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Gao Y, Su D, Xue Z, Ji L, Wang S. Association Between Serum Neurofilament Light Chain and Cognitive Performance Among Older Adults in the United States: A Cross-Sectional Study. Neurol Ther 2023; 12:2147-2160. [PMID: 37845473 PMCID: PMC10630257 DOI: 10.1007/s40120-023-00555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Serum neurofilament light chain (sNfL) is an emerging biomarker of neuronal damage in several neurological disorders. Its association with cognitive function in the general US population aged 60 years and above is unknown. The aim of this study was to investigate the correlation between sNfL and cognitive function in the general US population aged 60 and above. METHODS The data were obtained from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), which include 506 individuals aged 60 or older who met our search criteria. In our study, sNfL levels were divided into two groups based on dichotomization (19.0 pg/mL). After adjusting for multiple covariates, it was found that the high sNfL group (≥ 19.0 pg/mL) had lower cognitive performance than the low sNfL group (< 19.0 pg/mL). This relationship was also stable in subgroup analysis. CONCLUSION In this sample of an American elderly population, higher sNfL levels are correlated with lower cognitive performance. Our findings suggest that sNfL may become a potential screening tool for early prediction and confirmation of cognitive damage.
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Affiliation(s)
- Yuanyuan Gao
- Affiliated Hospital Six of Nantong University, Yancheng Third People's Hospital, No. 75 Juchang Road, Yancheng, 224000, Jiangsu, China
- Yancheng Third People's Hospital, Yancheng, 224000, Jiangsu, China
| | - Dan Su
- Affiliated Hospital Six of Nantong University, Yancheng Third People's Hospital, No. 75 Juchang Road, Yancheng, 224000, Jiangsu, China
- Yancheng Third People's Hospital, Yancheng, 224000, Jiangsu, China
| | - Zhouya Xue
- The First People's Hospital of Yancheng, Yancheng, 224000, Jiangsu, China
| | - Lin Ji
- Affiliated Hospital Six of Nantong University, Yancheng Third People's Hospital, No. 75 Juchang Road, Yancheng, 224000, Jiangsu, China
- Yancheng Third People's Hospital, Yancheng, 224000, Jiangsu, China
| | - Shu Wang
- Affiliated Hospital Six of Nantong University, Yancheng Third People's Hospital, No. 75 Juchang Road, Yancheng, 224000, Jiangsu, China.
- Yancheng Third People's Hospital, Yancheng, 224000, Jiangsu, China.
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2
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Screening for preclinical Alzheimer's disease: Deriving optimal policies using a partially observable Markov model. Health Care Manag Sci 2023; 26:1-20. [PMID: 36044131 DOI: 10.1007/s10729-022-09608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/21/2022] [Indexed: 11/04/2022]
Abstract
Alzheimer's Disease (AD) is believed to be the most common type of dementia. Even though screening for AD has been discussed widely, there is no screening program implemented as part of a policy in any country. Current medical research motivates focusing on the preclinical stages of the disease in a modeling initiative. We develop a partially observable Markov decision process model to determine optimal screening programs. The model contains disease free and preclinical AD partially observable states and the screening decision is taken while an individual is in one of those states. An observable diagnosed preclinical AD state is integrated along with observable mild cognitive impairment, AD and death states. Transition probabilities among states are estimated using data from Knight Alzheimer's Disease Research Center (KADRC) and relevant literature. With an objective of maximizing expected total quality-adjusted life years (QALYs), the output of the model is an optimal screening program that specifies at what points in time an individual over 50 years of age with a given risk of AD will be directed to undergo screening. The screening test used to diagnose preclinical AD has a positive disutility, is imperfect and its sensitivity and specificity are estimated using the KADRC data set. We study the impact of a potential intervention with a parameterized effectiveness and disutility on model outcomes for three different risk profiles (low, medium and high). When intervention effectiveness and disutility are at their best, the optimal screening policy is to screen every year between ages 50 and 95, with an overall QALY gain of 0.94, 1.9 and 2.9 for low, medium and high risk profiles, respectively. As intervention effectiveness diminishes and/or its disutility increases, the optimal policy changes to sporadic screening and then to never screening. Under several scenarios, some screening within the time horizon is optimal from a QALY perspective. Moreover, an in-depth analysis of costs reveals that implementing these policies are either cost-saving or cost-effective.
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3
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Rajendra A, Bondonno NP, Rainey-Smith SR, Gardener SL, Hodgson JM, Bondonno CP. Potential role of dietary nitrate in relation to cardiovascular and cerebrovascular health, cognition, cognitive decline and dementia: a review. Food Funct 2022; 13:12572-12589. [PMID: 36377891 DOI: 10.1039/d2fo02427f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is currently no effective treatment for dementia, of which Alzheimer's disease (AD) is the most common form. It is, therefore, imperative to focus on evidence-based preventive strategies to combat this extremely debilitating chronic disease. Nitric oxide (NO) is a key signalling molecule in the cardiovascular, cerebrovascular, and central nervous systems. Vegetables rich in nitrate, such as spinach and beetroot, are an important source of NO, with beneficial effects on validated markers of cardiovascular health and an association with a lower risk of cardiovascular disease. Given the link between cardiovascular disease risk factors and dementia, together with the important role of NO in vascular health and cognition, it is important to determine whether dietary nitrate could also improve cognitive function, markers of brain health, and lower risk of dementia. This review presents an overview of NO's role in the cardiovascular, cerebrovascular, and central nervous systems; an overview of the available evidence that nitrate, through effects on NO, improves cardiovascular health; and evaluates the current evidence regarding dietary nitrate's potential role in cerebrovascular health, cognitive function, and brain health assessed via biomarkers.
