is a key component of clinical evaluations for patients with dementia and Alzheimer's disease in primary health care (PHC) settings. The need for well-validated, culturally appropriate, and easy-to-use assessments is especially urgent in low- and middle-income countries (LMICs) that are experiencing rapid growth in their older adult populations. Objective To examine the feasibility and demographic determinants of performance for a tablet-based cognitive assessment tool (TabCAT) battery, which includes subtests for four cognitive domains, among older PHC patients in southeastNigeria. Methods A cross-sectional mixed-method descriptive study evaluating the useability and performance of TabCAT. Results We enrolled 207 participants (mean age of 64.7±13.5 years; 52% with only primary, 41% secondary, and 7% tertiary education). Most (91%) who initiated the assessment were able to complete it, requiring 10-15 minutes to complete. More years of education was associated with better test scores across all tests (p < 0.001). Living in a rural location was also associated with better performance (p < 0.05). Male compared to female sex did not associate with performance on any of the tests (all ps > 0.05). Conclusions Tablet-based cognitive assessment was feasible in rural and urban settings of Nigeria. Better performance on cognitive subtests linked to more education and residing in a rural area; however, sex did not predict performance. Digital cognitive assessment tools hold potential for widespread use in healthcare and educational contexts, particularly in regions with varying levels of urbanization and educational access.
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Affiliation(s)
- Chukwuanugo Ogbuagu
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Ekenechukwu Ogbuagu
- Family Medicine Department, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Obiageli Emelumadu
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
| | - Uzoma Okereke
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
| | - Irene Okeke
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
| | - Godswill Chigbo
- School of Public Health, University of Port-Harcourt, Port Harcourt, Nigeria
| | - Shireen Javendal
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Bruce Miller
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Victor Valcour
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Biostatistics and Epidemiology Department, University of California San Francisco, San Francisco, CA, USA
| | - Collette Goode
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Katherine L Possin
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Richard Uwakwe
- Department of Medicine, Mental Health Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Wuttke A, Palm S, Geschke K, Fellgiebel A. Public knowledge and attitudes about mental health in older age in Germany - Focus on dementia and late-life depression. Prev Med Rep 2023; 35:102384. [PMID: 37680860 PMCID: PMC10480774 DOI: 10.1016/j.pmedr.2023.102384] [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: 05/05/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Older people with mental disorders represent a particularly vulnerable group in the health care system. Despite this, mental disorders in this group often remain undiagnosed or are not treated in accordance with guidelines, potentially due to a lack of knowledge or unfavorable attitudes regarding mental disorders in older individuals. Therefore, in an anonymous online survey of 1,284 participants (71.8% female, mean age 52.3 ± 18.0 years), we assessed knowledge and attitudes regarding mental health in old age in general and regarding dementia and late-life depression in particular. Regression analyses were conducted to determine predictors of higher knowledge and more favorable attitudes based on sociodemographic data. On average, participants answered 11 ± 2 out of 15 of the knowledge questions correctly. Items on the prevention of dementia, late-life depression symptoms, and associated suicide risk were most likely to be answered incorrectly. Participants showed less favorable attitudes towards people living with dementia than towards people with late-life depression, and higher knowledge scores were associated with more favorable attitudes. Our findings highlight a clear need for psychoeducation in the field of dementia and late-life depression, with a special emphasis on prevention-related knowledge. Fostering knowledge in this area is highly relevant, as it might positively influence attitudes towards older people with mental disorders, in turn facilitating health care and health-promoting behavior among older people.
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Affiliation(s)
- Alexandra Wuttke
- Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus, Mainz, Germany
| | - Svenja Palm
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus, Mainz, Germany
| | - Katharina Geschke
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
- Hospital for Psychiatry, Psychosomatic and Psychotherapy, Agaplesion Elisabethenstift, Darmstadt, Germany
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13
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Sideman AB, Ma M, Hernandez de Jesus A, Alagappan C, Razon N, Dohan D, Chodos A, Al-Rousan T, Alving LI, Segal-Gidan F, Rosen H, Rankin KP, Possin KL, Borson S. Primary Care Pracitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care. JAMA Netw Open 2023; 6:e2336030. [PMID: 37768660 PMCID: PMC10539983 DOI: 10.1001/jamanetworkopen.2023.36030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Although the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care. Objective To describe PCP perspectives on their role in dementia diagnosis and care. Design, Setting, and Participation In this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis. Main Outcomes and Measures Overarching themes associated with PCP roles in dementia care. Results Interviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs' perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients' life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints. Conclusions and Relevance In this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Humanities and Social Sciences, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco
| | - Melissa Ma
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | | | - Cecilia Alagappan
- Global Brain Health Institute, University of California, San Francisco
| | - Na'amah Razon
- Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Anna Chodos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Loren I Alving
- California Alzheimer's Disease Center, University of California, San Francisco at Fresno
| | - Freddi Segal-Gidan
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Howie Rosen
- Department of Neurology, University of California, San Francisco
| | | | | | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles
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14
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Blotenberg I, Hoffmann W, René Thyrian J. Dementia in Germany: Epidemiology and Prevention Potential. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:470-476. [PMID: 37226316 PMCID: PMC10487668 DOI: 10.3238/arztebl.m2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/13/2022] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The further development of public-health approaches for the prevention of dementia requires estimates of the number of people with dementia, trends in incidence and prevalence, and the potential impact of preventive measures. METHODS The projections described here are based on incidence and prevalence data for Europe and on current and projected population figures from the German Federal Statistical Office. Four scenarios were calculated on the basis of two different population projections and the assumption of either stable or declining prevalence. Data from the German Aging Survey were used to estimate the prevention potential for eleven potentially modifiable risk factors for dementia. Weighting factors were determined to adjust for correlations between risk factors. RESULTS Approximately 1.8 million people were living with dementia in Germany as of December 31, 2021; the number of new dementia cases in 2021 is estimated at 360 000 to 440 000. In 2033, depending on the scenario, 1.65 to 2 million people aged 65 and older may be affected; we consider likelihood of the lower end of this range to be very low. It is estimated that 38% of these cases are associated with 11 potentially modifiable risk factors. A 15% reduction in the prevalence of risk factors could potentially decrease the number of cases by up to 138 000 in 2033. CONCLUSION We assume that the number of people with dementia in Germany will increase, but there is considerable prevention potential. Multimodal prevention approaches to promote healthy aging should be further developed and put into practice. Better data are needed on incidence and prevalence of dementia in Germany.
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Affiliation(s)
- Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
- Institute for Community Medicine, Greifswald University Medicine
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Location Rostock/Greifswald
- Institute for Community Medicine, Greifswald University Medicine
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15
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Tsai HR, Lo RY, Liang KH, Chen TL, Huang HK, Wang JH, Lee YC. Risk of Subsequent Dementia or Alzheimer Disease Among Patients With Age-Related Macular Degeneration: A Systematic Review and Meta-analysis. Am J Ophthalmol 2023; 247:161-169. [PMID: 36375591 DOI: 10.1016/j.ajo.2022.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Alzheimer disease (AD), a common form of dementia, shares several clinical and pathologic features with age-related macular degeneration (AMD). Epidemiologic reports on the association of AMD with subsequent dementia or AD are inconsistent. DESIGN Systematic review and meta-analysis. METHODS The Meta-analysis of Observational Studies in Epidemiology reporting guidelines were applied. The Newcastle-Ottawa Scale was used to evaluate the risk of bias in the included cohort studies that examined the association of AMD with subsequent dementia or AD. We estimated the pooled hazard ratios (HRs) of dementia or AD using random effects model meta-analysis and subgroup analysis on different follow-up periods, AMD subtype, gender, age, study design, and methods to ascertain dementia or AD. RESULTS A total of 8 223 581 participants were included in 8 studies published during 2000-2021. The meta-analysis showed that AMD was significantly associated with subsequent dementia (pooled HR 1.22, 95% CI 1.01-1.47) or AD (pooled HR 1.21, 95% CI 1.03-1.43). Our secondary analysis revealed that the association was more noticeable in dry AMD than wet AMD. CONCLUSIONS Patients with AMD have higher risks of developing dementia or AD, and therefore identifying related comorbidities and retinal biomarkers is much warranted for older adults with AMD in ophthalmologic practice.
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Affiliation(s)
- Hou-Ren Tsai
- From the Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (H.-R.T., Y.-C.L.), Hualien
| | - Raymond Y Lo
- Division of Cognitive/Geriatric Neurology, Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University (R.Y.L.), Hualien; Institute of Medical Sciences, Tzu Chi University (R.Y.L.), Hualien
| | - Kai-Hsiang Liang
- Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Tai-Li Chen
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (T.-L.C.), Hualien; Department of Dermatology, Taipei Veterans General Hospital (T.-L.C.), Taipei
| | - Huei-Kai Huang
- Department of Family medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (H.-K.H.), Hualien; Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (H.-K.H., J.-H.W.), Hualien
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (H.-K.H., J.-H.W.), Hualien
| | - Yuan-Chieh Lee
- From the Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (H.-R.T., Y.-C.L.), Hualien; Department of Ophthalmology and Visual Science, Tzu Chi University (Y.-C.L.), Hualien.
