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Wang HJ, Chinna-Meyyappan A, Feldman OJ, Lanctôt KL. Emerging therapies for treatment of agitation, psychosis, or apathy in Alzheimer's disease. Expert Opin Emerg Drugs 2024; 29:289-303. [PMID: 38822731 DOI: 10.1080/14728214.2024.2363215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Agitation, psychosis, and apathy are prevalent and highly distressing neuropsychiatric symptoms (NPS) of Alzheimer's disease (AD) that have been linked to numerous negative outcomes, including increased mortality, worsened cognitive decline, and caregiver burden. Current treatments for AD-associated agitation, namely atypical antipsychotics, provide some benefits but may increase the risk of serious adverse events and death. Meanwhile, no pharmacotherapies have been approved by regulatory agencies for the treatment of psychosis or apathy in AD. Over the past decade, many new and repurposed drugs have emerged as potential therapeutic options for managing these challenging NPS. AREAS COVERED This review aims to provide a comprehensive summary of pharmacotherapies that have recently been investigated in phase 2 and 3 clinical trials for the treatment of agitation, psychosis, or apathy in AD. EXPERT OPINION Novel atypical antipsychotics, serotonergic antidepressants, cannabinoids, and dextromethorphan combination drugs have shown promising results for alleviating agitation. Pimavanserin appears to be the most effective emerging therapy for psychosis, while methylphenidate has demonstrated good efficacy for apathy. Further research on biomarkers of NPS severity and treatment response, as well as continued improvements in methodological approaches are needed to advance the field.
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Affiliation(s)
- Hui Jue Wang
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Arun Chinna-Meyyappan
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Oriel J Feldman
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Wyman-Chick KA, Barrett MJ, Miller MJ, Kuntz JL, Chrenka EA, Rossom RC. Factors Associated With Increased Health Care Utilization for Patients With Dementia With Lewy Bodies: A Narrative Review. J Patient Cent Res Rev 2024; 11:97-106. [PMID: 39044852 PMCID: PMC11262839 DOI: 10.17294/2330-0698.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Numerous studies have demonstrated that dementia is associated with increased utilization of health care services, which in turn results in increased costs of care. Dementia with Lewy bodies (DLB) is associated with greater costs of care relative to other forms of dementia due to higher rates of hospitalization and nursing home placement directly related to neuropsychiatric symptoms, parkinsonism, increased susceptibility to delirium, and elevated rates of caregiver burden. There is a critical need for researchers to identify potentially modifiable factors contributing to increased costs of care and poor clinical outcomes for patients with DLB, which may include comorbidities, polypharmacy/contraindicated medications, and access to specialty care. Previous research has utilized Medicare claims data, limiting the ability to study patients with early-onset (ie, prior to age 65) DLB. Integrated health systems offer the ability to combine electronic medical record data with Medicare, Medicaid, and commercial claims data and may therefore be ideal for utilization research in this population. The goals of this narrative review are to 1) synthesize and describe the current literature on health care utilization studies for patients with DLB, 2) highlight the current gaps in the literature, and 3) provide recommendations for stakeholders, including researchers, health systems, and policymakers. It is important to improve current understanding of potentially modifiable factors associated with increased costs of care among patients with DLB to inform public health policies and clinical decision-making, as this will ultimately improve the quality of patient care.
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Affiliation(s)
- Kathryn A. Wyman-Chick
- Neuropsychology, HealthPartners, St. Paul, MN
- Center for Memory and Aging, HealthPartners Institute, Minneapolis, MN
| | | | | | | | - Ella A. Chrenka
- Center for Memory and Aging, HealthPartners Institute, Minneapolis, MN
| | - Rebecca C. Rossom
- Center for Memory and Aging, HealthPartners Institute, Minneapolis, MN
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Berkovic D, Macrae A, Gulline H, Horsman P, Soh SE, Skouteris H, Ayton D. The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2024; 64:gnad052. [PMID: 37144737 PMCID: PMC11020247 DOI: 10.1093/geront/gnad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Person-centered care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centered care, and its effectiveness, for people living with dementia in residential aged care. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis. Eligible studies were identified across 4 databases. Quantitative and qualitative studies containing data on person-centered care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random-effects model was conducted where more than 3 studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorize verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. RESULTS 41 studies were identified for inclusion. There were 34 person-centered care initiatives delivered, targeting 14 person-centered care outcomes. 3 outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardized mean difference -0.27, 95% confidence interval [CI], -0.58, 0.03), improvement in quality of life (standardized mean difference -0.63, 95% CI: -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI: -2.16, 0.05). Narrative meta-synthesis revealed barriers (e.g., time constraints) and enablers (e.g., staff collaboration) to providing person-centered care from a staff perspective. DISCUSSION AND IMPLICATIONS The effectiveness of person-centered care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centered care can be best implemented to improve resident outcomes.
