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Volkert D, Beck AM, Faxén-Irving G, Frühwald T, Hooper L, Keller H, Porter J, Rothenberg E, Suominen M, Wirth R, Chourdakis M. ESPEN guideline on nutrition and hydration in dementia - Update 2024. Clin Nutr 2024; 43:1599-1626. [PMID: 38772068 DOI: 10.1016/j.clnu.2024.04.039] [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: 04/02/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND & AIMS Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. METHODS The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. RESULTS 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. CONCLUSION Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Gerd Faxén-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Hietzing Municipal Hospital, Vienna, Austria
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Heather Keller
- Department of Kinesiology & Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Judi Porter
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Mostafaei S, Hoang MT, Jurado PG, Xu H, Zacarias-Pons L, Eriksdotter M, Chatterjee S, Garcia-Ptacek S. Machine learning algorithms for identifying predictive variables of mortality risk following dementia diagnosis: a longitudinal cohort study. Sci Rep 2023; 13:9480. [PMID: 37301891 PMCID: PMC10257644 DOI: 10.1038/s41598-023-36362-3] [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: 02/14/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Machine learning (ML) could have advantages over traditional statistical models in identifying risk factors. Using ML algorithms, our objective was to identify the most important variables associated with mortality after dementia diagnosis in the Swedish Registry for Cognitive/Dementia Disorders (SveDem). From SveDem, a longitudinal cohort of 28,023 dementia-diagnosed patients was selected for this study. Sixty variables were considered as potential predictors of mortality risk, such as age at dementia diagnosis, dementia type, sex, body mass index (BMI), mini-mental state examination (MMSE) score, time from referral to initiation of work-up, time from initiation of work-up to diagnosis, dementia medications, comorbidities, and some specific medications for chronic comorbidities (e.g., cardiovascular disease). We applied sparsity-inducing penalties for three ML algorithms and identified twenty important variables for the binary classification task in mortality risk prediction and fifteen variables to predict time to death. Area-under-ROC curve (AUC) measure was used to evaluate the classification algorithms. Then, an unsupervised clustering algorithm was applied on the set of twenty-selected variables to find two main clusters which accurately matched surviving and dead patient clusters. A support-vector-machines with an appropriate sparsity penalty provided the classification of mortality risk with accuracy = 0.7077, AUROC = 0.7375, sensitivity = 0.6436, and specificity = 0.740. Across three ML algorithms, the majority of the identified twenty variables were compatible with literature and with our previous studies on SveDem. We also found new variables which were not previously reported in literature as associated with mortality in dementia. Performance of basic dementia diagnostic work-up, time from referral to initiation of work-up, and time from initiation of work-up to diagnosis were found to be elements of the diagnostic process identified by the ML algorithms. The median follow-up time was 1053 (IQR = 516-1771) days in surviving and 1125 (IQR = 605-1770) days in dead patients. For prediction of time to death, the CoxBoost model identified 15 variables and classified them in order of importance. These highly important variables were age at diagnosis, MMSE score, sex, BMI, and Charlson Comorbidity Index with selection scores of 23%, 15%, 14%, 12% and 10%, respectively. This study demonstrates the potential of sparsity-inducing ML algorithms in improving our understanding of mortality risk factors in dementia patients and their application in clinical settings. Moreover, ML methods can be used as a complement to traditional statistical methods.
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Affiliation(s)
- Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Lluis Zacarias-Pons
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Vascular Health Research Group of Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Girona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Saikat Chatterjee
- Division of Information Science and Engineering, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
- Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden.
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Aye S, Jönsson L, Gustavsson A, Tate A, Ptacek SG, Eriksdotter M. Effect of mortality in cost‐effectiveness modeling of disease‐modifying treatment for Alzheimer's disease. ALZHEIMER'S & DEMENTIA : DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2023; 15:e12422. [PMID: 37009338 PMCID: PMC10053186 DOI: 10.1002/dad2.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION We examined (1) the magnitude of mortality attributed to Alzheimer's disease (AD), and (2) the effect of mortality in cost‐effectiveness modeling of hypothetical disease‐modifying treatment (DMT) in AD. METHOD Data were derived from Swedish Dementia Registry (N = 39,308). Mortality was analyzed with survival analysis and multinomial logistic regression. A Markov microsimulation model was used to model the cost effectiveness of DMT using routine care as a comparator. Three scenarios were simulated: (1) indirect effect, (2) no effect on overall mortality, (3) indirect effect on AD‐related mortality. RESULTS Overall mortality increased with cognitive decline, age, male sex, number of medications used, and lower body mass index. Nearly all cause‐specific mortality was associated with cognitive decline. DMT increased survival by 0.35 years in scenario 1 and 0.14 years in scenario 3. DMT with no mortality effect is the least cost effective. DISCUSSION The results provide key mortality estimates and demonstrate influences on the cost effectiveness of DMT. Highlights We describe cause‐specific mortality in relation to disease severity in Alzheimer's disease (AD). We model different assumptions of disease‐modifying treatment (DMT) on AD survival. DMT was the least cost effective when assuming no effect on AD survival. Cost effectiveness is mainly influenced by the relative cost of staying in each disease state.
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Affiliation(s)
- Sandar Aye
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Linus Jönsson
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Anders Gustavsson
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Quantity ResearchStockholmSweden
| | - Ashley Tate
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Sara Garcia Ptacek
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalHuddingeSweden
| | - Maria Eriksdotter
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalHuddingeSweden
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Li Z, Gong X, Cui X, Zhang W, Wang Y, Wu D, Yang M, Jia X, Duan C, Liu L, Guo J, Jia R, Zhang X, Chen Y, Tang Y, Liu M, Wang Y. Body mass index and death by cognitive impairment. Aging Clin Exp Res 2023; 35:689-698. [PMID: 36795235 DOI: 10.1007/s40520-023-02346-6] [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: 11/21/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Epidemiological studies have reported that among participants with impaired cognitive, overweight and mild obesity are associated with substantially improved survival, this finding has been termed the "obesity paradox" and has led to uncertainty about secondary prevention. AIMS To explore whether the association of BMI with mortality differed in different MMSE score, and whether the obesity paradox in patient with cognitive impairment (CI) is real. METHODS The study used data from CLHLS, a representative prospective population-based cohort study in China, which included 8348 participants aged ≥ 60 years between 2011 and 2018. The independent association between BMI and mortality in differed MMSE score by calculating hazard ratios (HRs) in multivariate Cox regression analysis. RESULTS During a median (IQR) follow-up of 41.18 months, a total of 4216 participants died. In the total population, underweight increased the risk of all-cause mortality (HRs, 1.33; 95% CI 1.23-1.44), compared with normal weight, and overweight was associated with a decreased risk of all-cause mortality (HR 0.83; 95% CI 0.74-0.93). However, compared to normal weight, only underweight was associated with increased mortality risk among participants with MMSE scores of 0-23, 24-26, 27-29, and 30, and the fully-adjusted HRs (95% CIs) for mortality were 1.30 (1.18, 1.43), 1.31 (1.07, 1.59), 1.55 (1.34, 1.80) and 1.66 (1.26, 2.20), respectively. The obesity paradox was not found in individuals with CI. Sensitivity analyses carried out had hardly any impact on this result. CONCLUSION We found no evidence of an obesity paradox in patients with CI, compared with patients of normal weight. But underweight individuals may have increased mortality risk whether in the population with CI or not. And overweight/obese people with CI should continue to aim for normal weight.
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Affiliation(s)
- Zhiqiang Li
- School of Public Health, China Medical University, Shenyang, China.,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Xinran Gong
- School of Public Health, China Medical University, Shenyang, China.,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Xin Cui
- Second Medical Center of Chinese People's Liberation Army General Hospital, Haidian District, Beijing, China
| | - Wuping Zhang
- Foreign Language Department, Graduate School of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanding Wang
- School of Public Health, China Medical University, Shenyang, China.,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Di Wu
- School of Public Health, China Medical University, Shenyang, China.,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Meitao Yang
- School of Public Health, China Medical University, Shenyang, China.,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Xinjing Jia
- School of Public Health, China Medical University, Shenyang, China.,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Chunyuan Duan
- School of Public Health, China Medical University, Shenyang, China.,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Lisha Liu
- Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China.,School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Jinpeng Guo
- Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Ruizhong Jia
- Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Xiushan Zhang
- Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Yong Chen
- Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Yue Tang
- Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China
| | - Miao Liu
- Department of Epidemiology and Statistics, Graduate School of Chinese PLA General Hospital, Beijing, China.
| | - Yong Wang
- School of Public Health, China Medical University, Shenyang, China. .,Chinese People's Liberation Army Center for Disease Control and Prevention, Dongda Street No.20 in Fengtai District, Beijing, 100071, China.