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16
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Smith C, Bhattacharya D, Scott S. Understanding how primary care practitioners can be supported to recognise, screen and initially diagnose oropharyngeal dysphagia: protocol for a behavioural science realist review. BMJ Open 2023; 13:e065121. [PMID: 36806074 PMCID: PMC9944651 DOI: 10.1136/bmjopen-2022-065121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) affects around 15% of older people; however, it is often unrecognised and underdiagnosed until patients are hospitalised. Screening is an important process which aims to facilitate proactive assessment, diagnosis and management of health conditions. Healthcare systems do not routinely screen for OD in older people, and healthcare professionals (HCPs) are largely unaware of the need to screen. This realist review aims to identify relevant literature and develop programme theories to understand what works, for whom, under what circumstances and how, to facilitate primary care HCPs to recognise, screen and initially diagnose OD. METHODS AND ANALYSIS We will follow five steps for undertaking a realist review: (1) clarify the scope, (2) literature search, (3) appraise and extract data, (4) evidence synthesis and (5) evaluation. Initial programme theories (IPTs) will be constructed after the preliminary literature search, informed by the Theoretical Domains Framework and with input from a stakeholder group. We will search Medline, Google Scholar, PubMed, EMBASE, CINAHL, AMED, Scopus and PsycINFO databases. We will obtain additional evidence through grey literature, snowball sampling, lateral searching and consulting the stakeholder group. Literature will be screened, evaluated and synthesised in Covidence. Evidence will be assessed for quality by evaluating its relevance and rigour. Data will be extracted and synthesised according to their relation to IPTs. We will follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication standards to report study results. ETHICS AND DISSEMINATION Formal ethical approval is not required for this review. We will disseminate this research through publication in a peer-reviewed journal, written pieces targeted to diverse groups of HCPs on selected online platforms and public engagement events. PROSPERO REGISTRATION NUMBER CRD42022320327.
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Affiliation(s)
- Caroline Smith
- School of Healthcare, University of Leicester, College of Life Sciences, Leicester, Leicestershire, UK
| | - Debi Bhattacharya
- School of Healthcare, University of Leicester, College of Life Sciences, Leicester, Leicestershire, UK
| | - Sion Scott
- School of Healthcare, University of Leicester, College of Life Sciences, Leicester, Leicestershire, UK
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Hamano T, Nagata M, Matsubara R, Ikebata Y, Ito T, Ibe A, Fujita Y, Kusaka Y, Tokunaga T, Enomoto S, Endo Y, Ueno A, Shirafuji N, Ikawa M, Hayashi K, Yamamura O, Nakamoto Y. Effectiveness of a self-reporting yes/no survey for dementia screening-trial in Fukui, Japan. Front Aging Neurosci 2023; 14:1029614. [PMID: 36688170 PMCID: PMC9845620 DOI: 10.3389/fnagi.2022.1029614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023] Open
Abstract
Background: Early intervention for dementia patients is extremely important for the prevention of dementia. However, so far, it is not clear as to what kind of screening will be useful for the early detection of dementia. Objective: We aimed to investigate the relationship between the results of a short self-reporting yes/no survey selected in Kihon Checklist, developed by the Japanese Ministry of Health, Labor and Welfare to identify older adults who are at risk of requiring support/care, and other original items developed by Dementia Prevention Team, Fukui, Japan, and Mini-Mental State Examination (MMSE) scores, and determine the diagnostic efficacy of the self-reporting yes/no survey. Methods: Self-reporting yes/no surveys were conducted for 87,687 individuals aged ≥65 years, living in Fukui, Japan, and did not have Long-Term Care Insurance, Japan. According to the survey results, selected individuals were advised to visit a local hospital to be assessed with MMSE. Results: Individuals who could not make a call by looking up phone numbers and manage their own deposits and savings at the bank or automatic teller machine (ATM) had an increased risk of low MMSE score (≤23; odds ratio: 2.74 [1.89-3.97]; 95% confidence interval: 2.12 [1.46-3.07]). Conclusions: Self-reporting yes/no survey could effectively screen for dementia. Not being able to make a call by looking up phone numbers and not being able to manage their own deposits and savings at the bank or ATM are signs of dementia.
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Affiliation(s)
- Tadanori Hamano
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan,Department of Aging and Dementia (DAD), Faculty of Medical Sciences, University of Fukui, Fukui, Japan,Life Science Innovation Center, University of Fukui, Fukui, Japan,*Correspondence: Tadanori Hamano
| | - Miwako Nagata
- Department of Neurology, Nakamura Hospital, Echizen-city, Japan
| | | | | | - Tatsuhiko Ito
- Department of Psychiatry, Sukoyaka Silver Hospital, Fukui, Japan
| | - Akihiro Ibe
- Department of Internal Medicine, Ibe Hospital, Echizen-cho, Japan
| | - Youshi Fujita
- Department of Neurology, Fujita Neurological Hospital, Fukui, Japan
| | - Yukinori Kusaka
- Department of Environmental Health, University of Fukui, Fukui, Japan
| | - Takahiro Tokunaga
- Research Promotion Office, Shinseikai Toyama Hospital, Toyama, Japan
| | - Soichi Enomoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan,Department of Aging and Dementia (DAD), Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshinori Endo
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Asako Ueno
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Norimichi Shirafuji
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masamichi Ikawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kouji Hayashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Osamu Yamamura
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Kobayashi M, Yamada Y, Shinkawa K, Nemoto M, Nemoto K, Arai T. Automated Early Detection of Alzheimer's Disease by Capturing Impairments in Multiple Cognitive Domains with Multiple Drawing Tasks. J Alzheimers Dis 2022; 88:1075-1089. [PMID: 35723100 PMCID: PMC9484124 DOI: 10.3233/jad-215714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Automatic analysis of the drawing process using a digital tablet and pen has been applied to successfully detect Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, most studies focused on analyzing individual drawing tasks separately, and the question of how a combination of drawing tasks could improve the detection performance thus remains unexplored. OBJECTIVE We aimed to investigate whether analysis of the drawing process in multiple drawing tasks could capture different, complementary aspects of cognitive impairments, with a view toward combining multiple tasks to effectively improve the detection capability. METHODS We collected drawing data from 144 community-dwelling older adults (27 AD, 65 MCI, and 52 cognitively normal, or CN) who performed five drawing tasks. We then extracted motion- and pause-related drawing features for each task and investigated the statistical associations of the features with the participants' diagnostic statuses and cognitive measures. RESULTS The drawing features showed gradual changes from CN to MCI and then to AD, and the changes in the features for each task were statistically associated with cognitive impairments in different domains. For classification into the three diagnostic categories, a machine learning model using the features from all five tasks achieved a classification accuracy of 75.2%, an improvement by 7.8% over that of the best single-task model. CONCLUSION Our results demonstrate that a common set of drawing features from multiple drawing tasks can capture different, complementary aspects of cognitive impairments, which may lead to a scalable way to improve the automated detection of AD and MCI.
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A systematic review and meta-analysis of studies on screening for mild cognitive impairment in primary healthcare. BMC Psychiatry 2022; 22:97. [PMID: 35139803 PMCID: PMC8827177 DOI: 10.1186/s12888-022-03730-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cognitive disorders and dementia have an important effect on individual independence and orientation. According to the Alzheimer's Disease International (ADI) 75% of people with dementia are not diagnosed; this may be as high as 90% in some low- and middle-income countries. This systematic review and meta-analysis aimed to identify the test performance of screening tools and compare them pairwise. The findings of our study can support countries in planning to establish and care for mild cognitive impairment in primary health centers. METHODS Medline (PubMed), Scopus, Cochrane, Dare, All EBM Reviews, CRD (OVID), and Proquest were searched from 2012 to November 2021. The risk of bias was assessed through the QUADAS-2 instrument. Given the high heterogeneity between studies, a random-effects model was used to calculate the pooled effect sizes for diagnostic accuracy measures (sensitivity, specificity, and area under curve indices). I2 test was used for assessing heterogeneity and predefined subgroup analyses were performed using participants' age, country's income, and sample size of studies. RESULTS A systematic search identified 18,132 records, of which, 20 studies were included in the quality assessment, and six were included in quantitative analysis. None of the studies had examined the feasibility or efficiency of mass screening. According to a pairwise comparison, IQCODE, AD8 and GPCOG showed equal or better diagnostic performance relative to the MMSE in terms of sensitivity and specificity. The random-effect model for the MMSE showed the pooled sensitivity equal to 0.73 (95% CI 0.57-0.90), the pooled specificity equal to 0.83 (95% CI 0.75-0.90), and the pooled AUC equal to 0.88 (95% CI 0.83-0.93). CONCLUSION Several benefits have been attached to short tests making them a suitable choice for use in primary healthcare settings. Considering factors such as accuracy, time of application, ease of scoring, and utilization charges, tests such as IQCODE, AD8, and GPCOG or appropriate combination with counterpart tools seem to be good alternatives to the use of the MMSE in primary care.
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Platen M, Fleßa S, Rädke A, Wucherer D, Thyrian JR, Mohr W, Scharf A, Mühlichen F, Hoffmann W, Michalowsky B. Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia. J Alzheimers Dis 2021; 83:1775-1787. [PMID: 34459396 PMCID: PMC8609693 DOI: 10.3233/jad-210439] [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] [Indexed: 01/02/2023]
Abstract
Background: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient’s preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could improve patient-reported outcomes for people living with dementia (PwD). Objective: This study aims to determine the prevalence of LvC and HvC in dementia and the associations of LvC and HvC with patients’ quality of life and hospitalization. Methods: The analysis was based on data of the DelpHi trial and included 516 PwD. Dementia-specific guidelines, the “Choosing Wisely” campaign and the PRISCUS list were used to indicate LvC and HvC treatments, resulting in 347 LvC and HvC related recommendations. Of these, 77 recommendations (51 for LvC, 26 for HvC) were measured within the DelpHi-trial and finally used for this analysis. The association of LvC and HvC treatments with PwD health-related quality of life (HRQoL) and hospitalization was assessed using multiple regression models. Results: LvC was highly prevalent in PwD (31%). PwD receiving LvC had a significantly lower quality of life (b = –0.07; 95% CI –0.14 – –0.01) and were significantly more likely to be hospitalized (OR = 2.06; 95% CI 1.26–3.39). Different HvC treatments were associated with both positive and negative changes in HRQoL. Conclusion: LvC could cause adverse outcomes and should be identified as early as possible and tried to be replaced. Future research should examine innovative models of care or treatment pathways supporting the identification and replacement of LvC in dementia.