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Affiliation(s)
- Danielle Berkovic
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ann Macrae
- Mission & Corporate Development, Baptcare, Melbourne, Victoria, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillipa Horsman
- Service Strategy Manager, Baptcare, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Warwick Professor in Health and Social Care Improvement and Implementation Science, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Seok JW, Kim G, Kim JU. Comparative efficacy of seven nonpharmacological interventions on global cognition in older adults with and without mild cognitive impairment: a network meta-analysis of randomized controlled trials. Sci Rep 2024; 14:8402. [PMID: 38600212 PMCID: PMC11006946 DOI: 10.1038/s41598-024-58232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
To maintain current cognitive function and access greater cognitive reserves, nonpharmacological interventions may be a viable alternative for older adults with or without cognitive impairment. This study aimed to compare different nonpharmacological interventions for enhancing global cognition, including mind-body exercise, physical exercise, non-invasive brain stimulation, cognitive training intervention (CTI), acutherapy (ACU), meditation, and music therapy, by applying a network meta-analysis (NMA). Sixty-one randomized controlled trials evaluating the efficacy of interventions on global cognition in older adults with or without mild cognitive decline were selected. An NMA was conducted to compare the efficacy of different nonpharmacological interventions. The NMA revealed that mind-body exercise (standardized mean difference, 1.384; 95% confidence interval, 0.777-1.992); ACU (1.283; 0.478-2.088); meditation (0.910; 0.097-1.724); non-invasive brain stimulation (1.242; 0.254-2.230); CTI (1.269; 0.736-1.802); and physical exercise (0.977; 0.212-1.742), showed positive effects compared to passive controls. There were no significant differences between the efficacies of other interventions. Nonpharmacological interventions may potentially enhance and maintain global cognition through various pathways, such as memorizing movements and enhancing brain plasticity by reducing stress in the older adult population. Additional studies are needed to clarify the impact of other variables, including intervention methods or psychological variables.
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Affiliation(s)
- Ji-Woo Seok
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672, Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea
| | - Gahye Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672, Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea
| | - Jaeuk U Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672, Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
- KM Convergence Science, University of Science and Technology, Daejeon, South Korea.
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Belenchia EJ. An individualized music listening program to reduce agitation in hospitalized patients with Alzheimer's disease and related dementias. Geriatr Nurs 2023; 52:157-164. [PMID: 37354755 DOI: 10.1016/j.gerinurse.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
The sudden change in environment with hospitalization in patients with dementia can provoke feelings of agitation. Listening to music can be an effective intervention to decrease agitation because the part of the brain recognizing music is unaffected by dementia, and music can elicit feelings of happiness. This project aimed to reduce agitation in patients with Alzheimer's disease and related dementias (ADRD) by implementing an individualized music listening program. The sample included 21 patients diagnosed with ADRD admitted to a medical-surgical unit at a community hospital. The four-item Pittsburgh Agitation Scale (PAS) was completed by clinical staff to document the degree to which their patient exhibited four types of agitated behavior. A paired t-test yielded a statistically significant (p<0.001) decrease in total scores from pre-test (M=4.83, SD=2.10) to post-test (M=1.38, SD=1.40). The findings demonstrate that implementing an individualized music listening program reduces agitation in patients with ADRD.
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Affiliation(s)
- Elizabeth J Belenchia
- Bridgeport Hospital - Milford Campus, Yale New Haven Health, 300 Seaside Avenue, Milford, CT 06460, United States.
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Ting YY, Tien Y, Huang HP. Effects of aromatherapy on agitation in patients with dementia in the community: A quasi-experimental study. Geriatr Nurs 2023; 51:422-428. [PMID: 37148590 DOI: 10.1016/j.gerinurse.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) are experienced by up to 90% of patients with dementia throughout dementia. This study aims to investigate the effect of aromatherapy on agitation in patients with dementia in the community. This prospective cohort study was conducted at a single day-care center for patients with dementia located in northern Taiwan with 2-week and 4-week follow-ups, comparing the severity of agitation between 3 measure points as the primary outcome. The aromatherapy was performed over 5 consecutive days for 4 weeks. Throughout the four-week observation were analyzed by GEE. Significant differences were found in the Chinese version of Cohen-Mansfield Agitation Inventory (CCMAI) total agitation score (ß=-3.622, p=0.037) and physically non-aggressive behavior subscale (ß=-4.005, p=0.004) between aromatherapy group and control group. The severity of dementia-related agitation, especially the severity of physically non-aggressive behavior in demented patients, could be significantly reduced by a four-week intervention of aromatherapy.
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Affiliation(s)
- Yi-Yun Ting
- Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Yun Tien
- Deparement of Psychiatry, Taoyuan Psychiatric Center, Taoyuan City, Taiwan
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.