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Affiliation(s)
- Anjana Rajendra
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
| | - Nicola P Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia. .,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Stephanie R Rainey-Smith
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia.,Australian Alzheimer's Research Foundation, Perth, Western Australia, Australia.,Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Lifestyle Approaches Towards Cognitive Health Research Group, Murdoch University, Murdoch, Western Australia, Australia.,School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Samantha L Gardener
- Australian Alzheimer's Research Foundation, Perth, Western Australia, Australia.,Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Lifestyle Approaches Towards Cognitive Health Research Group, Murdoch University, Murdoch, Western Australia, Australia
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia. .,Medical School, The University of Western Australia, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - Catherine P Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia. .,Medical School, The University of Western Australia, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
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4
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Improving community health-care systems' early detection of cognitive decline and dementia. Alzheimers Dement 2022; 18:2375-2381. [PMID: 36314503 DOI: 10.1002/alz.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
Preliminary estimates suggest that current global health-care systems lack the resource capacity to provide persons with dementia timely access to diagnosis, treatment, and care. There is an increasing need to improve timely identification of individuals who will likely progress to Alzheimer's disease (AD) dementia particularly among under-represented, underserved, and vulnerable populations. The rapidly evolving area of bioinformatics of health system data and the emergence of fluid-based biomarkers for pre-symptomatic AD may provide an innovative strategic option for health system planners. A think-tank style meeting entitled "The Campaign to Prevent Alzheimer's Disease Work Group on Community-Based Detection and Assessment of Cognitive Decline" developed recommendations to guide future sustainability activities, public policy campaigns, and implementation pilots. The group identified and explored different pathways of community-based detection using electronic health records, from different international health-care systems, to detect and surveil individuals with early possible cognitive impairment.
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5
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Li RX, Ma YH, Tan L, Yu JT. Prospective biomarkers of Alzheimer's disease: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101699. [PMID: 35905816 DOI: 10.1016/j.arr.2022.101699] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Alzheimer's disease (AD) involves a series of pathological changes and some biomarkers were reported to assist in monitoring and predicting disease progression before the emergence of clinical symptoms. We aimed to identify prospective biomarkers and quantify their effect on AD progression. METHODS PubMed, EMBASE and Web of Science databases were searched for prospective cohort studies published up to October 2021. Eligible studies were included, and the available data were extracted. Meta-analyses were conducted based on random-effect models. Relative risk (RR) with 95% confidence interval (CI) was adopted as the final effect size. RESULTS Totally 48,769 articles were identified, of which 84 studies with 20 prospective biomarkers were included in meta-analyses. In the present study, 15 biomarkers were associated with AD progression, comprising CSF Aβ42 (RR=2.49, 95%CI=1.68-3.69), t-tau (RR=1.88, 95%CI=1.49-2.37), p-tau (RR=1.74, 95%CI=1.37-2.21), tau/Aβ42 ratio (RR=5.11, 95%CI=2.01-13.00); peripheral blood Aβ42/Aβ40 (RR=1.26, 95%CI=1.05-1.51), t-tau (RR=1.33, 95%CI=1.08-1.64), NFL (RR=1.75, 95%CI=1.07-2.87); whole, left and right hippocampal volume (HV) (whole: RR=1.65, 95%CI=1.39-1.95; left: RR=2.60, 95%CI=1.02-6.64; right: RR=1.43, 95%CI=1.23-1.66), entorhinal cortex (EC) volume (RR=1.69, 95%CI=1.24-2.30), medial temporal lobe atrophy (MTA) (RR=1.52, 95%CI=1.33-1.74), 18 F-FDG PET (RR=2.24, 95%CI=1.29-3.89), 11 C-labeled Pittsburgh Compound B PET (11 C-PIB PET) (RR=3.91, 95%CI=1.06-14.41); APOE ε4 (RR=2.16, 1.83-2.55). A total of 70 articles were included in the qualitative review, in which 61 biomarkers were additionally associated with AD progression. CONCLUSION CSF Aβ42, t-tau, p-tau, tau/Aβ42; peripheral blood t-tau, Aβ42/Aβ40, NFL; whole, left and right HV, EC volume, MTA, 18 F-FDG PET, 11 C-PIB PET; APOE ε4 may be promising prospective biomarkers for AD progression.