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Affiliation(s)
- Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Steffen Fleßa
- Department of General Business Administration and Health Care Management, University of Greifswald, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
| | - Wiebke Mohr
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
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21
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Wimo A, Belger M, Bon J, Jessen F, Dumas A, Kramberger MG, Jamilis L, Johansson G, Rodrigo Salas A, Rodríguez Gómez O, Sannemann L, Stoekenbroek M, Gurruchaga Telleria M, Valero S, Vermunt L, Waterink L, Winblad B, Visser PJ, Zwan M, Boada M. A Cost-Consequence Analysis of Different Screening Procedures in Alzheimer's Disease: Results from the MOPEAD Project. J Alzheimers Dis 2021; 83:1149-1159. [PMID: 34420954 PMCID: PMC8543247 DOI: 10.3233/jad-210303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: For care planning and support, under-detection and late diagnosis of Alzheimer’s disease (AD) is a great challenge. Models of Patient-Engagement for Alzheimer’s Disease (MOPEAD) is an EU-funded project aiming at testing different strategies to improve this situation. Objective: To make a cost-consequence analysis of MOPEAD. Methods: Four screening strategies were tested in five countries (Germany, the Netherlands, Slovenia, Spain, and Sweden): 1) a web-approach; 2) Open-House initiative; 3) in primary care; and 4) by diabetes specialists. Persons-at-risk of AD in all strategies were offered referral to a hospital-based specialist. The primary health-economic outcome was the cost per true-positive case (TP) of AD from the screened population. Results: Of 2,847 screened persons, 1,121 screened positive (39%), 402 were evaluated at memory clinics (14%), and 236 got an AD diagnosis (8%). The cost per TP of those screened was €3,115 with the web-approach, €2,722 with the Open-House, €1,530 in primary care, and €1,190 by diabetes specialists. Sensitivity analyses that more likely reflect the real-world situation confirmed the results. The number-needed-to-screen was 30 with the web-approach, 8 with the Open-House and primary care, and 6 with the diabetes specialists. There were country differences in terms of screening rates, referrals to memory clinics, staff-types involved, and costs per TP. Conclusion: In primary care and by the diabetes specialist, the costs per TP/screened population were lowest, but the capacity of such settings to identify cases with AD-risk must be discussed. Hence new diagnostic strategies such as web-solutions and Open-House initiatives may be valuable after modifications.
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Affiliation(s)
- Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden
| | - Mark Belger
- Eli Lilly and Company Ltd (ELI), Bracknell, UK
| | - Jaka Bon
- University Medical Centre Ljubljana (UMCL), Ljubljana, Slovenia
| | - Frank Jessen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) Universität zu Köln, Köln, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Germany
| | - Annette Dumas
- ASDM Consulting, EU Affairs Director, Brussels, Belgium
| | - Milica G Kramberger
- Department of Neurology, University Medical Center Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Laura Jamilis
- GMV Soluciones Globales Internet S.A.U. (GMV), Spain
| | - Gunilla Johansson
- Department of Neurobiology, Care sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden
| | | | | | - Lena Sannemann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry, Cologne, Germany
| | | | - Miren Gurruchaga Telleria
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sergi Valero
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Lisa Vermunt
- Amsterdam UMC, VU University, Amsterdam, Amsterdam, the Netherlands
| | - Lisa Waterink
- Amsterdam UMC, VU University, Amsterdam, Amsterdam, the Netherlands
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden.,Karolinska University Hospital, Theme Inflammation and Aging, Huddinge, Sweden
| | | | - Marissa Zwan
- Amsterdam UMC, VU University, Amsterdam, Amsterdam, the Netherlands
| | - Mercè Boada
- Fundació ACE (FACE), Barcelona, Spain.,Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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22
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Campbell P, Rathod-Mistry T, Marshall M, Bailey J, Chew-Graham CA, Croft P, Frisher M, Hayward R, Negi R, Singh S, Tantalo-Baker S, Tarafdar S, Babatunde OO, Robinson L, Sumathipala A, Thein N, Walters K, Weich S, Jordan KP. Markers of dementia-related health in primary care electronic health records. Aging Ment Health 2021; 25:1452-1462. [PMID: 32578454 DOI: 10.1080/13607863.2020.1783511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Identifying routinely recorded markers of poor health in patients with dementia may help treatment decisions and evaluation of earlier outcomes in research. Our objective was to determine whether a set of credible markers of dementia-related health could be identified from primary care electronic health records (EHR). METHODS The study consisted of (i) rapid review of potential measures of dementia-related health used in EHR studies; (ii) consensus exercise to assess feasibility of identifying these markers in UK primary care EHR; (iii) development of UK EHR code lists for markers; (iv) analysis of a regional primary care EHR database to determine further potential markers; (v) consensus exercise to finalise markers and pool into higher domains; (vi) determination of 12-month prevalence of domains in EHR of 2328 patients with dementia compared to matched patients without dementia. RESULTS Sixty-three markers were identified and mapped to 13 domains: Care; Home Pressures; Severe Neuropsychiatric; Neuropsychiatric; Cognitive Function; Daily Functioning; Safety; Comorbidity; Symptoms; Diet/Nutrition; Imaging; Increased Multimorbidity; Change in Dementia Drug. Comorbidity was the most prevalent recorded domain in dementia (69%). Home Pressures were the least prevalent domain (1%). Ten domains had a statistically significant higher prevalence in dementia patients, one (Comorbidity) was higher in non-dementia patients, and two (Home Pressures, Diet/Nutrition) showed no association with dementia. CONCLUSIONS EHR captures important markers of dementia-related health. Further research should assess if they indicate dementia progression. These markers could provide the basis for identifying individuals at risk of faster progression and outcome measures for use in research.
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Affiliation(s)
- Paul Campbell
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Trishna Rathod-Mistry
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Michelle Marshall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - James Bailey
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Peter Croft
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Martin Frisher
- School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK
| | - Richard Hayward
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Rashi Negi
- Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Swaran Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shula Tantalo-Baker
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Suhail Tarafdar
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Opeyemi O Babatunde
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
| | - Louise Robinson
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - Athula Sumathipala
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Nwe Thein
- Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Kate Walters
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, London, UK
| | - Scott Weich
- Mental Health Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kelvin P Jordan
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
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23
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Seitz DP, Chan CC, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the detection of dementia within a primary care setting. Cochrane Database Syst Rev 2021; 7:CD011415. [PMID: 34261197 PMCID: PMC8406662 DOI: 10.1002/14651858.cd011415.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately detect dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the accuracy of the Mini-Cog for detecting dementia in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Calvin Ch Chan
- School of Medicine, Queen's University, Kingston, Canada
| | - Hailey T Newton
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Sudeep S Gill
- Department of Medicine, Queen's University, Kingston, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | | | - Bruce A Fage
- Department of Psychiatry, University of Toronto, Toronto, Canada
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24
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Shimoda A, Li Y, Hayashi H, Kondo N. Dementia risks identified by vocal features via telephone conversations: A novel machine learning prediction model. PLoS One 2021; 16:e0253988. [PMID: 34260593 PMCID: PMC8279312 DOI: 10.1371/journal.pone.0253988] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/16/2021] [Indexed: 12/16/2022] Open
Abstract
Due to difficulty in early diagnosis of Alzheimer's disease (AD) related to cost and differentiated capability, it is necessary to identify low-cost, accessible, and reliable tools for identifying AD risk in the preclinical stage. We hypothesized that cognitive ability, as expressed in the vocal features in daily conversation, is associated with AD progression. Thus, we have developed a novel machine learning prediction model to identify AD risk by using the rich voice data collected from daily conversations, and evaluated its predictive performance in comparison with a classification method based on the Japanese version of the Telephone Interview for Cognitive Status (TICS-J). We used 1,465 audio data files from 99 Healthy controls (HC) and 151 audio data files recorded from 24 AD patients derived from a dementia prevention program conducted by Hachioji City, Tokyo, between March and May 2020. After extracting vocal features from each audio file, we developed machine-learning models based on extreme gradient boosting (XGBoost), random forest (RF), and logistic regression (LR), using each audio file as one observation. We evaluated the predictive performance of the developed models by describing the receiver operating characteristic (ROC) curve, calculating the areas under the curve (AUCs), sensitivity, and specificity. Further, we conducted classifications by considering each participant as one observation, computing the average of their audio files' predictive value, and making comparisons with the predictive performance of the TICS-J based questionnaire. Of 1,616 audio files in total, 1,308 (81.0%) were randomly allocated to the training data and 308 (19.1%) to the validation data. For audio file-based prediction, the AUCs for XGboost, RF, and LR were 0.863 (95% confidence interval [CI]: 0.794-0.931), 0.882 (95% CI: 0.840-0.924), and 0.893 (95%CI: 0.832-0.954), respectively. For participant-based prediction, the AUC for XGboost, RF, LR, and TICS-J were 1.000 (95%CI: 1.000-1.000), 1.000 (95%CI: 1.000-1.000), 0.972 (95%CI: 0.918-1.000) and 0.917 (95%CI: 0.918-1.000), respectively. There was difference in predictive accuracy of XGBoost and TICS-J with almost approached significance (p = 0.065). Our novel prediction model using the vocal features of daily conversations demonstrated the potential to be useful for the AD risk assessment.