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Chen R, Yi Y, Xiao W, Zhong B, Zhang L, Zeng Y. Urinary protein biomarkers based on LC-MS/MS analysis to discriminate vascular dementia from Alzheimer's disease in Han Chinese population. Front Aging Neurosci 2023; 15:1070854. [PMID: 36761180 PMCID: PMC9905227 DOI: 10.3389/fnagi.2023.1070854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
Objective This study aimed to identify the potential urine biomarkers of vascular dementia (VD) and unravel the disease-associated mechanisms by applying Liquid chromatography tandem-mass spectrometry (LC-MS/MS). Methods LC-MS/MS proteomic analysis was applied to urine samples from 3 groups, including 14 patients with VD, 9 patients with AD, and 21 normal controls (NC). By searching the MS data by Proteome Discoverer software, analyzing the protein abundances qualitatively and quantitatively, comparing between groups, combining bioinformatics analysis using Gene Ontology (GO) and pathway crosstalk analysis using Kyoto Encyclopedia of Genes and Genomes (KEGG), and literature searching, the differentially expressed proteins (DEPs) of VD can be comprehensively determined at last and were further quantified by receiver operating characteristic (ROC) curve methods. Results The proteomic findings showed quantitative changes in patients with VD compared to patients with NC and AD groups; among 4,699 identified urine proteins, 939 and 1,147 proteins displayed quantitative changes unique to VD vs. NC and AD, respectively, including 484 overlapped common DEPs. Then, 10 unique proteins named in KEGG database (including PLOD3, SDCBP, SRC, GPRC5B, TSG101/STP22/VPS23, THY1/CD90, PLCD, CDH16, NARS/asnS, AGRN) were confirmed by a ROC curve method. Conclusion Our results suggested that urine proteins enable detection of VD from AD and VC, which may provide an opportunity for intervention.
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Affiliation(s)
- Ruijuan Chen
- Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Department of Emergency, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan, China
| | - Yuanjing Yi
- Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenbiao Xiao
- Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bowen Zhong
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China
| | - Le Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Zeng
- Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha, Hunan, China,*Correspondence: Yi Zeng,
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Borah K, Bora K, Mallik S, Zhao Z. Potential Therapeutic Agents on Alzheimer's Disease through Molecular Docking and Molecular Dynamics Simulation Study of Plant-Based Compounds. Chem Biodivers 2023; 20:e202200684. [PMID: 36480442 DOI: 10.1002/cbdv.202200684] [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: 07/27/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Globally Alzheimer's disease (AD) is a highly complex, heterogeneous, and multifactorial neurological disease. AD is categorized clinically through a steady loss in memory and progressive decline of cognitive function. So far, there is no effective cure is available for the treatment of AD. Here, we identified Plant-based compounds (PBCs) from seven therapeutic plants through pharmacophore and pharmacokinetics approaches. Subsequently, we retrieved 65 AD associated proteins by Text Mining approach .We observed the interactions between 39 PBCs with 65 AD-associated targets by using molecular docking. Further, we carried out Molecular dynamics simulation analysis to predict the steady binding of top drug-target complexes. The entire MD simulation results analysis was evidence that seven drug-target complexes consistently interacted during the in silico experiment. The top complexes were the target CHLE interacted with 2 PBCs (Pseudojujubogenin and Anahygrine), target VDAC1 interacted with Withanolide R, target THOP1 interacted with Withaolide R, target AOFB interacted with 2 PBCs (Nardostachysin and Viscosalactone B), and target ACHE interacted with the drug (12-Deoxywithastramonolide). These PBCs have stably and flexibly interacted at the protein's active site region. Our results suggest that these PBCs and targets are potential therapeutic candidates for molecular development in AD.
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Affiliation(s)
- Kasmika Borah
- Cotton University, Computer Science and IT Department, Hem Baruah Rd, Pan Bazaar, Guwahati, Assam, 781001, India
| | - Kangkana Bora
- Cotton University, Computer Science and IT Department, Hem Baruah Rd, Pan Bazaar, Guwahati, Assam, 781001, India
| | - Saurav Mallik
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Mendes A, Bergh S, Cesana BM, Handels R, Ciccone A, Cognat E, Fabbo A, Fascendini S, Frisoni GB, Froelich L, Jori MC, Mecocci P, Merlo P, Peters O, Tsolaki M, Defanti CA. Respectful Caring for the Agitated Elderly (ReCAGE): A Multicentre, Prospective, Observational Study to Evaluate the Effectiveness of Special Care Units for People with Dementia. J Alzheimers Dis 2023; 96:1083-1096. [PMID: 37927262 DOI: 10.3233/jad-230708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) bring complexity in the clinical management of people with dementia; therefore, it is important to evaluate different models of care, such as Special Care Units (SCU-B).∥Objective:To evaluate the SCU-B effectiveness toward alleviating BPSD and improving the quality of life (QoL) of patients and their caregivers.∥Methods:ReCAGE was a multicenter, controlled, longitudinal study where 508 patients with BPSD were enrolled in two cohorts: 262 patients from centers endowed with a SCU-B, and 246 from centers without SCU-B. Statistical analyses included factorial ANCOVA for comparison among centers. The primary endpoint was effectiveness of the SCU-B, measured through the Neuropsychiatric Inventory (NPI) changes. Secondary endpoints were change in QoL of patients and caregivers, and the tertiary endpoint was time to nursing home admission.∥Results:The NPI scores decreased in both arms, with a statistically significant difference from baseline to 36 months (p < 0.0001) in both cohorts. Over time, NPI decreased more steeply during the first year in the SCU-B arm, but in the following two years the slope was clearly in favor of the control arm. This different pattern of the two cohorts reached statistical significance at the interaction "cohort by time" (p < 0.0001). Conflicting results were found regarding the outcomes of quality of life, while there were no differences in time to institutionalization in both cohorts.∥Conclusion:The RECage study did not confirm the long-term superiority of the pathway comprising a SCU-B. A post-hoc analysis revealed data supporting their acute effectiveness during behavioral crises.