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Affiliation(s)
- Rui-Xian Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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Polygenic resilience scores capture protective genetic effects for Alzheimer's disease. Transl Psychiatry 2022; 12:296. [PMID: 35879306 PMCID: PMC9314356 DOI: 10.1038/s41398-022-02055-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 01/27/2023] Open
Abstract
Polygenic risk scores (PRSs) can boost risk prediction in late-onset Alzheimer's disease (LOAD) beyond apolipoprotein E (APOE) but have not been leveraged to identify genetic resilience factors. Here, we sought to identify resilience-conferring common genetic variants in (1) unaffected individuals having high PRSs for LOAD, and (2) unaffected APOE-ε4 carriers also having high PRSs for LOAD. We used genome-wide association study (GWAS) to contrast "resilient" unaffected individuals at the highest genetic risk for LOAD with LOAD cases at comparable risk. From GWAS results, we constructed polygenic resilience scores to aggregate the addictive contributions of risk-orthogonal common variants that promote resilience to LOAD. Replication of resilience scores was undertaken in eight independent studies. We successfully replicated two polygenic resilience scores that reduce genetic risk penetrance for LOAD. We also showed that polygenic resilience scores positively correlate with polygenic risk scores in unaffected individuals, perhaps aiding in staving off disease. Our findings align with the hypothesis that a combination of risk-independent common variants mediates resilience to LOAD by moderating genetic disease risk.
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7
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Rossini PM, Cappa SF, Lattanzio F, Perani D, Spadin P, Tagliavini F, Vanacore N. The Italian INTERCEPTOR Project: From the Early Identification of Patients Eligible for Prescription of Antidementia Drugs to a Nationwide Organizational Model for Early Alzheimer's Disease Diagnosis. J Alzheimers Dis 2020; 72:373-388. [PMID: 31594234 DOI: 10.3233/jad-190670] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease is the most common age-related neurodegenerative disorder and its burden on patients, families, and society grows significantly with lifespan. Early modifications of risk-enhancing lifestyles and treatment initiation expand personal autonomy and reduce management costs. Many clinical trials with potentially disease-modifying drugs are devoted to mild cognitive impairment (MCI) prodromal-to-Alzheimer's disease. The identification of biomarkers for early diagnosis may thus be crucial for early intervention and identification of high-risk subjects, the most appropriate target of new drugs as soon as they will be discovered. INTERCEPTOR is a strategic project by the Italian Ministry of Health and the Italian Medicines Agency (AIFA), aiming to validate the best combination (highly accurate, non-invasive, available on the whole national territory and financially sustainable) of biomarkers and organizational model for early diagnosis. 500 MCI subjects will be enrolled at baseline and followed-up for 3 years for at least 400 of them in order to define a "hub & spoke" nationwide model with recruiting (spokes) centers for MCI identification and expert (hubs) centers for risk diagnosis.
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Affiliation(s)
- Paolo Maria Rossini
- Area of Neuroscience, University Policlinic A. Gemelli Foundation-IRCCS, Rome, Italy.,Institute of Neurology, Catholic University, Rome, Italy
| | - Stefano F Cappa
- University School for Advanced Studies IUSS Pavia, Pavia, Italy.,IRCCS St. John of God, Brescia, Italy
| | | | - Daniela Perani
- Nuclear Medicine Unit and Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Spadin
- President "Associazione Italiana Malattia di Alzheimer" - AIMA, Italy
| | | | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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8
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Stephan BCM, Siervo M, Brayne C. How can population‐based studies best be utilized to reduce the global impact of dementia? Recommendations for researchers, funders, and policymakers. Alzheimers Dement 2020; 16:1448-1456. [DOI: 10.1002/alz.12127] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Blossom C. M. Stephan
- Institute of Mental Health Division of Psychiatry and Applied Psychology School of Medicine University of Nottingham Innovation Park Nottingham UK
| | - Mario Siervo
- School of Life Sciences Queen's Medical Centre The University of Nottingham Medical School Nottingham UK
| | - Carol Brayne
- Department of Public Health and Primary Care Cambridge Institute of Public Health University of Cambridge Cambridge UK
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9
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James BD, Bennett DA. Causes and Patterns of Dementia: An Update in the Era of Redefining Alzheimer's Disease. Annu Rev Public Health 2019; 40:65-84. [PMID: 30642228 DOI: 10.1146/annurev-publhealth-040218-043758] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The burden of dementia continues to increase as the population ages, with no disease-modifying treatments available. However, dementia risk appears to be decreasing, and progress has been made in understanding its multifactorial etiology. The 2018 National Institute on Aging-Alzheimer's Association (NIA-AA) research framework for Alzheimer's disease (AD) defines AD as a biological process measured by brain pathology or biomarkers, spanning the cognitive spectrum from normality to dementia. This framework facilitates interventions in the asymptomatic space and accommodates knowledge that many additional pathologies (e.g., cerebrovascular) contribute to the Alzheimer's dementia syndrome. The framework has implications for how we think about risk factors for "AD": Many commonly accepted risk factors are not related to AD pathology and would no longer be considered risk factors for AD. They may instead be related to other pathologies or resilience to pathology. This review updates what is known about causes, risk factors, and changing patterns of dementia, addressing whether they are related to AD pathology/biomarkers, other pathologies, or resilience.