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Affiliation(s)
- Akihiro Shimoda
- Department of Public Health, McCann Healthcare Worldwide Japan Inc., Tokyo, Japan
| | - Yue Li
- Department of Public Health, McCann Healthcare Worldwide Japan Inc., Tokyo, Japan
| | - Hana Hayashi
- Department of Public Health, McCann Healthcare Worldwide Japan Inc., Tokyo, Japan
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Naoki Kondo
- Department of Social Epidemiology and Global Health, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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25
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Thomas JA, Burkhardt HA, Chaudhry S, Ngo AD, Sharma S, Zhang L, Au R, Hosseini Ghomi R. Assessing the Utility of Language and Voice Biomarkers to Predict Cognitive Impairment in the Framingham Heart Study Cognitive Aging Cohort Data. J Alzheimers Dis 2021; 76:905-922. [PMID: 32568190 DOI: 10.3233/jad-190783] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a need for fast, accessible, low-cost, and accurate diagnostic methods for early detection of cognitive decline. Dementia diagnoses are usually made years after symptom onset, missing a window of opportunity for early intervention. OBJECTIVE To evaluate the use of recorded voice features as proxies for cognitive function by using neuropsychological test measures and existing dementia diagnoses. METHODS This study analyzed 170 audio recordings, transcripts, and paired neuropsychological test results from 135 participants selected from the Framingham Heart Study (FHS), which includes 97 recordings of cognitively normal participants and 73 recordings of cognitively impaired participants. Acoustic and linguistic features of the voice samples were correlated with cognitive performance measures to verify their association. RESULTS Language and voice features, when combined with demographic variables, performed with an AUC of 0.942 (95% CI 0.929-0.983) in predicting cognitive status. Features with good predictive power included the acoustic features mean spectral slope in the 500-1500 Hz band, variation in the F2 bandwidth, and variation in the Mel-Frequency Cepstral Coefficient (MFCC) 1; the demographic features employment, education, and age; and the text features of number of words, number of compound words, number of unique nouns, and number of proper names. CONCLUSION Several linguistic and acoustic biomarkers show correlations and predictive power with regard to neuropsychological testing results and cognitive impairment diagnoses, including dementia. This initial study paves the way for a follow-up comprehensive study incorporating the entire FHS cohort.
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Affiliation(s)
| | | | | | | | | | | | - Rhoda Au
- Boston University, Boston, MA, USA
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26
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Wiese LK, Williams CL, Hain D, Newman D, Houston CP, Kaack C, Galvin JE. Detecting dementia among older, ethnically diverse residents of rural subsidized housing. Geriatr Nurs 2021; 42:524-532. [PMID: 33039199 PMCID: PMC8024416 DOI: 10.1016/j.gerinurse.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christine L Williams
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, United States.
| | - Debra Hain
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - David Newman
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christina P Houston
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Carolina Kaack
- Louis and Anne Green Memory & Wellness Center, 777 Glades Road, Bldg AZ-79, Boca Raton, FL 33431, United States
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, 5250 University Drive, Coral Gables, FL, United States.
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27
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Cations M, Lang CE, Ward SA, Crotty M, Whitehead C, Maddison J, Inacio M. Cohort profile: Dementia in the Registry of Senior Australians. BMJ Open 2021; 11:e039907. [PMID: 33526495 PMCID: PMC7852970 DOI: 10.1136/bmjopen-2020-039907] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Clinical quality registries (CQRs) are being established in many countries to monitor, benchmark, and report on the quality of dementia care over time. Case ascertainment can be challenging given that diagnosis occurs in a variety of settings. The Registry of Senior Australians (ROSA) includes a large cohort of people with dementia from all Australian states and territories identified using routinely collected aged care assessment data. In ROSA, assessment data are linked to information about aged and health service use, medicine dispensing, hospitalisations and the National Death Index. The ROSA dementia cohort was established to capture people for the Australian dementia CQR currently in development who may not be identified elsewhere. PARTICIPANTS There were 373 695 people with dementia identified in aged care assessments from 2008 to 2016. Cross-sectional analysis from the time of cohort entry (e.g. when first identified with dementia on an aged care assessment) indicates that individuals were 84.1 years old on average, and 63.1% were female. More than 44% were first identified at entry to permanent residential aged care. The cohort recorded more severe cognitive impairment at entry than other international dementia registries. FINDINGS TO DATE The cohort has so far been used to demonstrate a declining prevalence of dementia in individuals entering the aged care sector, examine trends in psychotropic medicine prescribing, and to examine the impact of dementia on aged care service use and outcomes. FUTURE PLANS The ROSA dementia cohort will be updated periodically and is a powerful resource both on its own and as a contributor to the Australian dementia CQR. Integration of the ROSA dementia cohort with the dementia CQR will ensure that people with dementia using aged care services can benefit from the ongoing monitoring and benchmarking of care that a registry can provide.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - John Maddison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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28
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Bohlken J, Riedel-Heller S, Steininger G, Kostev K, Michalowsky B. Trends in Dementia and Mild Cognitive Impairment Prevalence and Incidence in German General and Specialist Practices Between 2015 and 2019. J Alzheimers Dis 2021; 79:1683-1690. [PMID: 33459653 DOI: 10.3233/jad-201385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The number of patients with dementia is forecast to grow continuously. However, there are indications that the incidence and prevalence is falling in high-income countries. OBJECTIVE To examine whether any effects of declining incidence and prevalence rates of dementia and mild cognitive impairment (MCI) were evident in Germany between 2015 and 2019. METHODS The analysis was based on 797 general and 132 specialists (neurological/psychiatric) practices and included 10.1 million patients aged 18 years and older who visited between January 2014 and December 2019 one of the practitioners. The prevalence and incidence of dementia and MCI were demonstrated descriptively. RESULTS Between 2015 and 2019, the prevalence (incidence) of dementia decreased from 2.18%(0.44%) in 2015 to 2.07%(0.35%) in 2019. A relatively large decrease in the prevalence (incidence) of dementia was observed in patients aged 80 and older, at -1.47%(-0.62%), compared to younger patients, at -0.40%(-0.18%). By contrast, the prevalence and incidence of MCI have remained constant over the years (0.19%to 0.22%and 0.06%, respectively). Overall, the number of patients diagnosed with dementia decreased slightly by 1%while the number of patients diagnosed with MCI increased by 17%. CONCLUSION Our results confirmed the reduction in the prevalence and incidence of dementia and revealed a decrease in the number of patients with dementia despite continued demographic changes. Future studies are warranted to determine whether the results are caused by changing risk and lifestyle factors or changes in medical diagnosis and treatment behavior of the practitioners.
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Affiliation(s)
- Jens Bohlken
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty at the University of Leipzig, Leipzig, Germany.,Professional Association of German Neurologists, Germany
| | - Steffi Riedel-Heller
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty at the University of Leipzig, Leipzig, Germany
| | - Gilles Steininger
- Department of Medicine, University Clinic of Marburg, Marburg, Germany
| | | | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany
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29
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Rosenwohl-Mack A, Dubbin L, Chodos A, Dulaney S, Fang ML, Merrilees J, Portacolone E. Use of Services by People Living Alone With Cognitive Impairment: A Systematic Review. Innov Aging 2021; 5:igab004. [PMID: 33796795 PMCID: PMC7990060 DOI: 10.1093/geroni/igab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Formal supports and social services are essential to people living alone with cognitive impairment (PLACI) because they are at risk of negative health outcomes and lack cohabitants who may support them with cognitively demanding tasks. To further our understanding of this critical and worldwide issue, we conducted a systematic review to understand whether, and how, PLACI access and use essential formal supports and services. RESEARCH DESIGN AND METHODS We searched 6 databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts) to identify quantitative and mixed-method literature on formal service use among PLACI. The initial search was conducted in 2018 and updated in 2020. RESULTS We identified 32 studies published between 1992 and 2019, representing 13 countries, that met our criteria: 16 reported on health services and 26 on social services. Most studies compared PLACI with people with cognitive impairment living with others. Health service use was lower or similar among PLACI, as opposed to counterparts living with others. Most studies reported a higher use of social services (e.g., home services) among PLACI than those living with others. Overall use of essential home service among PLACI was higher in Europe than in the United States, a country where large portions of PLACI were reported receiving no formal services. DISCUSSION AND IMPLICATIONS We identified wide variability among countries and major gaps in service use. Results for use of health services were mixed, although our findings suggest that PLACI may have fewer physician visits than counterparts living with others. Our findings suggest that varying policies and budgets for these services among countries may have affected our findings. We encourage researchers to evaluate and compare the influence of social policies in the well-being of PLACI. We also encourage policy makers to prioritize the needs of PLACI in national dementia strategies.
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Affiliation(s)
- Amy Rosenwohl-Mack
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, USA
| | - Leslie Dubbin
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, USA
| | - Anna Chodos
- Division of Geriatrics, University of California San Francisco, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, USA
| | - Sarah Dulaney
- Memory and Aging Center, University of California San Francisco, USA
| | - Min-Lin Fang
- Library, University of California San Francisco, USA
| | | | - Elena Portacolone
- Institute for Health & Aging, University of California San Francisco, USA
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Rodríguez-Salgado AM, Llibre-Guerra JJ, Tsoy E, Peñalver-Guia AI, Bringas G, Erlhoff SJ, Kramer JH, Allen IE, Valcour V, Miller BL, Llibre-Rodríguez JJ, Possin KL. A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults. J Alzheimers Dis 2021; 79:85-94. [PMID: 33216033 PMCID: PMC8216130 DOI: 10.3233/jad-200985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). OBJECTIVE To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. METHODS In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. RESULTS The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. CONCLUSION The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.