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Affiliation(s)
- Aline Mendes
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Sverre Bergh
- Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro" Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Ron Handels
- Faculty of Health Medicine and Life Sciences, Department of Psychiatry and Neuropsychology School for Mental Health and Neuroscience Alzheimer Centre Limburg Maastricht University Medical Centre Maastricht the Netherlands
| | - Alfonso Ciccone
- Department of Neurology with Neurosurgical Activity "Carlo Poma" Hospital, ASST di Mantova, Mantua, Italy
| | - Emmanuel Cognat
- Cognitive Neurology Centre, Lariboisière-Fernand Widal Hospital GHU AP-HP Nord, Paris, France
| | - Andrea Fabbo
- Department of Primary Care, Geriatric Service-Cognitive Disorders and Dementia, Local Health Authority of Modena (AUSL), Modena, Italy
| | | | - Giovanni B Frisoni
- Memory Centre, Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Patrizia Mecocci
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Italy
- Division of Clinical Geriatrics; NVS Department, Karolinska Institutet Stockholm, Sweden
| | - Paola Merlo
- Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, Bergamo, Italy
| | - Oliver Peters
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Magdalini Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Makedonia, Hellas. 1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Macedonia, Hellas
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Guzzon A, Rebba V, Paccagnella O, Rigon M, Boniolo G. The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia. PLoS One 2023; 18:e0285305. [PMID: 37172047 PMCID: PMC10180718 DOI: 10.1371/journal.pone.0285305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Almost 44 million people are currently living with dementia worldwide. This number is set to increase threefold by 2050, posing a serious threat to the sustainability of healthcare systems. Overuse of antipsychotic drugs for the management of the symptoms of dementia carries negative consequences for patients while also increasing the health expenditures for society. Supportive care (SC) interventions could be considered a safer and potentially cost-saving option. In this paper we provide a systematic review of the existing evidence regarding the cost-effectiveness and cost-utility of SC interventions targeted towards persons living with dementia and their caregivers. METHODS A systematic literature review was performed between February 2019 and December 2021 through searches of the databases PubMed (MEDLINE), Cochrane Library, CENTRAL, Embase and PsycINFO. The search strategy was based on PRISMA 2020 recommendations. We considered studies published through December 2021 with no lower date limit. We distinguished between five categories of SC strategies: cognitive therapies, physical activity, indirect strategies (organisational and environmental changes), interventions primarily targeted towards family caregivers, and multicomponent interventions. RESULTS Of the 5,479 articles retrieved, 39 met the inclusion criteria. These studies analysed 35 SC programmes located at different stages of the dementia care pathway. Eleven studies provided evidence of high cost-effectiveness for seven interventions: two multicomponent interventions; two indirect interventions; two interventions aimed at caregivers of community-dwelling persons with dementia; one community-based cognitive stimulation and occupational programme. CONCLUSION We find that the most promising SC strategies in terms of cost-effectiveness are multicomponent interventions (targeted towards both nursing home residents and day-care service users), indirect strategies (group living and dementia care management at home), some forms of tailored occupational therapy, together with some psychosocial interventions for caregivers of community-dwelling persons with dementia. Our results suggest that the adoption of effective SC interventions may increase the economic sustainability of dementia care.
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Affiliation(s)
- Angelica Guzzon
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Vincenzo Rebba
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics and Management "Marco Fanno", University of Padova, Padova, Italy
| | - Omar Paccagnella
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Boniolo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Ghosh M, Dunham M, O'Connell B. Systematic review of dyadic psychoeducational programs for persons with dementia and their family caregivers. J Clin Nurs 2022. [DOI: 10.1111/jocn.16570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Manonita Ghosh
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
| | - Melissa Dunham
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
| | - Beverly O'Connell
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
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Herrmann N, Wang HJ, Song BX, Bawa KK, Lanctôt KL. Risks and benefits of current and novel drugs to treat agitation in Alzheimer's disease. Expert Opin Drug Saf 2022; 21:1289-1301. [PMID: 36252087 DOI: 10.1080/14740338.2022.2136162] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION At present, no pharmacological interventions have been approved for the treatment of agitation in Alzheimer's disease (AD), an important neuropsychiatric symptom that has been linked to increased mortality and greater caregiver burden. Antipsychotics offer some benefit, but increase the risk of adverse events such as falls, extrapyramidal symptoms, stroke, and mortality. Over the past 10 years, several new and repurposed medications have shown promise for treating AD-associated agitation. AREAS COVERED We review the risks and benefits of emerging therapies for agitation in AD, which include newer atypical antipsychotics, selective serotonin reuptake inhibitors, cannabinoids, and dextromethorphan combination products. Other drugs such as mirtazapine, prazosin, and lithium are also discussed. Clinicaltrials.gov, PubMed/MEDLINE, EMBASE and Cochrane Central databases were searched for relevant studies from 1 January 2012 to 1 May 2022. EXPERT OPINION At the present time, there are no pharmacological interventions for the treatment of agitation in AD whose benefits clearly outweigh their potential safety concerns. Therefore, management of agitation in AD should primarily be based on non-pharmacological approaches. When medications are considered necessary, they should only be initiated with the caregiver's appreciation of their risks and benefits and with careful and ongoing assessment of their safety.