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5
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Deardorff WJ, Barnes DE, Jeon SY, Boscardin WJ, Langa KM, Covinsky KE, Mitchell SL, Whitlock EL, Smith AK, Lee SJ. Development and External Validation of a Mortality Prediction Model for Community-Dwelling Older Adults With Dementia. JAMA Intern Med 2022; 182:1161-1170. [PMID: 36156062 PMCID: PMC9513707 DOI: 10.1001/jamainternmed.2022.4326] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/06/2022] [Indexed: 12/14/2022]
Abstract
Importance Estimating mortality risk in older adults with dementia is important for guiding decisions such as cancer screening, treatment of new and chronic medical conditions, and advance care planning. Objective To develop and externally validate a mortality prediction model in community-dwelling older adults with dementia. Design, Setting, and Participants This cohort study included community-dwelling participants (aged ≥65 years) in the Health and Retirement Study (HRS) from 1998 to 2016 (derivation cohort) and National Health and Aging Trends Study (NHATS) from 2011 to 2019 (validation cohort). Exposures Candidate predictors included demographics, behavioral/health factors, functional measures (eg, activities of daily living [ADL] and instrumental activities of daily living [IADL]), and chronic conditions. Main Outcomes and Measures The primary outcome was time to all-cause death. We used Cox proportional hazards regression with backward selection and multiple imputation for model development. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (plots of predicted and observed mortality). Results Of 4267 participants with probable dementia in HRS, the mean (SD) age was 82.2 (7.6) years, 2930 (survey-weighted 69.4%) were female, and 785 (survey-weighted 12.1%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0-6.8) years, and 3466 (81.2%) participants died by end of follow-up. The final model included age, sex, body mass index, smoking status, ADL dependency count, IADL difficulty count, difficulty walking several blocks, participation in vigorous physical activity, and chronic conditions (cancer, heart disease, diabetes, lung disease). The optimism-corrected iAUC after bootstrap internal validation was 0.76 (95% CI, 0.75-0.76) with time-specific AUC of 0.73 (95% CI, 0.70-0.75) at 1 year, 0.75 (95% CI, 0.73-0.77) at 5 years, and 0.84 (95% CI, 0.82-0.85) at 10 years. On external validation in NHATS (n = 2404), AUC was 0.73 (95% CI, 0.70-0.76) at 1 year and 0.74 (95% CI, 0.71-0.76) at 5 years. Calibration plots suggested good calibration across the range of predicted risk from 1 to 10 years. Conclusions and Relevance We developed and externally validated a mortality prediction model in community-dwelling older adults with dementia that showed good discrimination and calibration. The mortality risk estimates may help guide discussions regarding treatment decisions and advance care planning.
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Affiliation(s)
- W James Deardorff
- Division of Geriatrics, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco
| | - Deborah E Barnes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sun Y Jeon
- Division of Geriatrics, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kenneth M Langa
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco
- Associate Editor, JAMA Internal Medicine
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elizabeth L Whitlock
- Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco
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Overbeek FCMS, Goudzwaard JA, van Hemmen J, van Bruchem-Visser RL, Papma JM, Polinder-Bos HA, Mattace-Raso FUS. The Multidimensional Prognostic Index Predicts Mortality in Older Outpatients with Cognitive Decline. J Clin Med 2022; 11:jcm11092369. [PMID: 35566497 PMCID: PMC9103737 DOI: 10.3390/jcm11092369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
Since the heterogeneity of the growing group of older outpatients with cognitive decline, it is challenging to evaluate survival rates in clinical shared decision making. The primary outcome was to determine whether the Multidimensional Prognostic Index (MPI) predicts mortality, whilst assessing the MPI distribution was considered secondary. This retrospective chart review included 311 outpatients aged ≥65 years and diagnosed with dementia or mild cognitive impairment (MCI). The MPI includes several domains of the comprehensive geriatric assessment (CGA). All characteristics and data to calculate the risk score and mortality data were extracted from administrative information in the database of the Alzheimer’s Center and medical records. The study population (mean age 76.8 years, men = 51.4%) was divided as follows: 34.1% belonged to MPI category 1, 52.1% to MPI category 2 and 13.8% to MPI category 3. Patients with dementia have a higher mean MPI risk score than patients with MCI (0.47 vs. 0.32; p < 0.001). The HRs and corresponding 95% CIs for mortality in patients in MPI categories 2 and 3 were 1.67 (0.81−3.45) and 3.80 (1.56−9.24) compared with MPI category 1, respectively. This study shows that the MPI predicts mortality in outpatients with cognitive decline.
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Affiliation(s)
- Femke C. M. S. Overbeek
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Jeannette A. Goudzwaard
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Judy van Hemmen
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (J.v.H.); (J.M.P.)
| | - Rozemarijn L. van Bruchem-Visser
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (J.v.H.); (J.M.P.)
| | - Harmke A. Polinder-Bos
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Francesco U. S. Mattace-Raso
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
- Correspondence: ; Tel.: +31-10-7035979
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7
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Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
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Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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8
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ApoE4 Is Associated with Lower Body Mass, Particularly Fat Mass, in Older Women with Cognitive Impairment. Nutrients 2022; 14:nu14030539. [PMID: 35276898 PMCID: PMC8838979 DOI: 10.3390/nu14030539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
A lower body mass is associated with the progression of Alzheimer’s disease (AD) and the risk of mortality in patients with AD; however, evidence of genetic determinants of decreased body mass in cognitively impaired older adults is limited. We therefore investigated the genetic effect of APOE-ε4 on body composition in older adults with mild cognitive impairment (MCI) and early-to-moderate-stage AD. A total of 1631 outpatients (aged 65–89 years) with MCI and early-to-moderate-stage AD were evaluated for the association between body composition and APOE-ε4 status. After adjusting for covariates, including cognitive function evaluated with the Mini-Mental State Examination, the presence of the APOE-ε4 was associated with lower weight (β = −1.116 ± 0.468 kg per presence, p = 0.017), fat mass (β = −1.196 ± 0.401 kg per presence, p = 0.003), and percentage of body fat (β = −1.700 ± 0.539% per presence, p = 0.002) in women but not in men. Additionally, the impact of APOE-ε4 on measures of body composition in women was more remarkable in MCI than in AD patients. The presence of the APOE-ε4 allele was associated with lower fat mass, particularly in women with MCI, independent of cognitive decline.
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Xu H, Garcia-Ptacek S, Trevisan M, Evans M, Lindholm B, Eriksdotter M, Carrero JJ. Kidney Function, Kidney Function Decline, and the Risk of Dementia in Older Adults: A Registry-Based Study. Neurology 2021; 96:e2956-e2965. [PMID: 33952656 PMCID: PMC8253567 DOI: 10.1212/wnl.0000000000012113] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/15/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. The aim of this study is to investigate the links among kidney function, kidney function decline, and dementia incidence. METHODS We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis or initiation of dementia treatments) among 329,822 residents of Stockholm who accessed health care during 2006 to 2011, were ≥65 years of age, had no history of dementia, or underwent kidney replacement therapy. We also estimated the rate of eGFR decline among 205,622 residents with repeated eGFR measurements during the first year of observation and investigated its association with subsequent dementia risk. RESULTS We detected 18,983 cases of dementia (5.8% of participants) over a median follow-up of 5 years. Dementia incidence rates were progressively higher with lower eGFR: from 6.56/1,000 person-years in those with eGFR of 90 to 104 mL/min to 30.28/1,000 person-years in those with eGFR <30 mL/min. After multivariable adjustment, lower eGFR was associated with a higher dementia risk (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.54-1.91 in eGFR 30-59 mL/min; HR 2.62, 95% CI 1.91-3.58 in eGFR <30 mL/min) compared with eGFR of 90 to 104 mL/min. A steeper decline in eGFR (decline >2 mL/min/1.73 m2/y) within 1 year was associated with higher dementia risk. Risk magnitudes were stronger for vascular dementia than for Alzheimer dementia. As many as 10% (95% CI 6%-14%) of dementia cases could be attributed to eGFR <60 mL/min/1.73 m2, a proportion higher than that attributed to other dementia risk factors such as cardiovascular disease and diabetes. CONCLUSIONS Both lower kidney function and steeper kidney function decline are associated with the development of dementia.