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Affiliation(s)
- Ana M Rodríguez-Salgado
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Jorge J Llibre-Guerra
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Elena Tsoy
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Ana Ibis Peñalver-Guia
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Giosmany Bringas
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Sabrina J Erlhoff
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Victor Valcour
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Katherine L Possin
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
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Bertsias A, Symvoulakis E, Tziraki C, Panagiotakis S, Mathioudakis L, Zaganas I, Basta M, Boumpas D, Simos P, Vgontzas A, Lionis C. Cognitive Impairment and Dementia in Primary Care: Current Knowledge and Future Directions Based on Findings From a Large Cross-Sectional Study in Crete, Greece. Front Med (Lausanne) 2020; 7:592924. [PMID: 33330553 PMCID: PMC7719838 DOI: 10.3389/fmed.2020.592924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/29/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Dementia severely affects the quality of life of patients and their caregivers; however, it is often not adequately addressed in the context of a primary care consultation, especially in patients with multi-morbidity. Study Population and Methods: A cross-sectional study was conducted between March-2013 and December-2014 among 3,140 consecutive patients aged >60 years visiting 14 primary health care practices in Crete, Greece. The Mini-Mental-State-Examination [MMSE] was used to measure cognitive status using the conventional 24-point cut-off. Participants who scored low on MMSE were matched with a group of elders scoring >24 points, according to age and education; both groups underwent comprehensive neuropsychiatric and neuropsychological assessment. For the diagnosis of dementia and Mild-Cognitive-Impairment (MCI), the Diagnostic and Statistical Manual-of-Mental-Disorders (DSM-IV) criteria and the International-Working-Group (IWG) criteria were used. Chronic conditions were categorized according to ICD-10 categories. Logistic regression was used to provide associations between chronic illnesses and cognitive impairment according to MMSE scores. Generalized Linear Model Lasso Regularization was used for feature selection in MMSE items. A two-layer artificial neural network model was used to classify participants as impaired (dementia/MCI) vs. non-impaired. Results: In the total sample of 3,140 participants (42.1% men; mean age 73.7 SD = 7.8 years), low MMSE scores were identified in 645 (20.5%) participants. Among participants with low MMSE scores 344 (54.1%) underwent comprehensive neuropsychiatric evaluation and 185 (53.8%) were diagnosed with Mild-Cognitive-Impairment (MCI) and 118 (34.3%) with dementia. Mental and behavioral disorders (F00-F99) and diseases of the nervous system (G00-G99) increased the odds of low MMSE scores in both genders. Generalized linear model lasso regularization indicated that 7/30 MMSE questions contributed the most to the classification of patients as impaired (dementia/MCI) vs. non-impaired with a combined accuracy of 82.0%. These MMSE items were questions 5, 13, 19, 20, 22, 23, and 26 of the Greek version of MMSE assessing orientation in time, repetition, calculation, registration, and visuo-constructive ability. Conclusions: Our study identified certain chronic illness-complexes that were associated with low MMSE scores within the context of primary care consultation. Also, our analysis indicated that seven MMSE items provide strong evidence for the presence of dementia or MCI.
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Affiliation(s)
- Antonios Bertsias
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Chariklia Tziraki
- MELABEV - Community Clubs for Eldercare, Research and Development Department, Jerusalem, Israel
| | - Symeon Panagiotakis
- Department of Internal Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Lambros Mathioudakis
- Department of Neurology, School of Medicine, University of Crete, Heraklion, Greece
| | - Ioannis Zaganas
- Department of Neurology, School of Medicine, University of Crete, Heraklion, Greece
| | - Maria Basta
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitrios Boumpas
- Department of Internal Medicine, School of Medicine, University of Athens, Athens, Greece
| | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece
- Computational Biomedicine Lab, Institute of Computer Science, Foundation for Research and Technology-Hellas, Herakleion, Greece
| | - Alexandros Vgontzas
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Monsees J, Schmachtenberg T, Hoffmann W, Kind A, Gilmore-Bykovskyi A, Kim AJ, Thyrian JR. Dementia in People with a Turkish Migration Background: Experiences and Utilization of Healthcare Services. J Alzheimers Dis 2020; 77:865-875. [PMID: 32741814 PMCID: PMC7508884 DOI: 10.3233/jad-200184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As the proportion of older people with migration background (PwM) increases, the proportion of older PwM with dementia might also increase. Dementia is underdiagnosed in this group and a large proportion of PwM with dementia and family caregivers are not properly supported. Healthcare utilization is lower among older migrant populations. Thus, a better understanding of how PwM and family caregivers perceive their situation and how they experience healthcare services is needed to improve utilization of the healthcare system. OBJECTIVE Analyze how family caregivers of PwM with dementia experience their situation, why healthcare services are utilized less often, and what can be done to reverse this. METHODS Eight semi-structured interviews were conducted with people with Turkish migration background caring for PwM with dementia. Qualitative content analysis was used for data analysis. RESULTS Daily care was performed by one family member with the support of others. Healthcare services were used by most participants. Participants identified a need for better access to relevant information and incorporation of Turkish culture into healthcare services. CONCLUSION PwM face similar challenges in taking care of persons with dementia as those without migration background. There is a willingness to use services, and services embracing Turkish culture would help to reduce hesitance and make affected people feel more comfortable, thereby increasing utilization and satisfaction. A limitation of this study is that participants were already connected to health services, which may not reflect the help-seeking behavior of those in the Turkish community who are not involved in healthcare.
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Affiliation(s)
- Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Tim Schmachtenberg
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Amy Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA
| | - Andrea Gilmore-Bykovskyi
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA.,University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Alice J Kim
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Chew KA, Chong EJY, Chen CLH, Xu X. Psychometric Properties of the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network Neuropsychological Battery in an Asian Older Adult Sample. J Am Med Dir Assoc 2020; 21:879-883.e1. [PMID: 32444287 DOI: 10.1016/j.jamda.2020.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite the wide usage of the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network (NINDS-CSN) neuropsychological battery for the detection of vascular cognitive impairment, its reliability and validity have not been established. Therefore, the present study established the psychometric properties of the battery in cognitively normal older adults in a clinical setting in Singapore. DESIGN Longitudinal study. SETTING AND PARTICIPANTS A total of 105 cognitively normal older adults age 50 years and older were assessed in a memory clinic setting. METHODS The 60-minute NINDS-CSN and 5-minute protocol were administered to participants at baseline and 3-month follow-up. Raw scores were transformed into standardized z scores. Test-retest reliability, concurrent validity and construct (convergent and discriminant) validity were reported. RESULTS Moderate-to-excellent test-retest reliability (r = 0.36-0.87), concurrent validity, and construct validity (r = 0.41-0.83) were found in both protocols over 3 months (all Ps < 0.01). Although the 5-minute protocol showed moderate validity (r = 0.41), the 60-minute protocol had excellent concurrent validity against a locally validated neuropsychological battery (r = 0.83). CONCLUSION AND IMPLICATIONS The NINDS-CSN is reliable and valid in assessing cognitive function. The 60-minute protocol demonstrates great utility beyond its current usage in vascular cognitive impairment populations to the general older adult population. The 5-minute protocol can be used as a brief cognitive screening tool in primary healthcare and the community, due to its brevity and accuracy. Future research should further examine the generalizability of the NINDS-CSN battery in other dementias and cognitive disorders.
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Affiliation(s)
- Kimberly A Chew
- Department of Pharmacology, National University of Singapore; Memory Aging and Cognition Centre, National University Health System
| | - Eddie J Y Chong
- Memory Aging and Cognition Centre, National University Health System; Department of Psychological Medicine, National University Hospital
| | - Christopher L H Chen
- Department of Pharmacology, National University of Singapore; Memory Aging and Cognition Centre, National University Health System
| | - Xin Xu
- Department of Pharmacology, National University of Singapore; The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; School of Public Health, Zhejiang University.
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Wang M, Xu X, Huang Y, Shao S, Chen X, Li J, Du J. Knowledge, attitudes and skills of dementia care in general practice: a cross-sectional study in primary health settings in Beijing, China. BMC FAMILY PRACTICE 2020; 21:89. [PMID: 32416731 PMCID: PMC7231407 DOI: 10.1186/s12875-020-01164-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/10/2020] [Indexed: 12/25/2022]
Abstract
Background General practitioners (GPs) play a significant role in dementia care. However, the knowledge and attitudes of them towards dementia care are poorly characterized. The present study aimed to investigate GPs’ knowledge, attitudes and skills of dementia care in primary health settings in Beijing. Methods A cross-sectional survey was conducted in 27 community health service centers (CHSCs) in Beijing. The GPs’ knowledge, attitudes and skills were assessed utilizing the Alzheimer’s Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and self-designed questionnaire, respectively. Results A total of 341 participants returned the questionnaire. The overall mean score of GPs’ dementia knowledge measured by the ADKS was 21.42 (SD = 2.73) out of 30 (71.4%), GPs’ attitudes to dementia care was 36.25 (SD = 5.12) out of 50 (72.5%), and GPs’ self-confidence on dementia care skills was 53.93 (SD = 9.57) out of 75 (71.9%). GPs’ overall knowledge towards dementia care was limited and the attitudes were generally positive. They had low level recognition of their roles towards dementia care. The majority of GPs believed that dementia care was within a specialist’s domain not that of general practice. Conclusion GPs demonstrate low levels of dementia knowledge and skills, but express generally positive attitudes towards dementia in this study. It is much needed to translate detailed dementia care handbook, and adequate dementia knowledge training for GPs into practice to improve care outcomes for people with dementia in China. In addition, dementia management should be covered in the national basic package of public health services in primary care.