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Affiliation(s)
- Nathan Herrmann
- Department of Psychiatry, Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hui Jue Wang
- Department of Psychiatry, Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Bing Xin Song
- Department of Psychiatry, Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Kritleen K Bawa
- Department of Psychiatry, Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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13
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Bijlani N, Nilforooshan R, Kouchaki S. An Unsupervised Data-Driven Anomaly Detection Approach for Adverse Health Conditions in People Living With Dementia: Cohort Study. JMIR Aging 2022; 5:e38211. [PMID: 36121687 PMCID: PMC9531007 DOI: 10.2196/38211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/04/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sensor-based remote health monitoring can be used for the timely detection of health deterioration in people living with dementia with minimal impact on their day-to-day living. Anomaly detection approaches have been widely applied in various domains, including remote health monitoring. However, current approaches are challenged by noisy, multivariate data and low generalizability. OBJECTIVE This study aims to develop an online, lightweight unsupervised learning-based approach to detect anomalies representing adverse health conditions using activity changes in people living with dementia. We demonstrated its effectiveness over state-of-the-art methods on a real-world data set of 9363 days collected from 15 participant households by the UK Dementia Research Institute between August 2019 and July 2021. Our approach was applied to household movement data to detect urinary tract infections (UTIs) and hospitalizations. METHODS We propose and evaluate a solution based on Contextual Matrix Profile (CMP), an exact, ultrafast distance-based anomaly detection algorithm. Using daily aggregated household movement data collected via passive infrared sensors, we generated CMPs for location-wise sensor counts, duration, and change in hourly movement patterns for each patient. We computed a normalized anomaly score in 2 ways: by combining univariate CMPs and by developing a multidimensional CMP. The performance of our method was evaluated relative to Angle-Based Outlier Detection, Copula-Based Outlier Detection, and Lightweight Online Detector of Anomalies. We used the multidimensional CMP to discover and present the important features associated with adverse health conditions in people living with dementia. RESULTS The multidimensional CMP yielded, on average, 84.3% recall with 32.1 alerts, or a 5.1% alert rate, offering the best balance of recall and relative precision compared with Copula-Based and Angle-Based Outlier Detection and Lightweight Online Detector of Anomalies when evaluated for UTI and hospitalization. Midnight to 6 AM bathroom activity was shown to be the most important cross-patient digital biomarker of anomalies indicative of UTI, contributing approximately 30% to the anomaly score. We also demonstrated how CMP-based anomaly scoring can be used for a cross-patient view of anomaly patterns. CONCLUSIONS To the best of our knowledge, this is the first real-world study to adapt the CMP to continuous anomaly detection in a health care scenario. The CMP inherits the speed, accuracy, and simplicity of the Matrix Profile, providing configurability, the ability to denoise and detect patterns, and explainability to clinical practitioners. We addressed the need for anomaly scoring in multivariate time series health care data by developing the multidimensional CMP. With high sensitivity, a low alert rate, better overall performance than state-of-the-art methods, and the ability to discover digital biomarkers of anomalies, the CMP is a clinically meaningful unsupervised anomaly detection technique extensible to multimodal data for dementia and other health care scenarios.
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Affiliation(s)
- Nivedita Bijlani
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Ramin Nilforooshan
- Surrey and Borders Partnership NHS Foundation Trust, Guildford, United Kingdom
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College, London, United Kingdom
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Samaneh Kouchaki
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
- Care Research and Technology Centre, UK Dementia Research Institute, Imperial College, London, United Kingdom
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14
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Reducing PDK1/Akt Activity: An Effective Therapeutic Target in the Treatment of Alzheimer's Disease. Cells 2022; 11:cells11111735. [PMID: 35681431 PMCID: PMC9179555 DOI: 10.3390/cells11111735] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022] Open
Abstract
Alzheimer’s disease (AD) is a common age-related neurodegenerative disease that leads to memory loss and cognitive function damage due to intracerebral neurofibrillary tangles (NFTs) and amyloid-β (Aβ) protein deposition. The phosphoinositide-dependent protein kinase (PDK1)/protein kinase B (Akt) signaling pathway plays a significant role in neuronal differentiation, synaptic plasticity, neuronal survival, and neurotransmission via the axon–dendrite axis. The phosphorylation of PDK1 and Akt rises in the brain, resulting in phosphorylation of the TNF-α-converting enzyme (TACE) at its cytoplasmic tail (the C-terminal end), changing its internalization as well as its trafficking. The current review aimed to explain the mechanisms of the PDK1/Akt/TACE signaling axis that exerts its modulatory effect on AD physiopathology. We provide an overview of the neuropathological features, genetics, Aβ aggregation, Tau protein hyperphosphorylation, neuroinflammation, and aging in the AD brain. Additionally, we summarized the phosphoinositide 3-kinase (PI3K)/PDK1/Akt pathway-related features and its molecular mechanism that is dependent on TACE in the pathogenesis of AD. This study reviewed the relationship between the PDK1/Akt signaling pathway and AD, and discussed the role of PDK1/Akt in resisting neuronal toxicity by suppressing TACE expression in the cell membrane. This work also provides a perspective for developing new therapeutics targeting PDK1/Akt and TACE for the treatment of AD.