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Affiliation(s)
- Bryan D James
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois 60612, USA; .,Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois 60612, USA; .,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA
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10
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From people with dementia to people with data: Participation and value in Alzheimer’s disease research. BIOSOCIETIES 2018. [DOI: 10.1057/s41292-017-0112-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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11
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Krysinska K, Sachdev PS, Breitner J, Kivipelto M, Kukull W, Brodaty H. Dementia registries around the globe and their applications: A systematic review. Alzheimers Dement 2017; 13:1031-1047. [PMID: 28576507 PMCID: PMC6872163 DOI: 10.1016/j.jalz.2017.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022]
Abstract
Patient registries are valuable tools helping to address significant challenges in research, care, and policy. Registries, well embedded in many fields of medicine and public health, are relatively new in dementia. This systematic review presents the current situation in regards to dementia registries worldwide. We identified 31 dementia registries operating on an international, national, or local level between 1986 and 2016. More than half of the registries aimed to conduct or facilitate research, including preclinical research registries and registries recruiting research volunteers. Other dementia registries collected epidemiological or quality of care data. We present evidence of practical and economic outcomes of registries for research, clinical practice and policy, and recommendations for future development. Global harmonization of recruitment methods and minimum data would facilitate international comparisons. Registries provide a positive return on investment; their establishment and maintenance require ongoing support by government, policy makers, research funding bodies, clinicians, and individuals with dementia and their caregivers.
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Affiliation(s)
- Karolina Krysinska
- Faculty of Medicine, Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia
| | - Perminder S Sachdev
- Faculty of Medicine, Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; NPI, Euroa Centre, School of Psychiatry, UNSW Sydney, NSW, Australia
| | - John Breitner
- McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Karolinska Institutet, Care Sciences and Society (NVS), Huddinge, Sweden
| | - Walter Kukull
- National Alzheimer's Coordinating Center (NACC), University of Washington, Seattle, WA, USA
| | - Henry Brodaty
- Faculty of Medicine, Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; NPI, Euroa Centre, School of Psychiatry, UNSW Sydney, NSW, Australia.
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12
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Shah H, Albanese E, Duggan C, Rudan I, Langa KM, Carrillo MC, Chan KY, Joanette Y, Prince M, Rossor M, Saxena S, Snyder HM, Sperling R, Varghese M, Wang H, Wortmann M, Dua T. Research priorities to reduce the global burden of dementia by 2025. Lancet Neurol 2016; 15:1285-1294. [DOI: 10.1016/s1474-4422(16)30235-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/04/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
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13
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14
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Pistollato F, Ohayon EL, Lam A, Langley GR, Novak TJ, Pamies D, Perry G, Trushina E, Williams RS, Roher AE, Hartung T, Harnad S, Barnard N, Morris MC, Lai MC, Merkley R, Chandrasekera PC. Alzheimer disease research in the 21st century: past and current failures, new perspectives and funding priorities. Oncotarget 2016; 7:38999-39016. [PMID: 27229915 PMCID: PMC5129909 DOI: 10.18632/oncotarget.9175] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 04/18/2016] [Indexed: 12/20/2022] Open
Abstract
Much of Alzheimer disease (AD) research has been traditionally based on the use of animals, which have been extensively applied in an effort to both improve our understanding of the pathophysiological mechanisms of the disease and to test novel therapeutic approaches. However, decades of such research have not effectively translated into substantial therapeutic success for human patients. Here we critically discuss these issues in order to determine how existing human-based methods can be applied to study AD pathology and develop novel therapeutics. These methods, which include patient-derived cells, computational analysis and models, together with large-scale epidemiological studies represent novel and exciting tools to enhance and forward AD research. In particular, these methods are helping advance AD research by contributing multifactorial and multidimensional perspectives, especially considering the crucial role played by lifestyle risk factors in the determination of AD risk. In addition to research techniques, we also consider related pitfalls and flaws in the current research funding system. Conversely, we identify encouraging new trends in research and government policy. In light of these new research directions, we provide recommendations regarding prioritization of research funding. The goal of this document is to stimulate scientific and public discussion on the need to explore new avenues in AD research, considering outcome and ethics as core principles to reliably judge traditional research efforts and eventually undertake new research strategies.