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Affiliation(s)
- Hong Xu
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden.
| | - Sara Garcia-Ptacek
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden
| | - Marco Trevisan
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden
| | - Marie Evans
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Lindholm
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden
| | - Juan Jesus Carrero
- From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden
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10
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Secnik J, Xu H, Schwertner E, Hammar N, Alvarsson M, Winblad B, Eriksdotter M, Garcia-Ptacek S, Religa D. Dementia Diagnosis Is Associated with Changes in Antidiabetic Drug Prescription: An Open-Cohort Study of ∼130,000 Swedish Subjects over 14 Years. J Alzheimers Dis 2021; 76:1581-1594. [PMID: 32741836 PMCID: PMC7504989 DOI: 10.3233/jad-200618] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Care individualization dominates in clinical guidelines for cognitively impaired patients with diabetes; however, few studies examined such adaptations. OBJECTIVE Describe long-term pharmacological changes in diabetes treatment in subjects with and without dementia. METHODS We performed a registry-based cohort study on 133,318 Swedish subjects (12,284 [9.2%] with dementia) with type 2 or other/unspecified diabetes. Dementia status originated from the Swedish Dementia Registry, while the National Patient Register, Prescribed Drug Register, and Cause of Death Register provided data on diabetes, comorbidities, drug dispensation, and mortality. Drug dispensation interval comprised years between 2005 and 2018 and the dispensation was assessed relative to index date (dementia diagnosis) in full cohort and propensity-score (PS) matched cohorts. Annual changes of drug dispensation were analyzed by linear regression, while Cox and competing-risk regression were used to determine the probability of drug dispensation after index date in naïve subjects. Studied medications included insulin, metformin, sulfonylureas, thiazolidinediones, dipeptidyl-peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 agonists (GLP-1a), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). RESULTS Dementia patients had higher probability of insulin dispensation (hazard ratio 1.21 [95% CI 1.11-1.31] and lower probability of DPP-4i (0.72 [0.66-0.79]), GLP-1a (0.51 [0.41-0.63]), and SGLT-2i dispensation (0.44 [0.36-0.54]) after index date. PS-matched analyses showed increased annual insulin dispensation (β difference 0.97%) and lower increase in DPP-4i (-0.58%), GLP-1a (-0.13%), and SGLT-2i (-0.21%) dispensation in dementia patients compared to dementia-free controls. CONCLUSION Dementia patients had lower probability of receiving newer antidiabetic drugs, with simultaneous higher insulin dispensation compared to dementia-free subjects.
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Affiliation(s)
- Juraj Secnik
- Department of Neurobiology, Center for Alzheimer Research, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Hong Xu
- Department of Neurobiology, Center for Alzheimer Research, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Schwertner
- Department of Neurobiology, Center for Alzheimer Research, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Niklas Hammar
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael Alvarsson
- Department of Molecular Medicine and Surgery, Growth and Metabolism, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Center for Alzheimer Research, Division of Neurogeriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Center for Alzheimer Research, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Center for Alzheimer Research, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Internal Medicine, Södersjukhuset, Section for Neurology, Stockholm, Sweden
| | - Dorota Religa
- Department of Neurobiology, Center for Alzheimer Research, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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11
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Kalar I, Xu H, Secnik J, Schwertner E, Kramberger MG, Winblad B, von Euler M, Eriksdotter M, Garcia‐Ptacek S. Calcium channel blockers, survival and ischaemic stroke in patients with dementia: a Swedish registry study. J Intern Med 2021; 289:508-522. [PMID: 32854138 PMCID: PMC8049076 DOI: 10.1111/joim.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of calcium channel blockers (CCB) on mortality and ischaemic stroke risk in dementia patients is understudied. OBJECTIVES To calculate the risk of death and ischaemic stroke in dementia patients treated with CCBs, considering individual agents and dose response. METHODS Longitudinal cohort study with 18 906 hypertensive dementia patients from the Swedish Dementia Registry (SveDem), 2008-2014. Other Swedish national registries contributed information on comorbidities, dispensed medication and outcomes. Individual CCB agents and cumulative defined daily doses (cDDD) were considered. RESULTS In patients with hypertension and dementia, nifedipine was associated with increased mortality risk (aHR 1.32; CI 1.01-1.73; P < 0.05) compared to non-CCB users. Patients diagnosed with Alzheimer's dementia (AD) or dementia with Lewy bodies/Parkinson's disease dementia (DLB-PDD) taking amlodipine had lower mortality risk (aHR, 0.89; CI, 0.80-0.98; P < 0.05 and aHR 0.58; CI, 0.38-0.86; P < 0.01, respectively), than those taking other CCBs. Amlodipine was associated with lower stroke risk in patients with Alzheimer's dementia compared to other CCBs (aHR 0.63; CI, 0.44-0.89; P < 0.05). Sensitivity analyses with propensity score-matched cohorts repeated the results for nifedipine (aHR 1.35; 95% CI, 1.02-1.78; P < 0.05) and amlodipine in AD (aHR, 0.87; CI, 0.78-0.97; P < 0.05) and DLB-PDD (aHR, 0.56, 95%CI, 0.37-0.85; P < 0.05). CONCLUSION Amlodipine was associated with reduced mortality risk in dementia patients diagnosed with AD and DLB-PDD. AD patients using amlodipine had a lower risk of ischaemic stroke compared to other CCB users.
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Affiliation(s)
- I. Kalar
- From theDivision of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Department of NeurologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- University of LjubljanaLjubljanaSlovenia
| | - H. Xu
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - J. Secnik
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - E. Schwertner
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - M. G. Kramberger
- From theDivision of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Department of NeurologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- University of LjubljanaLjubljanaSlovenia
| | - B. Winblad
- From theDivision of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | - M. von Euler
- Department of Clinical Research and EducationSödersjukhuset (KI SÖS)Karolinska InstitutetStockholmSweden
| | - M. Eriksdotter
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | - S. Garcia‐Ptacek
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Theme AgingKarolinska University HospitalStockholmSweden
- Department of Internal MedicineNeurology SectionSödersjukhusetStockholmSweden
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12
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Functional Decline and Body Composition Change in Older Adults With Alzheimer Disease: A Retrospective Cohort Study at a Japanese Memory Clinic. Alzheimer Dis Assoc Disord 2020; 35:36-43. [PMID: 33323780 DOI: 10.1097/wad.0000000000000426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is a dearth of longitudinal data on body composition, function, and physical performance in persons with Alzheimer's disease (AD). OBJECTIVES The aim was to describe the trajectories of function, body composition, and physical performance in older adults with AD. METHODS In this retrospective cohort study, data were collected from older adults (n=1402) diagnosed with AD (mean age: 78.1 y old, women: 69.3%). Cognitive function was assessed using the mini-mental state examination. Proxy-reported instrumental and basic activities of daily living were assessed using the Lawton and Barthel indexes. Body composition was assessed using bioelectrical impedance analysis. Physical performance was assessed using the timed up and go test and grip strength. RESULTS Median (interquartile range) of follow-up time was 2.2 (1.2 to 3.6) years. Participants' mini-mental state examination score, Barthel index, and Lawton index declined over time. Skeletal muscle mass index and physical performance (timed up and go test and grip strength) decreased, while fat mass index increased with time. No significant changes or slight decline in weight and body mass index was observed. CONCLUSIONS Muscle mass and physical performance are likely to decline in older adults with AD. Clinicians should assess muscle mass and physical performance trajectories regularly in these patients and intervene appropriately.
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13
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Changes in Drug Prescribing Practices Are Associated With Improved Outcomes in Patients With Dementia in Sweden: Experience from the Swedish Dementia Registry 2008-2017. J Am Med Dir Assoc 2020; 22:1477-1483.e3. [PMID: 33309648 DOI: 10.1016/j.jamda.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/30/2020] [Accepted: 11/07/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Evidence is lacking on how treatment of comorbidities improves outcomes in patients with dementia. In this study, we evaluated temporal changes in the management of comorbidities in relation to survival rates in incident dementia over a 10-year period in Sweden. DESIGN Observational cohort study. SETTING AND PARTICIPANTS A total of 40,219 patients with recently diagnosed dementia in memory clinics from the Swedish Dementia Registry (SveDem) from 2008 to 2017. METHODS In 1-year blocks, pharmacological treatment of dementia and comorbidities in relationship to risk for fractures, major cardiovascular events (MACE), and death were analyzed using Cox models. Standardized Incidence Ratios (SIR) of death are presented. RESULTS After standardization for demographics and comorbidities, the risk of fracture, MACE, and mortality decreased by 16%, 23%, and 28%, respectively, between 2008 and 2016. Each year decreased the risk of fracture by 3% (hazard ratio 0.97, 95% confidence interval 0.96-0.99), MACE by 4% (0.96, 0.95-0.97), and death by 5% (0.95, 0.93-0.97). Adjustment for changes in medication use attenuated these associations. Compared with the general population, the risk of death declined by 11%, corresponding to standardized incidence rate ratio, between 2008 and 2016. CONCLUSIONS AND IMPLICATIONS Over 10 years, a reduction in the short-term risks of fracture, MACE, and death in patients with dementia was associated with changes in drug prescribing practices. These improvements seem to be partly explained by progressive implementation of dementia diagnostic, treatment guidelines, and general management of comorbidities.