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15
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Machado BM, Castro CDSS. Use of multisensory stimulation in institutionalized older adults with moderate or severe dementia. Dement Neuropsychol 2022; 16:202-212. [PMID: 35720656 PMCID: PMC9173792 DOI: 10.1590/1980-5764-dn-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
The Multisensory Stimulation Program can help manage behavioral and psychological symptoms of dementia.
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Affiliation(s)
- Bento Miguel Machado
- Universidade de São Paulo, Programa de Pós Gradução Interunidades em Bioegenharia (EESC/FMRP/IQSC-USP), São Carlos SP, Brazil
| | - Carla da Silva Santana Castro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Ribeirão Preto SP, Brazil
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16
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Zhang Q, Zhang M, Chen Y, Zhu S, Zhou W, Zhang L, Dong G, Cao Y. Smoking Status and Cognitive Function in a National Sample of Older Adults. Front Psychiatry 2022; 13:926708. [PMID: 35873239 PMCID: PMC9301276 DOI: 10.3389/fpsyt.2022.926708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
AIMS To examine the correlation between smoking status and different domains of cognitive function in elderly Americans. METHODS We used data from the 2011 to 2014 U.S. National Health and Nutrition Examination Survey (NHANES). Participants over 60 years with available smoking history and cognitive function data were enrolled in our analysis. The NHANES study included the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) assessment, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST) to assess cognition. Multivariate regression analyses were used to estimate the association between cigarette smoking and cognitive function. RESULTS A total of 2,932 participants were enrolled in the analysis, including 372 (12.7%) current smokers, 1,115 (38%) former smokers, and 1,445 (49.3%) never smokers. Never smokers had in average 3.82 (95% CI, 2.21 to 5.43) points more than current smokers in the DSST, whereas former smokers had 3.12 (95% CI, 1.51 to 4.73) points more than current smokers. Besides, smoking was not associated with the results of the AFT or the CERAD test. CONCLUSIONS This study suggests that cigarette smoking is associated with processing speed among the American elderly.
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Affiliation(s)
- Qiaoyang Zhang
- Department of Psychology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Min Zhang
- Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yun Chen
- Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Shumin Zhu
- Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Wang Zhou
- Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Lihao Zhang
- Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Guanzhong Dong
- Department of Psychology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yin Cao
- Department of Psychology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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17
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Bhoopatiraju S, Grossberg G. Emerging Perspectives in the Management of Agitation in Alzheimer's Disease and Patients with Dementia. Neurology 2022. [DOI: 10.17925/usn.2022.18.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
While Alzheimer's disease, the most common cause of dementia, is perhaps best characterized by cognitive decline, more than 90% of patients exhibit behavioural and psychological symptoms of dementia. Agitation in patients with dementia is often difficult to manage, and is associated with increased morbidity and mortality in patients and a heightened caregiver burden. Thus, effective management of dementia-related agitation (DRA) is vital. Care should first be taken to consider and address causes of agitation and aggression, after which non-pharmacological interventions should be employed. If non-pharmacological measures are unsuccessful in reducing DRA then medications should be considered, although none are approved by the Food and Drug Administration for this indication. Electroconvulsive therapy may be a promising option for patients with treatment-refractory DRA, although more studies are needed. While there are several drugs in the pipeline for DRA treatment, results from robust randomized clinical trials are necessary before they can be administered to patients. Thus, clinicians should employ current strategies to manage DRA to ensure holistic care for patients with Alzheimer's disease.