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Affiliation(s)
| | - Elan L. Ohayon
- Green Neuroscience Laboratory, Neurolinx Research Institute, San Diego, CA, USA
| | - Ann Lam
- Physicians Committee for Responsible Medicine, Washington, DC, USA
- Green Neuroscience Laboratory, Neurolinx Research Institute, San Diego, CA, USA
| | - Gillian R. Langley
- Research and Toxicology Department, Humane Society International, London, UK
| | | | - David Pamies
- CAAT, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George Perry
- College of Sciences, University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Robin S.B. Williams
- Centre for Biomedical Sciences, School of Biological Sciences, Royal Holloway University of London, Egham, UK
| | - Alex E. Roher
- Division of Clinical Education, Midwestern University, Glendale, AZ, USA
- Division of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Thomas Hartung
- CAAT, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stevan Harnad
- Department of Psychology, University of Quebec/Montreal, Montreal, Canada
| | - Neal Barnard
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Martha Clare Morris
- Section of Nutrition and Nutritional Epidemiology, Department of Internal Medicine, Rush University, Chicago, IL, USA
| | - Mei-Chun Lai
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Ryan Merkley
- Physicians Committee for Responsible Medicine, Washington, DC, USA
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15
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Khachaturian ZS, Khachaturian AS. Politics of science: Progress toward prevention of the dementia-Alzheimer's syndrome. Mol Aspects Med 2015; 43-44:3-15. [PMID: 26054567 DOI: 10.1016/j.mam.2015.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Abstract
There exist many challenges hampering the discovery and development of effective interventions to prevent dementia. Three major trends have now intersected to influence the emerging interest in disease modifying therapies that may delay or halt dementia. The three crucial factors shaping this current focus are: (1) the emergence of the longevity revolution and the impact of a aging society, (2) the effects of the US Federal investment in research in advancing knowledge about the neurobiology of aging and dementia, and (3) the problem of US legislators and health policy makers to balance the allocation of evermore scarce research funding resources. The purpose of this essay is to provide a survey of the politics of science and to describe efforts to correctly manage the high level of expectations of both the patient and research communities. The perspective offered reviews the history and evolution of the ideas to treat or prevent dementia and Alzheimer's disease as a national strategic goal. The aim is to evaluate the interplay between science and formulation of public policy for setting research priority. We use the history of developing US National Institute of Aging's extramural research programs on brain aging and Alzheimer's disease (Khachaturian, 2006; 2007) as an initial case study.
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Affiliation(s)
- Zaven S Khachaturian
- Campaign to Prevent Alzheimer's Disease by 2020, 451 Hungerford Drive 119-344, Rockville, MD 20850, USA.
| | - Ara S Khachaturian
- Campaign to Prevent Alzheimer's Disease by 2020, 451 Hungerford Drive 119-344, Rockville, MD 20850, USA
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16
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Almeida RP, Schultz SA, Austin BP, Boots EA, Dowling NM, Gleason CE, Bendlin BB, Sager M, Hermann BP, Zetterberg H, Carlsson C, Johnson S, Asthana S, Okonkwo OC. Effect of Cognitive Reserve on Age-Related Changes in Cerebrospinal Fluid Biomarkers of Alzheimer Disease. JAMA Neurol 2015; 72:699-706. [PMID: 25893879 PMCID: PMC4639566 DOI: 10.1001/jamaneurol.2015.0098] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Although advancing age is the strongest risk factor for the development of symptomatic Alzheimer disease (AD), recent studies have shown that there are individual differences in susceptibility to age-related alterations in the biomarkers of AD pathophysiology. OBJECTIVE To investigate whether cognitive reserve (CR) modifies the adverse influence of age on key cerebrospinal fluid (CSF) biomarkers of AD. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional cohort of 268 individuals (211 in a cognitively normal group and 57 in a cognitively impaired group) from the Wisconsin Registry for Alzheimer's Prevention and the Wisconsin Alzheimer's Disease Research Center participated in this study. They underwent lumbar puncture for collection of CSF samples, from which Aβ42, total tau (t-tau), and phosphorylated tau (p-tau) were immunoassayed. In addition, we computed t-tau/Aβ42 and p-tau/Aβ42 ratios. Cognitive reserve was indexed by years of education, with 16 or more years taken to confer high reserve. Covariate-adjusted regression analyses were used to test whether the effect of age on CSF biomarkers was modified by CR. The study dates were March 5, 2010, to February 13, 2013. MAIN OUTCOMES AND MEASURES Cerebrospinal fluid levels of Aβ42, t-tau, p-tau, t-tau/Aβ42, and p-tau/Aβ42. RESULTS There were significant age × CR interactions for CSF t-tau (β [SE] = -6.72 [2.84], P = .02), p-tau (β [SE] = -0.71 [0.27], P = .01), t-tau/Aβ42 (β [SE] = -0.02 [0.01], P = .02), and p-tau/Aβ42 (β [SE] = -0.002 [0.001], P = .004). With advancing age, individuals with high CR exhibited attenuated adverse alterations in these CSF biomarkers compared with individuals with low CR. This attenuation of age effects by CR tended to be more pronounced in the cognitively impaired group compared with the cognitively normal group. There was evidence of a dose-response relationship such that the effect of age on the biomarkers was progressively attenuated given additional years of schooling. CONCLUSIONS AND RELEVANCE In a sample composed of a cognitively normal group and a cognitively impaired group, higher CR was associated with a diminution of age-related alterations in CSF biomarkers of AD. This suggests one pathway through which CR might favorably alter lifetime risk for symptomatic AD.