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14
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Chen TB, Weng SC, Chou YY, Lee YS, Liang CK, Lin CS, Lan TH, Lin SY, Lin YT. Predictors of Mortality in the Oldest Old Patients with Newly Diagnosed Alzheimer Disease in a Residential Aged Care Facility. Dement Geriatr Cogn Disord 2020; 48:93-104. [PMID: 31600747 DOI: 10.1159/000503059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Taiwan, the causes of death and related factors in the oldest old people with Alzheimer disease (AD) are not well characterized. We investigated the factors associated with mortality in the oldest old patients with newly diagnosed AD admitted to a long-stay residential facility. METHODS We performed a prospective study of newly diagnosed AD patients at a veterans' home between 2012 and 2016. At admission, all eligible participants received a comprehensive geriatric assessment, including demographic variables, lifestyle habits, cognitive evaluations, medical conditions (comorbidities, Age-Adjusted Charlson Comorbidity Index score, and polypharmacy), nutritional status evaluated by the Mini Nutritional Assessment-Short Form and body mass index (BMI), and global functional status. A Cox proportional hazards model was used to evaluate the predictive values of clinical parameters for all-cause mortality. RESULTS The cohort comprised 84 newly diagnosed AD patients (mean age 86.6 ± 3.9 years) with a mean follow-up period of 2.1 ± 1.2 years. The overall median survival was 3.5 years from the time of AD diagnosis (95% confidence interval, 3.1-3.9 years). BMI was significantly lower in the deceased group than in the alive group (20.7 ± 2.9 vs. 22.6 ± 3.4, p = 0.023). Logistic regression demonstrated that the clinical parameters significantly associated with mortality were high global comorbidity, low nutritional status (malnutrition and underweight), and impaired physical function at the time of AD diagnosis. CONCLUSION Comorbidity burden, nutritional status, and physical functional status at the time of dementia diagnosis are important contributors to poor outcome in the oldest old. Efforts to control concurrent chronic disorders, nutritional interventions, and physical independency as a long-term care strategy for dementia may provide survival benefit.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shuo-Chun Weng
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Yin Chou
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Shan Lee
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Kaung Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chu-Sheng Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
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15
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Haaksma ML, Eriksdotter M, Rizzuto D, Leoutsakos JMS, Olde Rikkert MGM, Melis RJF, Garcia-Ptacek S. Survival time tool to guide care planning in people with dementia. Neurology 2020; 94:e538-e548. [PMID: 31843808 PMCID: PMC7080282 DOI: 10.1212/wnl.0000000000008745] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/25/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To develop survival prediction tables to inform physicians and patients about survival probabilities after the diagnosis of dementia and to determine whether survival after dementia diagnosis can be predicted with good accuracy. METHODS We conducted a nationwide registry-linkage study including 829 health centers, i.e., all memory clinics and ≈75% of primary care facilities, across Sweden. Data including cognitive function from 50,076 people with incident dementia diagnoses ≥65 years of age and registered with the Swedish Dementia Register in 2007 to 2015 were used, with a maximum follow-up of 9.7 years for survival until 2016. Sociodemographic factors, comorbidity burden, medication use, and dates of death were obtained from nationwide registries. Cox proportional hazards regression models were used to create tables depicting 3-year survival probabilities for different risk factor profiles. RESULTS By August 2016, 20,828 (41.6%) patients in our cohort had died. Median survival time from diagnosis of dementia was 5.1 (interquartile range 2.9-8.0) years for women and 4.3 (interquartile range 2.3-7.0) years for men. Predictors of mortality were higher age, male sex, increased comorbidity burden and lower cognitive function at diagnosis, a diagnosis of non-Alzheimer dementia, living alone, and using more medications. The developed prediction tables yielded c indexes of 0.70 (95% confidence interval [CI] 0.69-0.71) to 0.72 (95% CI 0.71-0.73) and showed good calibration. CONCLUSIONS Three-year survival after dementia diagnosis can be predicted with good accuracy. The survival prediction tables developed in this study may aid clinicians and patients in shared decision-making and advance care planning.
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Affiliation(s)
- Miriam L Haaksma
- From the Department of Geriatric Medicine (M.L.H., M.G.M.O.R., R.J.F.M.), Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Aging Research Center (M.L.H., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna; Division of Clinical Geriatrics (M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.E., S.G.-P.), Karolinska University Hospital, Huddinge, Sweden; Department of Psychiatry (J.-M.S.L.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Radboud University Medical Center (M.G.M.O.R.), Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands; and Department of Internal Medicine (S.G.-P.), Section for Neurology, Södersjukhuset Stockholm, Sweden
| | - Maria Eriksdotter
- From the Department of Geriatric Medicine (M.L.H., M.G.M.O.R., R.J.F.M.), Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Aging Research Center (M.L.H., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna; Division of Clinical Geriatrics (M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.E., S.G.-P.), Karolinska University Hospital, Huddinge, Sweden; Department of Psychiatry (J.-M.S.L.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Radboud University Medical Center (M.G.M.O.R.), Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands; and Department of Internal Medicine (S.G.-P.), Section for Neurology, Södersjukhuset Stockholm, Sweden
| | - Debora Rizzuto
- From the Department of Geriatric Medicine (M.L.H., M.G.M.O.R., R.J.F.M.), Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Aging Research Center (M.L.H., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna; Division of Clinical Geriatrics (M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.E., S.G.-P.), Karolinska University Hospital, Huddinge, Sweden; Department of Psychiatry (J.-M.S.L.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Radboud University Medical Center (M.G.M.O.R.), Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands; and Department of Internal Medicine (S.G.-P.), Section for Neurology, Södersjukhuset Stockholm, Sweden
| | - Jeannie-Marie S Leoutsakos
- From the Department of Geriatric Medicine (M.L.H., M.G.M.O.R., R.J.F.M.), Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Aging Research Center (M.L.H., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna; Division of Clinical Geriatrics (M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.E., S.G.-P.), Karolinska University Hospital, Huddinge, Sweden; Department of Psychiatry (J.-M.S.L.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Radboud University Medical Center (M.G.M.O.R.), Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands; and Department of Internal Medicine (S.G.-P.), Section for Neurology, Södersjukhuset Stockholm, Sweden
| | - Marcel G M Olde Rikkert
- From the Department of Geriatric Medicine (M.L.H., M.G.M.O.R., R.J.F.M.), Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Aging Research Center (M.L.H., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna; Division of Clinical Geriatrics (M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.E., S.G.-P.), Karolinska University Hospital, Huddinge, Sweden; Department of Psychiatry (J.-M.S.L.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Radboud University Medical Center (M.G.M.O.R.), Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands; and Department of Internal Medicine (S.G.-P.), Section for Neurology, Södersjukhuset Stockholm, Sweden
| | - René J F Melis
- From the Department of Geriatric Medicine (M.L.H., M.G.M.O.R., R.J.F.M.), Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Aging Research Center (M.L.H., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna; Division of Clinical Geriatrics (M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.E., S.G.-P.), Karolinska University Hospital, Huddinge, Sweden; Department of Psychiatry (J.-M.S.L.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Radboud University Medical Center (M.G.M.O.R.), Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands; and Department of Internal Medicine (S.G.-P.), Section for Neurology, Södersjukhuset Stockholm, Sweden
| | - Sara Garcia-Ptacek
- From the Department of Geriatric Medicine (M.L.H., M.G.M.O.R., R.J.F.M.), Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Aging Research Center (M.L.H., D.R.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna; Division of Clinical Geriatrics (M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.E., S.G.-P.), Karolinska University Hospital, Huddinge, Sweden; Department of Psychiatry (J.-M.S.L.), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD; Radboud University Medical Center (M.G.M.O.R.), Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands; and Department of Internal Medicine (S.G.-P.), Section for Neurology, Södersjukhuset Stockholm, Sweden.