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Affiliation(s)
- Meirong Wang
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Xiaojingyuan Xu
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Yafang Huang
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Shuang Shao
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Xiaolei Chen
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China
| | - Jing Li
- Dongfeng Community Health Service Center, Chaoyang district, Nan Shi Li Ju, Beijing, 100016, China.
| | - Juan Du
- School of General Practice and Continuing Education, Capital Medical University, No. 10, You An Men Wai Xi Tou Tiao, Beijing, 100069, China.
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Zwingmann I, Michalowsky B, Esser A, Kaczynski A, Monsees J, Keller A, Hertel J, Wucherer D, Thyrian JR, Eichler T, Kilimann I, Teipel S, Dreier Wolfgramm A, Hoffmann W. Identifying Unmet Needs of Family Dementia Caregivers: Results of the Baseline Assessment of a Cluster-Randomized Controlled Intervention Trial. J Alzheimers Dis 2020; 67:527-539. [PMID: 30584136 PMCID: PMC6398541 DOI: 10.3233/jad-180244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caregivers providing informal care for people with dementia (PwD) often report unmet needs, burden, and health impairments. Optimal support for family dementia caregivers will likely benefit from better understanding and assessment of the prevalence and types of caregivers' unmet needs and associated socio-demographic and clinical characteristics. OBJECTIVE The present study investigates 1) the number and types of caregivers' unmet needs, 2) socio-demographic and clinical characteristics of both PwD and caregivers, and 3) caregivers' burden and health-related outcomes that are related to caregivers' unmet needs. METHODS The present analyses are based on cross-sectional data of n = 226 dyads of caregivers and their community-dwelling PwD participating in a comprehensive standardized, computer-based caregivers' needs assessment within a general practitioner (GP)-based, cluster-randomized intervention trial. RESULTS A total of n = 505 unmet needs were identified for n = 171 caregivers from the intervention group at baseline. Only 24.3% caregivers reported no unmet need (n = 55), whereas 75.7% caregivers had at least one unmet need (n = 171). Caregivers had on average 2.19 unmet needs (mean = 2.19, SD = 2.15). Specifically, 53.1% of caregivers had one up to three unmet needs (n = 120), 18.6% (n = 42) had three up to six unmet needs, and 4.0% (n = 9) had more than six unmet needs. DISCUSSION Our results underline the importance of a comprehensive needs assessment for family dementia caregivers to develop and implement concepts that can provide family dementia caregivers with optimal support.
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Affiliation(s)
- Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Alexander Esser
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Adina Dreier Wolfgramm
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Düzel E, Thyrian JR, Berron D. [Innovation in diagnostics-mobile technologies]. DER NERVENARZT 2019; 90:914-920. [PMID: 31420690 DOI: 10.1007/s00115-019-0773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Progressive cognitive deficits are the main clinical symptom of Alzheimer's disease; however, the precise recording of cognitive deficits and assessment of their progression pose major problems in patient care and early interventions. OBJECTIVE Which problems for care and early intervention result from the current practice of cognitive assessment of patients with memory problems and which opportunities arise from the use of mobile apps? MATERIAL AND METHODS Evaluation of current care structures, discussion of basic work, expert recommendations and current developments. RESULTS The current practice of the pencil and paper-based diagnostics of cognitive deficits, which is temporally and spatially bound to a clinical environment, constrains the feasibility, validity and reliability of cognitive assessment and the quantification of progression. This limits the meaningful use of further diagnostic measures, such as magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analyses. Recent progress in mobile app-based technologies, illustrated here with the example of the neotiv app, can help to overcome these problems. CONCLUSION Mobile app-based technologies can help to improve the cognitive assessment of patients with the main symptom of memory complaints. They can reduce overuse and underuse of diagnostic and therapeutic pathways and enable a targeted and meaningful use of advanced diagnostics. In addition, they can structure risk-modifying preventive measures, identify iatrogenic impairment of cognition and in this respect also strengthen patient competence.
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Affiliation(s)
- Emrah Düzel
- Institut für Kognitive Neurologie und Demenzforschung (IKND), Magdeburg, Deutschland. .,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Greifswald, Greifswald, Deutschland.,Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - David Berron
- Institut für Kognitive Neurologie und Demenzforschung (IKND), Magdeburg, Deutschland.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.,Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Schweden
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Thyrian JR, Hertel J, Schulze LN, Dörr M, Prüss H, Hempel P, Bimmler M, Kunze R, Grabe HJ, Teipel S, Hoffmann W. Prevalence and Determinants of Agonistic Autoantibodies Against α1-Adrenergic Receptors in Patients Screened Positive for Dementia: Results from the Population-Based DelpHi-Study. J Alzheimers Dis 2019; 64:1091-1097. [PMID: 30010118 DOI: 10.3233/jad-171096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a need to assess promising biomarkers for diagnosis and treatment response in real-life settings. Despite the important role of vascular risk factors, cardiovascular biomarkers have played a minor role in dementia research. Agonistic autoantibodies (agAAB) directed against G-protein-coupled receptors (GPCR) are discussed as modulators of pathology and clinical manifestation. OBJECTIVE 1) Describe prevalence of agAAB directed against GPCR, especially agABB against α1-adrenergic receptors (α1-AR-agAAB) and agABB directed against β2-adrenergic receptors (β2-AR-agAAB) and 2) identify factors associated with agAAB in people with dementia during routine care. METHODS Blood samples and data from 95 subjects who screened positive for dementia from a primary care cohort, analyzed using an enzyme-linked immunosorbent assay (ELISA) for detecting agAAB. Sociodemographic and clinical data were assessed, and medical records checked. RESULTS In 40 (42%) samples, agAAB was detected, with n = 29 (31%) representing α1-AR-agAAB and n = 21 (22%) β2-AR-agAAB. There was no association between the presence of any antibody and a formal diagnosis of dementia. However, patients with coronary heart disease were more likely (OR = 4.23) to have α1-AR-agAAB than those without coronary heart disease. There were no associations between agAAB and age, sex, education, or cognitive impairment. DISCUSSION For the first time, we show that autoantibodies have a significant prevalence in people with dementia in a routine care setting. Previous findings were restricted to highly selective samples. We replicated the association between α1-AR-agAAB in patients with coronary heart diseases but were not able to find other factors associated with the presence of agAAB.
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Pelegrini LNC, Mota GMP, Ramos CF, Jesus E, Vale FAC. Diagnosing dementia and cognitive dysfunction in the elderly in primary health care: A systematic review. Dement Neuropsychol 2019; 13:144-153. [PMID: 31285788 PMCID: PMC6601305 DOI: 10.1590/1980-57642018dn13-020002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/20/2019] [Indexed: 11/21/2022] Open
Abstract
Dementia is a public health issue making the screening and diagnosing of dementia and its prodromal phases in all health settings imperative. OBJECTIVE using PRISMA, this systematic review aimed to identify how low-, middle-, and high-income countries establish dementia and cognitive dysfunction diagnoses in primary health care. METHODS studies from the past five years in English, Spanish, and Portuguese were retrieved from Scopus, PubMed, Embase, Lilacs, Scielo, and Web of Science. Of 1987 articles, 33 were selected for analysis. RESULTS only three articles were from middle-income countries and there were no studies from low-income countries. The most used instrument was the Mini-Mental State Examination (MMSE). Mild Cognitive Impairment (MCI) and dementia criteria were based on experts' recommendation as well as on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), respectively. CONCLUSION differences between these criteria among high- and middle-income countries were observed.
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Affiliation(s)
- Lucas N C Pelegrini
- PhD student on the Graduate Program in Fundamental Nursing - Nursing School of Ribeirão Preto/ University of São Paulo (EERP/USP), Ribeirão Preto, SP, Brazil
| | - Gabriela M P Mota
- Master's student on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Caio F Ramos
- Master's student on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Francisco A C Vale
- Professor on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Ponjoan A, Garre-Olmo J, Blanch J, Fages E, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, Garcia-Gil M, Ramos R. Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care. Clin Epidemiol 2019; 11:217-228. [PMID: 30881138 PMCID: PMC6407519 DOI: 10.2147/clep.s186590] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Updated estimates of incidence and prevalence of dementia are crucial to ensure adequate public health policy. However, most of the epidemiological studies in the population in Spain were conducted before 2010. This study assessed the validity of dementia diagnoses recorded in electronic health records contained in a large primary-care database to determine if they could be used for research purposes. Then, to update the epidemiology of dementia in Catalonia (Spain), we estimated crude and standardized prevalence and incidence rates of dementia in Catalonia in 2016. Methods The System for the Development of Research in Primary Care (SIDIAP) database contains anonymized information for >80% of the Catalan population. Validity of dementia codes in SIDIAP was assessed in patients at least 40 years old by asking general practitioners for additional evidence to support the diagnosis. Crude and standardized incidence and prevalence (95% CI) in people aged ≥65 years were estimated assuming a Poisson distribution. Results The positive predictive value of dementia diagnoses recorded in SIDIAP was estimated as 91.0% (95% CI 87.5%–94.5%). Age-and sex-standardized incidence and prevalence of dementia were 8.6/1,000 person-years (95% CI 8.0–9.3) and 5.1% (95% CI 4.5%–5.7%), respectively. Conclusion SIDIAP contains valid dementia records. We observed incidence and prevalence estimations similar to recent face-to-face studies conducted in Spain and higher than studies using electronic health data from other European populations.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,Santa Clara Primary Care Health Center, Catalan Health Institute, Girona, Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Ester Fages
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.,Santa Clara Primary Care Health Center, Catalan Health Institute, Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - María Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain,
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain, .,Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain,
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Zaganas IV, Simos P, Basta M, Kapetanaki S, Panagiotakis S, Koutentaki I, Fountoulakis N, Bertsias A, Duijker G, Tziraki C, Scarmeas N, Plaitakis A, Boumpas D, Lionis C, Vgontzas AN. The Cretan Aging Cohort: Cohort Description and Burden of Dementia and Mild Cognitive Impairment. Am J Alzheimers Dis Other Demen 2019; 34:23-33. [PMID: 30259758 PMCID: PMC10852504 DOI: 10.1177/1533317518802414] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Our aim was to explore the burden of dementia in the Cretan Aging Cohort, comprised of 3140 persons aged ≥60 years (56.8% women, 5.8 ± 3.3 years formal education, 86.2% living in rural areas) who attended selected primary health-care facilities on the island of Crete, Greece. In the first study phase, a formal diagnosis of dementia had been reached in 4.0% of the participants. However, when selected 505 participants underwent thorough neuropsychiatric evaluation in the second phase of this study (344 with Mini-Mental State Examination [MMSE] <24 and 161 with MMSE ≥24), and results were extrapolated to the entire cohort, the prevalence of dementia and mild cognitive impairment was estimated at 10.8% (9.7%-11.9%) and 32.4% (30.8%-34.0%), respectively. Using both the field diagnostic data and the extrapolated data, the highest dementia prevalence (27.2%) was found in the 80- to 84-year-old group, who also showed the lowest educational level, apparently due to lack of schooling during World War II.