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Affiliation(s)
- Rodrigo P. Almeida
- Fluminense Federal University, Niteroi, Brazil
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stephanie A. Schultz
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Benjamin P. Austin
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Elizabeth A. Boots
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - N. Maritza Dowling
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carey E. Gleason
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Barbara B. Bendlin
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mark Sager
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bruce P. Hermann
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- University of London Institute of Neurology, Queen Square, London, United Kingdom
| | - Cindy Carlsson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sterling Johnson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sanjay Asthana
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ozioma C. Okonkwo
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Hospital, Madison WI
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Saunders KT, Langbaum JB, Holt CJ, Chen W, High N, Langlois C, Sabbagh M, Tariot PN. Arizona Alzheimer's Registry: Strategy and Outcomes of a Statewide Research Recruitment Registry. J Prev Alzheimers Dis 2014; 1:74-79. [PMID: 26491650 PMCID: PMC4610410 DOI: 10.14283/jpad.2014.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Arizona Alzheimer's Consortium (AAC) created the Arizona Alzheimer's Registry, a screening and referral process for people interested in participating in Alzheimer's disease related research. The goals of the Registry were to increase awareness of Alzheimer's disease research and accelerate enrollment into AAC research studies. METHODS Participation was by open invitation to adults 18 and older. Those interested provided consent and completed a written questionnaire. A subset of Registrants underwent an initial telephone cognitive assessment. Referral to AAC sites was based on medical history, telephone cognitive assessment, and research interests. RESULTS A total of 1257 people consented and 1182 underwent an initial cognitive screening. Earned media (38.7%) was the most effective recruitment strategy. Participants had a mean age of 68.1 (SD 10.6), 97% were Caucasian, had 15.2 (SD 2.7) mean years of education, and 60% were female. 30% reported a family history of dementia and 70% normal cognition. Inter-rater agreement between self-reported memory status and the initial telephone cognitive assessment had a kappa of 0.31-0.43. 301 were referred to AAC sites. CONCLUSION IThe Registry created an infrastructure and process to screen and refer a high volume of eager Registrants. These methods were found to be effective at prescreening individuals for studies, which facilitated AAC research recruitment. The established infrastructure and experiences gained from the Registry have served as the prototype for the web-based Alzheimer's Prevention Registry, a national registry focusing on Alzheimer's disease prevention research.
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Affiliation(s)
- K T Saunders
- University of Arizona College of Medicine Phoenix, AZ, USA
| | - J B Langbaum
- Banner Alzheimer's Institute Phoenix, AZ, USA ; Arizona Alzheimer's Consortium Phoenix, AZ, USA
| | - C J Holt
- Saint Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - W Chen
- University of Arizona College of Medicine Phoenix, AZ, USA
| | - N High
- Banner Alzheimer's Institute Phoenix, AZ, USA ; Arizona Alzheimer's Consortium Phoenix, AZ, USA
| | - C Langlois
- Banner Alzheimer's Institute Phoenix, AZ, USA ; Arizona Alzheimer's Consortium Phoenix, AZ, USA
| | - M Sabbagh
- Arizona Alzheimer's Consortium Phoenix, AZ, USA ; Banner Sun Health Research Institute, Sun City, AZ, USA
| | - P N Tariot
- Banner Alzheimer's Institute Phoenix, AZ, USA ; Arizona Alzheimer's Consortium Phoenix, AZ, USA
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Solomon A, Mangialasche F, Richard E, Andrieu S, Bennett DA, Breteler M, Fratiglioni L, Hooshmand B, Khachaturian AS, Schneider LS, Skoog I, Kivipelto M. Advances in the prevention of Alzheimer's disease and dementia. J Intern Med 2014; 275:229-50. [PMID: 24605807 PMCID: PMC4390027 DOI: 10.1111/joim.12178] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Definitions and diagnostic criteria for all medical conditions are regularly subjected to reviews and revisions as knowledge advances. In the field of Alzheimer's disease (AD) research, it has taken almost three decades for diagnostic nomenclature to undergo major re-examination. The shift towards presymptomatic and pre-dementia stages of AD has brought prevention and treatment trials much closer to each other than before. METHODS Here we discuss: (i) the impact of diagnostic reliability on the possibilities for developing preventive strategies for AD; (ii) the scientific evidence to support moving from observation to action; (iii) ongoing intervention studies; and (iv) the methodological issues and prospects for balancing strategies for high-risk individuals with those for broad population-based prevention. RESULTS The associations between neuropathology and cognition are still not entirely clear. In addition, the risk factors for AD dementia and the neuropathological hallmarks of AD may not necessarily be the same. Cognitive impairment has a clearer clinical significance and should therefore remain the main focus of prevention. Risk/protective factors for dementia/AD need to be studied from a life-course perspective. New approaches in prevention trials include enrichment strategies based on genetic risk factors or beta-amyloid biomarkers (at least four ongoing pharmacological trials), and multidomain interventions simultaneously targeting various vascular and lifestyle-related risk factors (at least three ongoing trials). Experience from prevention programmes in other chronic diseases can provide additional methodological improvements. CONCLUSIONS Building infrastructures for international collaborations is necessary for managing the worldwide public health problem of AD and dementia. The International Database on Aging and Dementia (IDAD) and the European Dementia Prevention Initiative (EDPI) are examples of ongoing international efforts aiming to improve the methodology of preventive studies and provide the basis for larger intervention trials.