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18
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Burhanullah MH, Rosenberg P. Low-Dose Lithium for Management of Neuropsychiatric Symptoms in Alzheimer Disease. Am J Geriatr Psychiatry 2022; 30:43-45. [PMID: 34176730 DOI: 10.1016/j.jagp.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Muhammad Haroon Burhanullah
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD.
| | - Paul Rosenberg
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD
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19
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Outen JD, Burhanullah H, Vandrey R, Amjad H, Harper DG, Patrick RE, May RL, Agronin ME, Forester BP, Rosenberg PB. Cannabinoids for Agitation in Alzheimer's Disease. Am J Geriatr Psychiatry 2021; 29:1253-1263. [PMID: 33573996 PMCID: PMC8313629 DOI: 10.1016/j.jagp.2021.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Agitation is a common neuropsychiatric symptom of Alzheimer's disease (AD) that greatly impacts quality of life and amplifies caregiver burden. Agitation in AD may be associated with volume loss in the anterior cingulate cortex, posterior cingulate cortex, insula, amygdala, and frontal cortex, as well as with degeneration of monoaminergic neurotransmission, disrupted circadian rhythms, and frailty. Current pharmacologic options have troubling safety concerns and only modest efficacy. There is increasing interest in cannabinoids as promising agents due to preclinical and early clinical research that suggest cannabinoids can elicit anxiolytic, antidepressant, and/or anti-inflammatory effects. Cannabinoids may relieve agitation by regulating neurotransmitters, improving comorbidities and circadian rhythms, and increasing cerebral circulation. Here we discuss the possible contributory mechanisms for agitation in AD and the therapeutic relevance of cannabinoids, including CBD and THC.
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Affiliation(s)
- John D. Outen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Haroon Burhanullah
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Ryan Vandrey
- Behavioral Pharmacology Research, Johns Hopkins University School of Medicine
| | - Halima Amjad
- Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine
| | - David G. Harper
- Division of Geriatric Psychiatry, McLean Hospital,Department of Psychiatry, Harvard Medical School
| | - Regan E. Patrick
- Division of Geriatric Psychiatry, McLean Hospital,Department of Psychiatry, Harvard Medical School
| | - Rose L. May
- Division of Geriatric Psychiatry, McLean Hospital
| | - Marc E. Agronin
- Department of Mental Health and Clinical Research, Miami Jewish Health
| | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital,Department of Psychiatry, Harvard Medical School
| | - Paul B. Rosenberg
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
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20
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de Oliveira J, Kucharska E, Garcez ML, Rodrigues MS, Quevedo J, Moreno-Gonzalez I, Budni J. Inflammatory Cascade in Alzheimer's Disease Pathogenesis: A Review of Experimental Findings. Cells 2021; 10:cells10102581. [PMID: 34685563 PMCID: PMC8533897 DOI: 10.3390/cells10102581] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
Alzheimer’s disease (AD) is the leading cause of dementia worldwide. Most AD patients develop the disease in late life, named late onset AD (LOAD). Currently, the most recognized explanation for AD pathology is the amyloid cascade hypothesis. It is assumed that amyloid beta (Aβ) aggregation and deposition are critical pathogenic processes in AD, leading to the formation of amyloid plaques, as well as neurofibrillary tangles, neuronal cell death, synaptic degeneration, and dementia. In LOAD, the causes of Aβ accumulation and neuronal loss are not completely clear. Importantly, the blood–brain barrier (BBB) disruption seems to present an essential role in the induction of neuroinflammation and consequent AD development. In addition, we propose that the systemic inflammation triggered by conditions like metabolic diseases or infections are causative factors of BBB disruption, coexistent inflammatory cascade and, ultimately, the neurodegeneration observed in AD. In this regard, the use of anti-inflammatory molecules could be an interesting strategy to treat, delay or even halt AD onset and progression. Herein, we review the inflammatory cascade and underlying mechanisms involved in AD pathogenesis and revise the anti-inflammatory effects of compounds as emerging therapeutic drugs against AD.
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Affiliation(s)
- Jade de Oliveira
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre 90050-000, Brazil; (J.d.O.); (M.S.R.)
| | - Ewa Kucharska
- Faculty of Education, Institute of Educational Sciences, Jesuit University Ignatianum in Krakow, 31-501 Krakow, Poland;
| | - Michelle Lima Garcez
- Department of Biochemistry, Federal University of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil;
| | - Matheus Scarpatto Rodrigues
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre 90050-000, Brazil; (J.d.O.); (M.S.R.)