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Affiliation(s)
- Ioannis V. Zaganas
- Neurology Department, Medical School, Heraklion, University of Crete, Crete, Greece
| | - Panagiotis Simos
- Psychiatry Department, University of Crete, Medical School, Heraklion, Crete, Greece
- Foundation of Research and Technology, Institute of Computer Science, Heraklion, Greece
| | - Maria Basta
- Psychiatry Department, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Stefania Kapetanaki
- Neurology Department, Medical School, Heraklion, University of Crete, Crete, Greece
| | - Symeon Panagiotakis
- Internal Medicine Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Irini Koutentaki
- Psychiatry Department, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Nikolaos Fountoulakis
- Internal Medicine Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Antonios Bertsias
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Crete, Greece
| | - George Duijker
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Chariklia Tziraki
- Research Department, Community Elders Club, Melabev, Jerusalem, Israel
| | - Nikolaos Scarmeas
- Department of Social Medicine, Psychiatry and Neurology, 1st Neurology Clinic, Aiginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Plaitakis
- Neurology Department, Mount Sinai School of Medicine, New York, NY, USA
| | - Dimitrios Boumpas
- Internal Medicine Department, Medical School, University of Athens, Athens, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Crete, Greece
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Abstract
The importance of better care integration is emphasized in many national dementia plans. The inherent complexity of organizing care for people with dementia provides both the justification for improving care integration and the challenges to achieving it. The prevention, detection, and early diagnosis of cognitive disorders mainly resides in primary care, but how this is best integrated within the range of disorders that primary care clinicians are expected to screen is unclear. Models of integrated community dementia assessment and management have varying degrees of involvement of primary and specialist care, but share an emphasis on improving care coordination, interdisciplinary teamwork, and personalized care. Integrated care strategies in acute care are still in early development, but have been a focus of investigation in the past decade. Integrated care outreach strategies to reduce transfers from long-term residential care to acute care have been consistently effective. Integrated long-term residential care includes considerations of end-of-life care. Future directions should include strategies for training and education, early detection in anticipation of disease modifying treatments, integration of technological developments into dementia care, integration of dementia care into general health and social care, and the encouragement of a dementia-friendly society.
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Affiliation(s)
- Brian Draper
- a School of Psychiatry , University of NSW , Sydney , NSW , Australia
| | - Lee-Fay Low
- b Faculty of Health Sciences , University of Sydney , Sydney , NSW , Australia
| | - Henry Brodaty
- c Centre for Healthy Brain Ageing , University of NSW Sydney , Sydney , NSW , Australia
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[Prevalence of dementia in people with a migration background in Germany]. Z Gerontol Geriatr 2018; 52:654-660. [PMID: 30377762 DOI: 10.1007/s00391-018-01469-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/11/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In Germany the number of people with a migration background was 16.5 million people in 2013 with 9% being older than 65 years. In this population utilization of health services is low, especially in older people, although they often display worse health outcomes. Little is known about the number of people with dementia and migration background in Germany and their distribution on the state level, resulting in a challenge that is barely assessable for the healthcare system. OBJECTIVE The depiction of the prevalence of dementia in people with a migration background for Germany and the individual federal states. METHOD The number of people with a migration background and dementia living in Germany and the individual federal states was estimated for different ethnic groups using country and state-specific data on the population, dementia frequency and age-specific prevalence. RESULTS Out of 1.86 million people with a migration background who are 65 years or older, approximately 96,500 persons (5.2%) have dementia. The majority are of European (84,490), more specifically Polish (13,960), Italian (8920) and Turkish (8840) heritage. North Rhine-Westphalia (26,000), Baden-Wuerttemberg (18,080) and Bavaria (16,710) are presumed to show the highest rates of people affected. CONCLUSION In Germany people with a migration background and dementia represent a large target group for health care; however, the numbers and ethnic populations affected differ considerably between states. These analyses can be used for state-specific healthcare planning of culture-specific and culture-sensitive services and care so that specific healthcare improvements can be achieved.
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Rosa IM, Henriques AG, Wiltfang J, da Cruz E Silva OAB. Putative Dementia Cases Fluctuate as a Function of Mini-Mental State Examination Cut-Off Points. J Alzheimers Dis 2018; 61:157-167. [PMID: 29125486 DOI: 10.3233/jad-170501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As the population ages, there is a growing need to quickly and accurately identify putative dementia cases. Many cognitive tests are available; among those commonly used are the Cognitive Dementia Rating (CDR) and the Mini-Mental Status Examination (MMSE). The aim of this work was to compare the validity and reliability of these cognitive tests in a primary care based cohort (pcb-Cohort). The MMSE and the CDR were applied to 568 volunteers in the pcb-Cohort. Distinct cut-off points for the MMSE were considered, namely MMSE 27, MMSE 24, and MMSE PT (adapted for the Portuguese population). The MMSE 27 identified the greatest number of putative dementia cases, and, as determined by the ROC curve, it was the most sensitive and specific of the MMSE cut-offs considered. Putative predictive or risk factors identified included age, literacy, depression, and diabetes mellitus (DM). DM has previously been indicated as a risk factor for dementia and Alzheimer's disease. Comparatively, the MMSE 27 cut-off has the greatest sensibility (94.9%) and specificity (66.3%) when compared to MMSE PT and MMSE 24. Upon comparing MMSE and CDR scores, the latter identified a further 146 putative dementia cases, thus permitting one to propose that in an ideal situation, both tests should be employed. This increases the likelihood of identifying putative dementia cases for subsequent follow up work, thus these cognitive tests represent important tools in patient care. Further, this is a significant study for Portuguese populations, where few of these studies have been carried out.
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Affiliation(s)
- Ilka M Rosa
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Ana G Henriques
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Jens Wiltfang
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal.,Department of Psychiatry and Psychotherapy, University Medicine Göttingen, Göttingen, Germany
| | - Odete A B da Cruz E Silva
- Department of Medical Sciences, Neuroscience and Signalling Laboratory, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
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Seitz DP, Chan CCH, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting. Cochrane Database Syst Rev 2018; 2:CD011415. [PMID: 29470861 PMCID: PMC6491332 DOI: 10.1002/14651858.cd011415.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately diagnose dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the diagnostic accuracy of the Mini-Cog for diagnosing Alzheimer's disease dementia and related dementias in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Calvin CH Chan
- Queen's UniversitySchool of Medicine49 King Street EastKingstonONCanadaK7L 2Z5
| | - Hailey T Newton
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Sudeep S Gill
- Queen's UniversityDepartment of MedicineSt. Mary's of the Lake Hospital340 Union StreetKingstonONCanadaK7L 5A2
| | - Nathan Herrmann
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueRoom FG‐05TorontoONCanadaM4N 3M5
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | | | - Bruce A Fage
- University of TorontoDepartment of PsychiatryTorontoONCanada
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Delwel S, Binnekade TT, Perez RSGM, Hertogh CMPM, Scherder EJA, Lobbezoo F. Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues. Clin Oral Investig 2018; 22:93-108. [PMID: 29143189 PMCID: PMC5748411 DOI: 10.1007/s00784-017-2264-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/24/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published. OBJECTIVE To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues. METHODS A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list. RESULTS The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia. CONCLUSIONS The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow. SCIENTIFIC RATIONALE FOR STUDY With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia. PRINCIPAL FINDINGS Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow. PRACTICAL IMPLICATIONS The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.
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Affiliation(s)
- Suzanne Delwel
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands.
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands.
| | - Tarik T Binnekade
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Faculty of Medicine, Department of Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands
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Corriveau RA, Koroshetz WJ, Gladman JT, Jeon S, Babcock D, Bennett DA, Carmichael ST, Dickinson SLJ, Dickson DW, Emr M, Fillit H, Greenberg SM, Hutton ML, Knopman DS, Manly JJ, Marder KS, Moy CS, Phelps CH, Scott PA, Seeley WW, Sieber BA, Silverberg NB, Sutherland ML, Taylor A, Torborg CL, Waddy SP, Gubitz AK, Holtzman DM. Alzheimer's Disease-Related Dementias Summit 2016: National research priorities. Neurology 2017; 89:2381-2391. [PMID: 29117955 DOI: 10.1212/wnl.0000000000004717] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/05/2017] [Indexed: 01/02/2023] Open
Abstract
Goal 1 of the National Plan to Address Alzheimer's Disease is to prevent and effectively treat Alzheimer disease and Alzheimer disease-related dementias by 2025. To help inform the research agenda toward achieving this goal, the NIH hosts periodic summits that set and refine relevant research priorities for the subsequent 5 to 10 years. This proceedings article summarizes the 2016 Alzheimer's Disease-Related Dementias Summit, including discussion of scientific progress, challenges, and opportunities in major areas of dementia research, including mixed-etiology dementias, Lewy body dementia, frontotemporal degeneration, vascular contributions to cognitive impairment and dementia, dementia disparities, and dementia nomenclature.