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Affiliation(s)
- Alina Solomon
- Karolinska Institutet Alzheimer Disease Research Center (KI-ADRC), Stockholm, Sweden
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Francesca Mangialasche
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Edo Richard
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Sandrine Andrieu
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Monique Breteler
- German Center for Neurodegenerative Diseases (DZNE) and University of Bonn, Bonn, Germany
| | - Laura Fratiglioni
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Babak Hooshmand
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Ara S. Khachaturian
- Campaign to Prevent Alzheimer’s Disease by 2020 (PAD2020), Rockville, MD, USA
| | - Lon S. Schneider
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Research Unit, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden
| | - Miia Kivipelto
- Karolinska Institutet Alzheimer Disease Research Center (KI-ADRC), Stockholm, Sweden
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Xiao C, Davis FJ, Chauhan BC, Viola KL, Lacor PN, Velasco PT, Klein WL, Chauhan NB. Brain transit and ameliorative effects of intranasally delivered anti-amyloid-β oligomer antibody in 5XFAD mice. J Alzheimers Dis 2013; 35:777-88. [PMID: 23542865 DOI: 10.3233/jad-122419] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Alzheimer's disease (AD) is a global health crisis with limited treatment options. Despite major advances in neurotherapeutics, poor brain penetration due to the blood-brain barrier continues to pose a big challenge in overcoming the access of therapeutics to the central nervous system. In that regard, the non-invasive intranasal route of brain targeting is gaining considerable attention. The nasal mucosa offers a large surface area, rapid absorption, and avoidance of first-pass metabolism increasing drug bioavailability with less systemic side effects. Intranasal delivery is known to utilize olfactory, rostral migratory stream, and trigeminal routes to reach the brain. This investigation confirmed that intranasal delivery of oligomeric amyloid-β antibody (NU4) utilized all three routes to enter the brain with a resident time of 96 hours post single bolus intranasal administration, and showed evidence of perikaryal and parenchymal uptake of NU4 in 5XFAD mouse brain, confirming the intranasal route as a non-invasive and efficient way of delivering therapeutics to the brain. In addition, this study demonstrated that intranasal delivery of NU4 antibody lowered cerebral amyloid-β and improved spatial learning in 5XFAD mice.
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Affiliation(s)
- Chun Xiao
- Neuroscience Research, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
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Khachaturian AS, Meranus DH, Kukull WA, Khachaturian ZS. Big data, aging, and dementia: Pathways for international harmonization on data sharing. Alzheimers Dement 2013; 9:S61-2. [DOI: 10.1016/j.jalz.2013.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ara S. Khachaturian
- Alzheimer's & DementiaThe Journal of the Alzheimer's Association451 Hungerford Drive, Suite 119‐355RockvilleMD20850USA
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21
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Erten-Lyons D, Sherbakov LO, Piccinin AM, Hofer SM, Dodge HH, Quinn JF, Woltjer RL, Kramer PL, Kaye JA. Review of selected databases of longitudinal aging studies. Alzheimers Dement 2013; 8:584-9. [PMID: 23102128 DOI: 10.1016/j.jalz.2011.09.232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/09/2011] [Accepted: 09/23/2011] [Indexed: 12/01/2022]
Abstract
One of the recommendations of the 2010 Leon Thal Symposium, organized to develop strategies to prevent Alzheimer's disease, was to build a global database of longitudinal aging studies. Although several databases of longitudinal aging studies exist, none of these are comprehensive or complete. In this article, we review selected databases of longitudinal aging studies. We also make recommendations on future steps to create a comprehensive database. Additionally, we discuss issues related to data harmonization.
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Affiliation(s)
- Deniz Erten-Lyons
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
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22
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Naylor MD, Karlawish JH, Arnold SE, Khachaturian AS, Khachaturian ZS, Lee VMY, Baumgart M, Banerjee S, Beck C, Blennow K, Brookmeyer R, Brunden KR, Buckwalter KC, Comer M, Covinsky K, Feinberg LF, Frisoni G, Green C, Guimaraes RM, Gwyther LP, Hefti FF, Hutton M, Kawas C, Kent DM, Kuller L, Langa KM, Mahley RW, Maslow K, Masters CL, Meier DE, Neumann PJ, Paul SM, Petersen RC, Sager MA, Sano M, Schenk D, Soares H, Sperling RA, Stahl SM, van Deerlin V, Stern Y, Weir D, Wolk DA, Trojanowski JQ. Advancing Alzheimer's disease diagnosis, treatment, and care: recommendations from the Ware Invitational Summit. Alzheimers Dement 2013; 8:445-52. [PMID: 22959699 DOI: 10.1016/j.jalz.2012.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/28/2022]
Abstract
To address the pending public health crisis due to Alzheimer's disease (AD) and related neurodegenerative disorders, the Marian S. Ware Alzheimer Program at the University of Pennsylvania held a meeting entitled "State of the Science Conference on the Advancement of Alzheimer's Diagnosis, Treatment and Care," on June 21-22, 2012. The meeting comprised four workgroups focusing on Biomarkers; Clinical Care and Health Services Research; Drug Development; and Health Economics, Policy, and Ethics. The workgroups shared, discussed, and compiled an integrated set of priorities, recommendations, and action plans, which are presented in this article.