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16
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Lin CH, Yang HT, Chen PK, Wang SH, Lane HY. Precision Medicine of Sodium Benzoate for the Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD). Neuropsychiatr Dis Treat 2020; 16:509-518. [PMID: 32110025 PMCID: PMC7039065 DOI: 10.2147/ndt.s234371] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/09/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Behavioral and psychological symptoms of dementia (BPSD) are associated with poorer prognosis of dementia. A 24-week study demonstrated that sodium benzoate, a D-amino acid oxidase (DAAO) inhibitor, surpassed placebo in improving cognitive function in early-phase Alzheimer's disease; however, benzoate did not excel placebo in another 6-week study on BPSD. The current study examined whether the precision medicine approach was able to identify specific individuals with BPSD who could benefit from benzoate treatment. METHODS In the randomized, double-blind, placebo-controlled, 6-week trial, 97 patients with BPSD were allocated to receive 250-1500 mg/day of sodium benzoate or placebo. Cognitive function was measured by the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) and behavioral and psychological symptoms were mainly measured by Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). DAAO level, amino acids (L-serine, D-serine, L-alanine, and D-alanine, glycine), and two antioxidants (catalase, superoxide dismutase) were assayed in peripheral blood. RESULTS After benzoate treatment, DAAO inhibition was correlated with ADAS-cog decrease (p = 0.034), while baseline DAAO level was correlated with baseline BEHAVE-AD score. Multiple linear regression analyses showed that cognitive improvement after benzoate treatment was correlated with DAAO decrease, female gender, younger age, BMI, baseline BPSD severity, and antipsychotic use. CONCLUSION The finding suggests that sodium benzoate may have potential to benefit cognitive function in a fraction of BPSD patients after 6 weeks of treatment. Of note, the precision medicine approach may be helpful for identifying individuals who could respond to benzoate. More studies are warranted to confirm the preliminary findings. TRIAL REGISTRATION The trial was registered online (https://clinicaltrials.gov/ct2/show/NCT02103673).
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Affiliation(s)
- Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Ting Yang
- School of Food Safety, Taipei Medical University, Taipei, Taiwan
| | - Ping-Kun Chen
- School of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Shi-Heng Wang
- Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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17
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Liu B, Luo Z, Pinto JM, Shiroma EJ, Tranah GJ, Wirdefeldt K, Fang F, Harris TB, Chen H. Relationship Between Poor Olfaction and Mortality Among Community-Dwelling Older Adults: A Cohort Study. Ann Intern Med 2019; 170:673-681. [PMID: 31035288 PMCID: PMC7673250 DOI: 10.7326/m18-0775] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Poor olfaction is common among older adults and has been linked to higher mortality. However, most studies have had a relatively short follow-up and have not explored potential explanations. OBJECTIVE To assess poor olfaction in relation to mortality in older adults and to investigate potential explanations. DESIGN Community-based prospective cohort study. SETTING 2 U.S. communities. PARTICIPANTS 2289 adults aged 71 to 82 years at baseline (37.7% black persons and 51.9% women). MEASUREMENTS Brief Smell Identification Test in 1999 or 2000 (baseline) and all-cause and cause-specific mortality at 3, 5, 10, and 13 years after baseline. RESULTS During follow-up, 1211 participants died by year 13. Compared with participants with good olfaction, those with poor olfaction had a 46% higher cumulative risk for death at year 10 (risk ratio, 1.46 [95% CI, 1.27 to 1.67]) and a 30% higher risk at year 13 (risk ratio, 1.30 [CI, 1.18 to 1.42]). Similar associations were found in men and women and in white and black persons. However, the association was evident among participants who reported excellent to good health at baseline (for example, 10-year mortality risk ratio, 1.62 [CI, 1.37 to 1.90]) but not among those who reported fair to poor health (10-year mortality risk ratio, 1.06 [CI, 0.82 to 1.37]). In analyses of cause-specific mortality, poor olfaction was associated with higher mortality from neurodegenerative and cardiovascular diseases. Mediation analyses showed that neurodegenerative diseases explained 22% and weight loss explained 6% of the higher 10-year mortality among participants with poor olfaction. LIMITATION No data were collected on change in olfaction and its relationship to mortality. CONCLUSION Poor olfaction is associated with higher long-term mortality among older adults, particularly those with excellent to good health at baseline. Neurodegenerative diseases and weight loss explain only part of the increased mortality. PRIMARY FUNDING SOURCE National Institutes of Health and Michigan State University.
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Affiliation(s)
- Bojing Liu
- Karolinska Institutet, Stockholm, Sweden, and Michigan State University College of Human Medicine, East Lansing, Michigan (B.L.)
| | - Zhehui Luo
- Michigan State University College of Human Medicine, East Lansing, Michigan (Z.L., H.C.)
| | | | - Eric J Shiroma
- National Institute on Aging of the National Institutes of Health, Bethesda, Maryland (E.J.S., T.B.H.)
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, California (G.J.T.)
| | | | - Fang Fang
- Karolinska Institutet, Stockholm, Sweden (K.W., F.F.)
| | - Tamara B Harris
- National Institute on Aging of the National Institutes of Health, Bethesda, Maryland (E.J.S., T.B.H.)
| | - Honglei Chen
- Michigan State University College of Human Medicine, East Lansing, Michigan (Z.L., H.C.)
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18
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Ning P, Yang B, Li S, Mu X, Shen Q, Hu F, Tang Y, Yang X, Xu Y. Systematic review of the prognostic role of body mass index in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:356-367. [PMID: 30931632 DOI: 10.1080/21678421.2019.1587631] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Pingping Ning
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Baiyuan Yang
- Department of Neurology, Seventh People’s Hospital of Chengdu, Chengdu, Sichuan Province, P.R. China,
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Xin Mu
- Department of Neurology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, P.R. China and
| | - Qiuyan Shen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Fayun Hu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Yao Tang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
| | - Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, P.R. China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China,
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19
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Antipsychotic Treatment Associated With Increased Mortality Risk in Patients With Dementia. A Registry-Based Observational Cohort Study. J Am Med Dir Assoc 2019; 20:323-329.e2. [DOI: 10.1016/j.jamda.2018.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
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20
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Petek B, Villa-Lopez M, Loera-Valencia R, Gerenu G, Winblad B, Kramberger MG, Ismail MAM, Eriksdotter M, Garcia-Ptacek S. Connecting the brain cholesterol and renin-angiotensin systems: potential role of statins and RAS-modifying medications in dementia. J Intern Med 2018; 284:620-642. [PMID: 30264910 DOI: 10.1111/joim.12838] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Millions of people worldwide receive agents targeting the renin-angiotensin system (RAS) to treat hypertension or statins to lower cholesterol. The RAS and cholesterol metabolic pathways in the brain are autonomous from their systemic counterparts and are interrelated through the cholesterol metabolite 27-hydroxycholesterol (27-OHC). These systems contribute to memory and dementia pathogenesis through interference in the amyloid-beta cascade, vascular mechanisms, glucose metabolism, apoptosis, neuroinflammation and oxidative stress. Previous studies examining the relationship between these treatments and cognition and dementia risk have produced inconsistent results. Defining the blood-brain barrier penetration of these medications has been challenging, and the mechanisms of action on cognition are not clearly established. Potential biases are apparent in epidemiological and clinical studies, such as reverse epidemiology, indication bias, problems defining medication exposure, uncertain and changing doses, and inappropriate grouping of outcomes and medications. This review summarizes current knowledge of the brain cholesterol and RAS metabolism and the mechanisms by which these pathways affect neurodegeneration. The putative mechanisms of action of statins and medications inhibiting the RAS will be examined, together with prior clinical and animal studies on their effects on cognition. We review prior epidemiological studies, analysing their strengths and biases, and identify areas for future research. Understanding the pathophysiology of the brain cholesterol system and RAS and their links to neurodegeneration has enormous potential. In future, well-designed epidemiological studies could identify potential treatments for Alzheimer's disease (AD) amongst medications that are already in use for other indications.