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Affiliation(s)
- Roderick A Corriveau
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO.
| | - Walter J Koroshetz
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Jordan T Gladman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Sophia Jeon
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Debra Babcock
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David A Bennett
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - S Thomas Carmichael
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Susan L-J Dickinson
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Dennis W Dickson
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Marian Emr
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Howard Fillit
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Steven M Greenberg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Michael L Hutton
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David S Knopman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Jennifer J Manly
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Karen S Marder
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Claudia S Moy
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Creighton H Phelps
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Paul A Scott
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - William W Seeley
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Beth-Anne Sieber
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Nina B Silverberg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Margaret L Sutherland
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Angela Taylor
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Christine L Torborg
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Salina P Waddy
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - Amelie K Gubitz
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
| | - David M Holtzman
- From the National Institute of Neurological Disorders and Stroke (R.A.C., W.J.K., J.T.G., S.J., D.B., M.E., C.S.M., P.A.S., B.-A.S., M.L.S., C.L.T., A.K.G.), Bethesda, MD; Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (S.T.C.), David Geffen School of Medicine, University of California, Los Angeles; The Association for Frontotemporal Degeneration (S.L.-J.D.), Radnor, PA; Department of Neuroscience (D.W.D.), Mayo Clinic, Jacksonville, FL; The Alzheimer's Drug Discovery Foundation (H.F.); Icahn School of Medicine at Mount Sinai (H.F.), New York, NY; Department of Neurology (S.M.G.), Massachusetts General Hospital, Harvard Medical School, Boston; Eli Lilly and Company (M.L.H.), Lilly Research Centre, Erl Wood Manor, Windlesham, UK; Department of Neurology (D.S.K.), Mayo Clinic Rochester, MN; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.J.M., K.S.M.) and College of Physicians and Surgeons (K.S.M.), Columbia University, New York, NY; National Institute on Aging (C.H.P., N.B.S.), Bethesda, MD; Memory and Aging Center, Department of Neurology (W.W.S.), and Department of Pathology (W.W.S.), University of California San Francisco; Lewy Body Dementia Association (A.T.), Lilburn, GA; National Institute of Diabetes and Digestive and Kidney Diseases (S.P.W.), Bethesda, MD; and Knight Alzheimer's Disease Research Center (D.M.H.), Hope Center for Neurological Disorders (D.M.H.), and Department of Neurology (D.M.H.), Washington University in St. Louis, MO
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Thyrian JR, Eichler T, Michalowsky B, Wucherer D, Reimann M, Hertel J, Richter S, Dreier A, Hoffmann W. Community-Dwelling People Screened Positive for Dementia in Primary Care: A Comprehensive, Multivariate Descriptive Analysis Using Data from the DelpHi-Study. J Alzheimers Dis 2017; 52:609-17. [PMID: 27031481 DOI: 10.3233/jad-151076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Efficient help and care for people with dementia (PWD) is dependent on knowledge about PWD in primary care. OBJECTIVE This analysis comprehensively describes community-dwelling PWD in primary care with respect to various dementia care specific variables. METHODS The analyses are based on baseline data of the ongoing general practitioner-based, randomized, controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help). 6,838 patients were screened for dementia in 136 GP practices; 17.1% were screened positive, 54.4% of those agreed to participate and data could be assessed in n = 516 subjects. We assessed age, sex, living situation, cognitive status, functional status, level of impairment, comorbidities, formal diagnosis of dementia, depression, neuropsychiatric symptoms, quality of life, utilization of medical support, and pharmacological therapy. RESULTS Concerning clinical-, dementia-, and health-related variables, the sample under examination was on average mildly cognitively and functionally impaired (MMSE, m = 22.2; BADL, m = 3.7). A level of care was assigned in 38.0%. Depression was identified in 15.4% and other frequent comorbidities were high blood pressure (83.3%), coronary heart diseases (37.1%), cerebrovascular diseases (22.3%), among others. In 48.6%, neuropsychiatric symptoms were present in a clinically relevant severity. Pharmacological treatment with antidementia medication was received by 25.8% and antidepressant medication by 14.0%. Utilization of services was generally low. CONCLUSION The comprehensive description of people screened positive for dementia in primary care reveals a complex and unique population of patients. They are considerably underdiagnosed and in their majority mildly to moderately affected. More in-depth analyses are needed to study relations, associations and interactions between different variables.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Melanie Reimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
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Mate KE, Magin PJ, Brodaty H, Stocks NP, Gunn J, Disler PB, Marley JE, Pond CD. An evaluation of the additional benefit of population screening for dementia beyond a passive case-finding approach. Int J Geriatr Psychiatry 2017; 32:316-323. [PMID: 26988976 DOI: 10.1002/gps.4466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE General practitioners (GPs) fail to identify more than 50% of dementia cases using the existing passive case-finding approach. Using data from the "Ageing in General Practice" study, we sought to establish the additional benefit of screening all patients over the age of 75 for dementia beyond those patients already identified by passive case-finding. METHOD Patients were classified as "case-finding" (n = 425) or "screening" (n = 1006) based on their answers to four subjective memory related questions or their GP's clinical judgement of their dementia status. Cognitive status of each patient was formally assessed by a research nurse using the Cambridge Cognition Examination (CAMCOG-R). Patients then attended their usual GP for administration of the GP assessment of Cognition (GPCOG) dementia screening instrument, and follow-up care and/or referral as necessary in light of the outcome. RESULTS The prevalence of dementia was significantly higher in the case-finding group (13.6%) compared to the screening group (4.6%; p < 0.01). The GPCOG had a positive predictive value (PPV) of 61% in the case-finding group and 39% in the screening group; negative predictive value was >95% in both groups. GPs and their patients both found the GPCOG to be an acceptable cognitive assessment tool. The dementia cases missed via case-finding were younger (p = 0.024) and less cognitively impaired (p = 0.020) than those detected. CONCLUSION There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening.
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Affiliation(s)
- Karen E Mate
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | - Parker J Magin
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Australia
| | - Nigel P Stocks
- Discipline of General Practice, School of Population Health, The University of Adelaide, SA, Australia
| | - Jane Gunn
- Department of General Practice The University of Melbourne, VIC, Australia
| | - Peter B Disler
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | - John E Marley
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | - C Dimity Pond
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
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49
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Lang L, Clifford A, Wei L, Zhang D, Leung D, Augustine G, Danat IM, Zhou W, Copeland JR, Anstey KJ, Chen R. Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ Open 2017; 7:e011146. [PMID: 28159845 PMCID: PMC5293981 DOI: 10.1136/bmjopen-2016-011146] [Citation(s) in RCA: 283] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates. METHODS/SETTING/PARTICIPANTS A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measures of interest were the prevalence and determinants of undetected dementia. RESULTS 23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria. CONCLUSIONS The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.
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Affiliation(s)
- Linda Lang
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
- Post Graduate Academic Institute of Medicine, University of Wolverhampton, Wolverhampton, UK
| | - Angela Clifford
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
| | - Li Wei
- Department of Practice and Policy, University College London, London, UK
| | - Dongmei Zhang
- School of Health Administration, Anhui Medical University, China
| | - Daryl Leung
- New Cross Hospital, The Royal Wolverhampton NHS Trust, UK
| | - Glenda Augustine
- Department of Public Health, Wolverhampton City Council, Wolverhampton, UK
| | - Isaac M Danat
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
| | - Weiju Zhou
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
| | - John R Copeland
- Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Kaarin J Anstey
- Dementia Collaborative Research Centre-Early Diagnosis and Prevention, Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
- Post Graduate Academic Institute of Medicine, University of Wolverhampton, Wolverhampton, UK
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50
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Wucherer D, Eichler T, Hertel J, Kilimann I, Richter S, Michalowsky B, Thyrian JR, Teipel S, Hoffmann W. Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia. J Alzheimers Dis 2017; 55:691-701. [PMID: 27716668 PMCID: PMC5147617 DOI: 10.3233/jad-160581] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD). OBJECTIVE Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM. METHODS DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany. The comprehensive baseline assessment includes a home medication review. The present analyses are based on the data from 448 study participants (age 70+, DemTect <9). PIMs were identified using the list of Potentially Inappropriate Medications in the Elderly (Priscus). RESULTS (1) A total of 99 study participants (22%) received at least one PIM. The highest prevalence was found for antidepressants, benzodiazepines, and analgetics. The most frequently prescribed PIMs were amitriptyline, etoricoxib, and doxazosin. (2) Use of a PIM was significantly associated with a diagnosis of a mental or behavioral disorder. CONCLUSIONS The prescription rate of PIMs for community-dwelling PWD was comparable with the rates found for the general population of older people in Germany (20-29%). Antidepressants with anticholinergic properties and long-acting benzodiazepines were the most prescribed PIMs, despite having an unfavorable benefit-risk ratio. This high prevalence of PIM prescriptions in a vulnerable population of PWD indicates that standard care for dementia should include careful medication review and management.
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Affiliation(s)
- Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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