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Affiliation(s)
- Mary D Naylor
- Institute on Aging, University of Pennsylvania, Philadelphia, USA.
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23
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Kivipelto M, Solomon A, Ahtiluoto S, Ngandu T, Lehtisalo J, Antikainen R, Bäckman L, Hänninen T, Jula A, Laatikainen T, Lindström J, Mangialasche F, Nissinen A, Paajanen T, Pajala S, Peltonen M, Rauramaa R, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): Study design and progress. Alzheimers Dement 2013; 9:657-65. [DOI: 10.1016/j.jalz.2012.09.012] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 08/12/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Miia Kivipelto
- Department of Neurology; Institute of Clinical Medicine, University of Eastern Finland; Kuopio Finland
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
- Aging Research Center; Karolinska Institutet; Stockholm Sweden
- Alzheimer's Disease Research Center; Karolinska Institutet; Stockholm Sweden
| | - Alina Solomon
- Department of Neurology; Institute of Clinical Medicine, University of Eastern Finland; Kuopio Finland
- Aging Research Center; Karolinska Institutet; Stockholm Sweden
- Alzheimer's Disease Research Center; Karolinska Institutet; Stockholm Sweden
| | - Satu Ahtiluoto
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
| | - Tiia Ngandu
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
- Alzheimer's Disease Research Center; Karolinska Institutet; Stockholm Sweden
| | - Jenni Lehtisalo
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
| | - Riitta Antikainen
- Institute of Health Sciences/Geriatrics; University of Oulu and University Hospital; Oulu Finland
- Oulu City Hospital; Oulu Finland
| | - Lars Bäckman
- Aging Research Center; Karolinska Institutet; Stockholm Sweden
| | - Tuomo Hänninen
- Department of Neurology; Kuopio University Hospital; Kuopio Finland
| | - Antti Jula
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
| | - Tiina Laatikainen
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
| | - Jaana Lindström
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
| | | | - Aulikki Nissinen
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
| | - Teemu Paajanen
- Department of Neurology; Institute of Clinical Medicine, University of Eastern Finland; Kuopio Finland
| | - Satu Pajala
- Department of Lifestyle and Participation; National Institute for Health and Welfare; Helsinki Finland
| | - Markku Peltonen
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
| | - Rainer Rauramaa
- Kuopio Research Institute of Exercise Medicine; Kuopio Finland
| | | | - Timo Strandberg
- Institute of Health Sciences/Geriatrics; University of Oulu and University Hospital; Oulu Finland
- Department of Medicine, Geriatric Clinic; University of Helsinki and University Hospital; Helsinki Finland
| | - Jaakko Tuomilehto
- Department of Public Health; University of Helsinki; Helsinki Finland
- South Ostrobothnia Central Hospital; Seinäjoki Finland
| | - Hilkka Soininen
- Department of Neurology; Institute of Clinical Medicine, University of Eastern Finland; Kuopio Finland
- Department of Neurology; Kuopio University Hospital; Kuopio Finland
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Methodological challenges in designing dementia prevention trials — The European Dementia Prevention Initiative (EDPI). J Neurol Sci 2012; 322:64-70. [DOI: 10.1016/j.jns.2012.06.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 06/01/2012] [Accepted: 06/25/2012] [Indexed: 11/23/2022]
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Khachaturian ZS, Khachaturian AS, Thies W. The draft "National Plan" to address Alzheimer's disease - National Alzheimer's Project Act (NAPA). Alzheimers Dement 2012; 8:234-6. [PMID: 22546355 DOI: 10.1016/j.jalz.2012.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This perspective updates the status of the "National Plan to Address Alzheimer's Disease" and the recommendations of the NAPA Advisory Council's Sub-committee on Research. Here, we identify some of the critical issues the future reiterations of the National Plan should consider during implementation phase of the plan. The Journal invites the scientific community to contribute additional ideas and suggestions towards a national research initiative.
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Khachaturian ZS. Prospects for designating Alzheimer's disease research a national priority. Alzheimers Dement 2012; 7:557-61. [PMID: 22055971 DOI: 10.1016/j.jalz.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This editorial evaluates the prospects of the National Alzheimer's Project Act (NAPA) succeeding to shape public policies that would substantially increase national expenditures for research on Alzheimer's disease. The essay identifies, in the context of 30-year history, some of the difficult challenges the NAPA Advisory Council must address and offers specific recommendations for an action plan by the Secretary, Department of Health and Human Services (DHHS).
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The amyloid cascade hypothesis for Alzheimer's disease: an appraisal for the development of therapeutics. Nat Rev Drug Discov 2011; 10:698-712. [DOI: 10.1038/nrd3505] [Citation(s) in RCA: 1485] [Impact Index Per Article: 114.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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