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Affiliation(s)
- B Petek
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,University of Ljubljana, Ljubljana, Slovenia
| | - M Villa-Lopez
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - R Loera-Valencia
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - G Gerenu
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosciences, Biodonostia Health Research Institute, San Sebastian, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases, CIBERNED, Health Institute Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain
| | - B Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - M G Kramberger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,University of Ljubljana, Ljubljana, Slovenia
| | - M-A-M Ismail
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Neuro, Diseases of the Nervous System patient flow, Karolinska University Hospital, Huddinge, Sweden
| | - M Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Neurology Section, Södersjukhuset, Stockholm, Sweden
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21
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Fereshtehnejad SM, Lökk J, Wimo A, Eriksdotter M. No Significant Difference in Cognitive Decline and Mortality between Parkinson’s Disease Dementia and Dementia with Lewy Bodies: Naturalistic Longitudinal Data from the Swedish Dementia Registry. JOURNAL OF PARKINSONS DISEASE 2018; 8:553-561. [DOI: 10.3233/jpd-181367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Johan Lökk
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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22
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Park K, Oeda T, Kohsaka M, Tomita S, Umemura A, Sawada H. Low body mass index and life prognosis in Parkinson's disease. Parkinsonism Relat Disord 2018; 55:81-85. [DOI: 10.1016/j.parkreldis.2018.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/04/2018] [Accepted: 05/14/2018] [Indexed: 12/14/2022]
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23
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Giil LM, Aarsland D, Hellton K, Lund A, Heidecke H, Schulze-Forster K, Riemekasten G, Vik-Mo AO, Kristoffersen EK, Vedeler CA, Nordrehaug JE. Antibodies to Multiple Receptors are Associated with Neuropsychiatric Symptoms and Mortality in Alzheimer’s Disease: A Longitudinal Study. J Alzheimers Dis 2018; 64:761-774. [DOI: 10.3233/jad-170882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lasse M. Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, UK
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
| | | | - Anders Lund
- Department of Clinical Science, University of Bergen, Norway
| | | | | | - Gabriela Riemekasten
- Department of Rheumatology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Audun Osland Vik-Mo
- Department of Clinical Science, University of Bergen, Norway
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
| | - Einar K. Kristoffersen
- Department of Clinical Science, University of Bergen, Norway
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Christian A. Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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24
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Roheger M, Zupanic E, Kåreholt I, Religa D, Kalbe E, Eriksdotter M, Garcia-Ptacek S. Mortality and nursing home placement of dementia patients in rural and urban areas: a cohort study from the Swedish Dementia Registry. Scand J Caring Sci 2018; 32:1308-1313. [DOI: 10.1111/scs.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/08/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Mandy Roheger
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI); University Hospital Cologne; Cologne Germany
| | - Eva Zupanic
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Neurology; University Medical Centre; Ljubljana Slovenia
| | - Ingemar Kåreholt
- Aging Research Center; Karolinska Institutet and Stockholm University; Stockholm Sweden
- Institute of Gerontology; School of Health and Welfare; Aging Research Network-Jönköping (ARN-J); Jönköping University; Jönköping Sweden
| | - Dorota Religa
- Theme Aging; Karolinska University Hospital; Stockholm Sweden
- Division of Neurogeriatrics; Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI); University Hospital Cologne; Cologne Germany
| | - Maria Eriksdotter
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Theme Aging; Karolinska University Hospital; Stockholm Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Internal Medicine; Section for Neurology; Södersjukhuset; Stockholm Sweden
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25
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Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries. J Am Med Dir Assoc 2018; 19:154-161. [DOI: 10.1016/j.jamda.2017.08.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
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26
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Garre-Olmo J, Garcia-Ptacek S, Calvó-Perxas L, Turró-Garriga O, López-Pousa S, Eriksdotter M. Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi). J Alzheimers Dis 2018; 53:1341-51. [PMID: 27392854 PMCID: PMC5115613 DOI: 10.3233/jad-160098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to compare the frequency of dementia diagnoses from two dementia registries in Europe. Patients registered between 2007 and 2013 in the Swedish Dementia Registry (SveDem; Sweden) and in the Registry of Dementias of Girona (ReDeGi; North-East of Spain) were selected. We compared sociodemographic data, Mini-Mental State Examination (MMSE) scores, dementia subtype, and medication consumption of 22,384 cases from SveDem and 5,032 cases from ReDeGi. The average age (78.1 years SveDem versus 79.7 years ReDeGi) and the gender (female 58.2% SveDem versus 61.5% ReDeGi) did not greatly differ. MMSE score at diagnosis was higher for SveDem cases (22.1 versus 17.8). Alzheimer’s disease (AD) accounted for the main dementia subtype (36.6% SveDem versus 55.6% ReDeGi). The proportion of vascular dementia (VaD) and mixed dementia was higher in SveDem (18.8% versus 6.4% and 24.9 versus 13.4%), with an odds ratio (OR) and 95% confidence interval (CI) for SveDem relative to the ReDeGi of 3.41 (3.03–3.84) for VaD, and 2.15 (1.97–2.35) for mixed dementia. This was at the expense of a lower frequency of AD in SveDem (OR 0.41; 95% CI 0.39–0.44). Other dementia diagnoses such as frontotemporal dementia or dementia with Lewy bodies did not significantly differ between registries (2.3% versus 2.9%; 1.9 versus 3.1%). Large differences in medication consumption at the time of dementia diagnosis were detected (4.7 treatments SveDem versus 6.8 ReDeGi). Northern and southern European dementia cohorts differ in demographic characteristics, MMSE score at diagnosis, and drug treatment profile.
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Affiliation(s)
- Josep Garre-Olmo
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain.,Deparment of Medical Sciences, University of Girona, Girona, Catalonia, Spain
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Laia Calvó-Perxas
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Oriol Turró-Garriga
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Secundino López-Pousa
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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27
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Zupanic E, von Euler M, Kåreholt I, Contreras Escamez B, Fastbom J, Norrving B, Religa D, Kramberger MG, Winblad B, Johnell K, Eriksdotter M, Garcia-Ptacek S. Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study. Neurology 2017; 89:1860-1868. [PMID: 28986410 PMCID: PMC5664294 DOI: 10.1212/wnl.0000000000004598] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare access to intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) and its outcomes in patients with and without dementia. METHODS This was a longitudinal cohort study of the Swedish dementia and stroke registries. Patients with preexisting dementia who had AIS from 2010 to 2014 (n = 1,356) were compared with matched patients without dementia (n = 6,755). We examined access to thrombolysis and its outcomes at 3 months (death, residency, and modified Rankin Scale [mRS] score). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic and ordinal logistic regression. RESULTS The median age at stroke onset was 83 years in both groups. IVT was administered to 94 (7.0%) patients with dementia and 639 (9.5%) patients without dementia. The OR of receiving IVT was 0.68 (95% CI 0.54-0.86) for patients with dementia. When the analysis was repeated exclusively among patients independent in everyday activities, dementia status was no longer significant (OR 0.79, 95% CI 0.60-1.06). However, differences persisted in patients ≤80 years of age (OR 0.58, 95% CI 0.36-0.94). In patients who received thrombolysis, the incidence of symptomatic intracerebral hemorrhage (sICH; 7.4% vs 7.3%) and death at 3 months (22.0% vs 18.8%) did not differ significantly between the 2 groups. However, mRS score and accommodation status were worse among patients with dementia after 3 months in adjusted analyses (both p < 0.001). Unfavorable outcomes with an mRS score of 5 to 6 were doubled in patients with dementia (56.1% vs 28.1%). CONCLUSIONS Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months.
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Affiliation(s)
- Eva Zupanic
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Mia von Euler
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Ingemar Kåreholt
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Beatriz Contreras Escamez
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Johan Fastbom
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Bo Norrving
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Dorota Religa
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Milica G Kramberger
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Bengt Winblad
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Kristina Johnell
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Maria Eriksdotter
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- From the Karolinska Institutet (E.Z., D.R., B.W.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden; Department of Neurology (E.Z., M.G.K.), University Medical Centre, Ljubljana, Slovenia; Karolinska Institutet (M.v.E.), Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna; Karolinska University Hospital (M.v.E.), Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University (I.K., J.F., K.J.), Aging Research Center, Stockholm, Sweden; Jönköping University (I.K.), Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping; Karolinska Institutet (B.C.E., M.E., S.G.-P.), Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden; Department of Geriatrics (B.C.E.), Hospital Universitario de Getafe, Madrid, Spain; Lund University (B.N.), Skane University Hospital, Department of Clinical Sciences Lund, Neurology; Karolinska University Hospital, Department of Geriatric Medicine (D.R., M.E., S.G.-P.); and Södersjukhuset (S.G.-P.), Department of Internal Medicine, Section for Neurology, Stockholm, Sweden.
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Franx BAA, Arnoldussen IAC, Kiliaan AJ, Gustafson DR. Weight Loss in Patients with Dementia: Considering the Potential Impact of Pharmacotherapy. Drugs Aging 2017; 34:425-436. [PMID: 28478593 DOI: 10.1007/s40266-017-0462-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unintentional body weight loss is common in patients with dementia and is linked to cognitive impairment and poorer disease outcomes. It is proposed that some dementia medications with market approval, while aiming to improve cognitive and functional outcomes of a patient with dementia, are associated with reported body weight or body mass index loss. This review presents evidence in the published literature on body weight loss in dementia, describes selected theories behind body weight loss, evaluates the potential impact of approved dementia pharmacotherapies on body weight, considers the potential role for medical foods, understands the potential influence of treatments for neuropsychiatric symptoms and signs, and finally, summarizes this important area.
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Affiliation(s)
- Bart A A Franx
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse A C Arnoldussen
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Amanda J Kiliaan
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA. .,Neuropsychiatric Epidemiology Unit (EPINEP), Institute for Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Department of Health and Education, University of Skövde, Skövde, Sweden.
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de Souto Barreto P, Cadroy Y, Kelaiditi E, Vellas B, Rolland Y. The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes. Clin Nutr 2017; 36:423-428. [DOI: 10.1016/j.clnu.2015.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 11/09/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
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Garcia-Ptacek S, Modéer IN, Kåreholt I, Fereshtehnejad SM, Farahmand B, Religa D, Eriksdotter M. Differences in diagnostic process, treatment and social Support for Alzheimer's dementia between primary and specialist care: resultss from the Swedish Dementia Registry. Age Ageing 2017; 46:314-319. [PMID: 27810851 PMCID: PMC5859983 DOI: 10.1093/ageing/afw189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022] Open
Abstract
Background the increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC). Design cross-sectional study. Subjects a total of, 9,625 patients diagnosed with AD registered 2011–14 in SveDem, the Swedish Dementia Registry. Methods descriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication. Results a total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P < 0.001), had lower MMSE (median 21 vs. 22; P < 0.001) and more likely to receive home care (31% vs. 20%; P < 0.001) or day care (5% vs. 3%; P < 0.001). Fewer diagnostic tests were performed in PC and diagnostic time was shorter. Basic testing was less likely to be complete in PC. The greatest differences were found for neuroimaging (82% in PC vs. 98% in SC) and clock tests (84% vs. 93%). These differences remained statistically significant after adjusting for MMSE and demographic characteristics. PC patients received less antipsychotic medication and more anxiolytics and hypnotics, but there were no significant differences in use of cholinesterase inhibitors between PC and SC. Conclusion primary and specialist AD patients differ in background characteristics, and this can influence diagnostic work-up and treatment. PC excels in restriction of antipsychotic use. Use of head CT and clock test in PC are areas for improvement in Sweden.
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Affiliation(s)
- Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden
- Address correspondence to: S. Garcia-Ptacek, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Novum plan 5 SE141-83, Huddinge, Stockholm, Sweden. Tel: +46(0)8-58585408.
| | - Ingrid Nilsson Modéer
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
| | - Ingemar Kåreholt
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
- Department of Neurology and Neurosurgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Bahman Farahmand
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
| | - Dorota Religa
- Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 141 57 Huddinge, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Stockholm, Sweden
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Garcia‐Ptacek S, Kåreholt I, Cermakova P, Rizzuto D, Religa D, Eriksdotter M. Causes of Death According to Death Certificates in Individuals with Dementia: A Cohort from the Swedish Dementia Registry. J Am Geriatr Soc 2016; 64:e137-e142. [DOI: 10.1111/jgs.14421] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Garcia‐Ptacek
- Division of Clinical Geriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska InstitutetStockholm Sweden
- Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden
| | - Ingemar Kåreholt
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm UniversityStockholm Sweden
- Institute of Gerontology School of Health and Welfare Jönköping University Jönköping Sweden
| | - Pavla Cermakova
- Division of Neurogeriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden
- International Clinical Research Center and St. Anne's University Hospital Brno Czech Republic
| | - Debora Rizzuto
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm UniversityStockholm Sweden
| | - Dorota Religa
- Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden
- Division of Neurogeriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Mossakowski Medical Research Centre Polish Academy of Sciences Warsaw Poland
| | - Maria Eriksdotter
- Division of Clinical Geriatrics Center for Alzheimer Research Department of Neurobiology Care Sciences and Society Karolinska InstitutetStockholm Sweden
- Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden
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Eschbach D, Kirchbichler T, Wiesmann T, Oberkircher L, Bliemel C, Ruchholtz S, Buecking B. Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study. Clin Interv Aging 2016; 11:1239-1246. [PMID: 27672318 PMCID: PMC5026212 DOI: 10.2147/cia.s109281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients. Patients and methods This prospective intervention study included cognitively impaired geriatric patients (Mini–Mental State Examination <25, age >65 years) with hip-related fractures. We assessed Mini Nutritional Assessment (MNA), Nutritional Risk Screening (NRS 2002), body mass index, calf circumference, American Society of Anesthesiologists’ classification, and Braden Scale. All patients received parenteral nutritional supplementation of 800 kcal/d for the 96-hour perioperative period. Serum albumin and pseudocholinesterase were monitored. Information related to the study design and any complications in the clinical course were documented. Results A total of 96 patients were screened, among whom eleven women (median age: 87 years; age range: 74–91 years) and nine men (median age: 82 years; age range: 73–89 years) were included. The Mini–Mental State Examination score was 9.5 (0–24). All patients were manifestly undernourished or at risk according to MNA and NRS 2002. The body mass index was 23 kg/m2 (13–30 kg/m2), the calf circumference was 29.5 cm (18–34 cm), and the mean American Society of Anesthesiologists’ classification status was 3 (2–4). Braden Scale showed 18 patients at high risk of developing pressure ulcers. In all, 12 patients had nonsurgical complications with 10% mortality. Albumin as well as pseudocholinesterase dropped significantly from admission to discharge. The study design proved to be feasible. Conclusion The testing of MNA and NRS 2002 was feasible. Cognitively impaired trauma patients proved to be especially at risk of malnutrition. Since 96 hours of parenteral nutrition as a crisis intervention was insufficient, additional supplementation could be considered. Laboratory and functional outcome parameters for measuring successive supplementation certainly need further evaluations involving randomized controlled trials.
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Affiliation(s)
- D Eschbach
- Center for Orthopedics and Trauma Surgery
| | | | - T Wiesmann
- Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany
| | | | - C Bliemel
- Center for Orthopedics and Trauma Surgery
| | | | - B Buecking
- Center for Orthopedics and Trauma Surgery
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Abstract
Dementia is a frequent complication of Parkinson disease (PD) with a yearly incidence of around 10% of patients with PD. Lewy body pathology is the most important factor in the development of Parkinson disease dementia (PDD) and there is evidence for a synergistic effect with β-amyloid. The clinical phenotype in PDD extends beyond the dysexecutive syndrome that is often present in early PD and encompasses deficits in recognition memory, attention, and visual perception. Sleep disturbances, hallucinations, neuroleptic sensitivity, and fluctuations are often present. This review provides an update on current knowledge of PDD including aspects of epidemiology, pathology, clinical presentation, management, and prognosis.
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Affiliation(s)
- Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden Department of Geriatric Medicine, Memory Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Milica G Kramberger
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Challenges in the Management of Geriatric Obesity in High Risk Populations. Nutrients 2016; 8:nu8050262. [PMID: 27153084 PMCID: PMC4882675 DOI: 10.3390/nu8050262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 01/26/2023] Open
Abstract
The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.
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Peterlin BL, Sacco S, Bernecker C, Scher AI. Adipokines and Migraine: A Systematic Review. Headache 2016; 56:622-44. [PMID: 27012149 DOI: 10.1111/head.12788] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Migraine is comorbid with obesity. Recent research suggests an association between migraine and adipocytokines, proteins that are predominantly secreted from adipose tissue and which participate in energy homeostasis and inflammatory processes. OBJECTIVES In this review, we first briefly discuss the association between migraine and obesity and the importance of adipose tissue as a neuroendocrine organ. We then present a systematic review of the extant literature evaluating circulating levels of adiponectin and leptin in those with migraine. METHODS A search of the PubMed database was conducted using the keywords "migraine," "adiponectin," and "leptin." In addition reference lists of relevant articles were reviewed for possible inclusion. English language studies published between 2005 and 2015 evaluating circulating blood concentration of adiponectin or leptin in those with migraine were included. CONCLUSIONS While the existing data are suggestive that adipokines may be associated with migraine, substantial study design differences and conflicting results limit definitive conclusions. Future research utilizing carefully considered designs and methodology is warranted. In particular careful and systematic characterization of pain states at the time of samples, as well as systematic consideration of demographic (e.g., age, sex) and other vital covariates (e.g., obesity status, lipids) are needed to determine if adipokines play a role in migraine pathophysiology and if any adipokine represents a viable, novel migraine biomarker, or drug target.
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Affiliation(s)
- B Lee Peterlin
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA
| | - Simona Sacco
- University of L'Aquila, Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, L'Aquila, Italy
| | - Claudia Bernecker
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria.,Medical University of Graz, Department of Blood Group Serology and Transfusion Medicine, Graz, Austria
| | - Ann I Scher
- Uniformed Services University, Bethesda, MD, USA
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Stenvinkel P, Gillespie IA, Tunks J, Addison J, Kronenberg F, Drueke TB, Marcelli D, Schernthaner G, Eckardt KU, Floege J, Froissart M, Anker SD. Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients. J Am Soc Nephrol 2015; 27:1479-86. [PMID: 26567245 DOI: 10.1681/asn.2015030252] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/09/2015] [Indexed: 11/03/2022] Open
Abstract
High body mass index (BMI) is paradoxically associated with better outcome in hemodialysis (HD) patients. Persistent inflammation commonly features in clinical conditions where the obesity paradox is described. We examined the relationship between BMI and mortality in HD patients, accounting for inflammation, in a historic cohort study of 5904 incident HD patients enrolled in 2007-2009 (312 facilities; 15 European countries) with ≥3 months of follow-up. Patients were classified by presence (n=3231) or absence (n=2673) of inflammation (C-reactive protein ≥10 mg/l and/or albumin ≤35 g/l). Patients were divided into quintiles by BMI (Q1-Q5: <21.5, 21.5-24.0, >24.0-26.4, >26.4-29.8, and >29.8 kg/m(2), respectively). Noninflamed patients in BMI Q5 formed the reference group. During a median follow-up period of 36.7 months, 1929 deaths occurred (822 cardiovascular), with 655 patients censored for renal transplantation and 1183 for loss to follow-up. Greater mortality was observed in inflamed patients (P<0.001). In fully adjusted time-dependent analyses, the all-cause mortality risk in noninflamed patients was higher only in the lowest BMI quintile (hazard ratio [HR, 1.80; 95% confidence interval [95% CI], 1.26 to 2.56). No protective effect was associated with higher BMI quintiles in noninflamed patients. Conversely, higher BMI associated with lower all-cause mortality risk in inflamed patients (HR [95% CI] for Q1: 5.63 [4.25 to 7.46]; Q2: 3.88 [2.91 to 5.17]; Q3: 2.89 [2.16 to 3.89]; Q4: 2.14 [1.59 to 2.90]; and Q5: 1.77 [1.30 to 2.40]). Thus, whereas a protective effect of high BMI was observed in inflamed patients, this effect was mitigated in noninflamed patients.
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Affiliation(s)
- Peter Stenvinkel
- Department of Renal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden;
| | - Iain A Gillespie
- Center for Observational Research, Amgen Ltd., Uxbridge, United Kingdom
| | - Jamie Tunks
- Global Biostatistical Science, Amgen Ltd., Cambridge, United Kingdom
| | - Janet Addison
- Center for Observational Research, Amgen Ltd., Uxbridge, United Kingdom
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tilman B Drueke
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Hôpital Paul Brousse and Université Paris-Sud, Villejuif, France
| | - Daniele Marcelli
- Europe, Middle East, Africa and Latin America Medical Board, Fresenius Medical Care, Bad Homburg, Germany
| | | | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Germany
| | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Marc Froissart
- International Development Nephrology, Amgen Europe GmbH, Zug, Switzerland; and
| | - Stefan D Anker
- Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany
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Abstract
PURPOSE OF REVIEW The obesity paradox is a highly controversial concept that may be attributed to methodological limitations related to its identification. One of the primary concerns is the use of BMI to define obesity. This index does not differentiate lean versus adipose tissue compartments (i.e. body composition) confounding health consequences for morbidity and mortality, especially in clinical populations. This review will describe the past year's evidence on the obesity paradox phenomenon, primarily focusing on the role of abnormal body composition phenotypes in explaining the controversies observed in the literature. RECENT FINDINGS In spite of the substantial number of articles investigating the obesity paradox phenomenon, less than 10% used a direct measure of body composition and when included, it was not fully explored (only adipose tissue compartment evaluated). When lean tissue or muscle mass is taken into account, the general finding is that a high BMI has no protective effect in the presence of low muscle mass and that it is the latter that associates with poor prognosis. SUMMARY In view of the body composition variability of patients with identical BMI, it is unreasonable to rely solely on this index to identify obesity. The consequences of a potential insubstantial obesity paradox are mixed messages related to patient-related prognostication.
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Affiliation(s)
- Carla M Prado
- aDepartment of Agricultural, Food and Nutritional Science, University of AB, Edmonton, Alberta, Canada bPost Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil cPennington Biomedical Research Center, Baton Rouge, Los Angeles, USA
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Ye BS, Jang EY, Kim SY, Kim EJ, Park SA, Lee Y, Hong CH, Choi SH, Yoon B, Yoon SJ, Na HR, Lee JH, Jeong JH, Kim HJ, Na DL, Seo SW. Unstable Body Mass Index and Progression to Probable Alzheimer’s Disease Dementia in Patients with Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2015; 49:483-91. [DOI: 10.3233/jad-150556] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Yoon Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University School of Medicine, Pusan, Korea
| | - Sun Ah Park
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Bora Yoon
- Department of Neurology, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
| | - Hae Ri Na
- Department of Neurology, Bobath Memorial Hospital, Seongnam, Korea
| | - Jae-Hong Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jee H. Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University
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Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, Vandewoude M, Wirth R, Schneider SM. ESPEN guidelines on nutrition in dementia. Clin Nutr 2015; 34:1052-73. [PMID: 26522922 DOI: 10.1016/j.clnu.2015.09.004] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified. OBJECTIVE It is the purpose of these guidelines to cover these issues with evidence-based recommendations. METHODS The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members. RESULTS 26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life. CONCLUSION Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany.
| | - Michael Chourdakis
- Department of Medicine, Aristotle University of Thessaloniki (AUTH), Greece
| | - Gerd Faxen-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Krankenhaus Hietzing, Vienna, Austria
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Merja H Suominen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Maurits Vandewoude
- Department of Geriatrics, Medical School, University of Antwerp, Belgium
| | - Rainer Wirth
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany; St. Marien-Hospital Borken, Department for Internal Medicine and Geriatrics, Borken, Germany
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Nice, France
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Religa D, Fereshtehnejad SM, Cermakova P, Edlund AK, Garcia-Ptacek S, Granqvist N, Hallbäck A, Kåwe K, Farahmand B, Kilander L, Mattsson UB, Nägga K, Nordström P, Wijk H, Wimo A, Winblad B, Eriksdotter M. SveDem, the Swedish Dementia Registry - a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice. PLoS One 2015; 10:e0116538. [PMID: 25695768 PMCID: PMC4335024 DOI: 10.1371/journal.pone.0116538] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Swedish Dementia Registry (SveDem) was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden. METHODS SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se). The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes. RESULTS The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden. CONCLUSION SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.
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Affiliation(s)
- Dorota Religa
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Seyed-Mohammad Fereshtehnejad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | - Pavla Cermakova
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | | | - Sara Garcia-Ptacek
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | | | | | | | - Bahman Farahmand
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Ulla-Britt Mattsson
- Neuropsychiatric clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Helle Wijk
- Sahlgrenska Academy, Institute of Health and Care Sciences at Gothenburg University, Gothenburg, Sweden
| | - Anders Wimo
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Maria Eriksdotter
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
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Morley JE. New Horizons in the Management of Alzheimer Disease. J Am Med Dir Assoc 2015; 16:1-5. [DOI: 10.1016/j.jamda.2014.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 12/21/2022]
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Garcia-Ptacek S, Kåreholt I, Farahmand B, Cuadrado ML, Religa D, Eriksdotter M. Dementia and Obesity Paradox: Reply to the Letter by Dr Moga et al. J Am Med Dir Assoc 2015; 16:79-81. [DOI: 10.1016/j.jamda.2014.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 11/24/2022]
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Bales CW. The Relationship of Body Mass to Survival in Persons With Dementia: A Nutritionist's Viewpoint. J Am Med Dir Assoc 2015; 16:81-2. [DOI: 10.1016/j.jamda.2014.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
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Moga DC, Abner EL, Brouwer ES. Dementia and “Obesity Paradox”: Is This for Real or Are We Missing Something? An Epidemiologist's Perspective. J Am Med Dir Assoc 2015; 16:78-9. [DOI: 10.1016/j.jamda.2014.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022]
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