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA;
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
- Neuroscience Graduate Program, Graduate School of Biomedical Sciences, MD Anderson Cancer Center, UTHealth, The University of Texas Houston, Houston, TX 77030, USA
- Graduate Program in Health Sciences, Translational Psychiatry Laboratory, University of Southern Santa Catarina (UNESC), Criciuma 88806-000, Brazil
| | - Ines Moreno-Gonzalez
- Department of Cell Biology, Faculty of Sciences, University of Malaga, IBIMA, 29010 Malaga, Spain;
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), 29010 Malaga, Spain
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Josiane Budni
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Neurologia Experimental, Universidade do Extremo Sul Catarinense, Criciuma 88806-000, Brazil
- Correspondence: ; Tel.: +55-48431-2539
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21
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Ong YC, Tang A, Tam W. Effectiveness of robot therapy in the management of behavioural and psychological symptoms for individuals with dementia: A systematic review and meta-analysis. J Psychiatr Res 2021; 140:381-394. [PMID: 34144442 DOI: 10.1016/j.jpsychires.2021.05.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/13/2021] [Accepted: 05/29/2021] [Indexed: 12/17/2022]
Abstract
Robot therapy presents a promising alternative in dementia care. However, its effectiveness has not been verified comprehensively. This systematic review and meta-analysis aim at evaluating the effectiveness of robot therapy in the management of behavioural and psychological symptoms for individuals with dementia. Studies assessing the effectiveness of robot therapy were identified using 10 academic research databases: CENTRAL, CINAHL, CNKI, The Cochrane Library, Embase, IEEE Xplore, MEDLINE, PubMed, Scopus, and ProQuest Dissertations & Theses. Additional references were identified from the reference lists of included studies and relevant reviews. Data extraction and risk of bias assessment were conducted independently by two review authors. Meta-analyses and subgroup analyses were performed and the heterogeneity of studies was examined. 18 published articles from 14 studies involving a total of 1256 participants were included. Participants with robot therapy had a significant decrease in agitation (SMD -0.38, 95% CI -0.66, -0.09; p = 0.01) and a significant increase in social interaction (SMD 0.49, 95% CI 0.01, 0.97; p = 0.04) while effects for depression, anxiety, cognitive status, and quality of life were not statistically significant. Results from this review show that robot therapy can effectively reduce agitation and increase social interactions for individuals with dementia. Future clinical practice should consider the potential of robot therapy as an option to be implemented into current dementia programmes. Further large-scale trials are required for the thorough investigation of different intervention formats and robot types, while considering potential confounding factors.
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Affiliation(s)
- Yoke Chin Ong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Arthur Tang
- Department of Software, Sungkyunkwan University, Suwon, Republic of Korea.
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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22
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Nonlinear Phase Synchronization Analysis of EEG Signals in Amnesic Mild Cognitive Impairment with Type 2 Diabetes Mellitus. Neuroscience 2021; 472:25-34. [PMID: 34333062 DOI: 10.1016/j.neuroscience.2021.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 01/21/2023]
Abstract
Studying the nonlinear synchronization of electroencephalogram (EEG) in type 2 diabetic mellitus (T2DM) to find the EEG characteristics related to cognitive impairment is beneficial to the early prevention and diagnosis of mild cognitive impairment. Correlation between probabilities of recurrence (CPR) is a nonlinear phase synchronization method based on recurrence and recurrence probability, which had shown its superiority in detecting epilepsy. In this study, CPR method was used for the first time to analyze the synchronization of eye-closed resting EEG signals with T2DM. The 27 participants were divided into amnesic mild cognitive impairment (aMCI) group (17 case) and control group (10 cases with age and education matched). The CPR values in two groups were statistically analyzed by Mann-Whitney U test, and the correlation between EEG synchronization and cognitive function was studied by Spearman's correlation. The results showed that aMCI group had lower CPR values at each electrode pair than control group, and two groups had decreased CPR values with the increase of the spatial distance of the electrode pair in inter hemispheric. The CPR values were significantly different in frontal, parietal and temporal regions in intra hemispheric between two groups. The CPR values of C3-F7, F4-C4 and FP2-T6 were significantly positively correlated with the MOCA values. This study showed that the synchronization values of EEG signals obtained by the CPR method were significantly different between aMCI and control group, and they were the EEG characteristics associated with cognitive impairment in T2DM.
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23
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Al Ghassani A, Rababa M, Abu Khait A. Agitation in people with dementia: A concept analysis. Nurs Forum 2021; 56:1015-1023. [PMID: 34227111 DOI: 10.1111/nuf.12629] [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: 02/23/2021] [Revised: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
AIM This article aims to clarify the concept of agitation in people with dementia (PWD) by identifying its attributes, antecedents, and consequences to propose an operational definition of the concept. BACKGROUND Agitation is a recurrent behavior problem for many people with and without dementia, which results in psychosocial distress. The current literature lacks the conceptual clarity of agitation, which limits its effective nursing management. DATA SOURCES Several databases search was utilized that comprise computer searches of PsycINFO, MEDLINE (PubMed), the Cumulative Index of Nursing and Allied Health of data between the years 1970 and 2013. DESIGN Concept analysis. REVIEW METHODS Rodgers' Evolutionary Method of concept analysis (2000) was employed as a guide for analyzing the agitation concept. RESULTS Four main attributes were used to describe and propose a definition of agitation in PWD: disruptive behaviors, repetitiveness, inappropriateness, and aggression. CONCLUSION This analysis provides an operational definition that will improve knowledge of investigating relevant issues to agitation, which can be used by nurses and family caregivers when managing and preventing agitation in PWD.
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Affiliation(s)
- Amal Al Ghassani
- Community and Mental Health Department, Oman College of Health Sciences, Al Qurum, Muscat, Oman
| | - Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdallah Abu Khait
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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24
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Poptsi E, Tsolaki M, Bergh S, Cesana BM, Ciccone A, Fabbo A, Frisoni GB, Frölich L, Lavolpe S, Guazzarini AG, Hugon J, Fascendini S, Defanti CA. Rationale, Design, and Methodology of a Prospective Cohort Study for Coping with Behavioral and Psychological Symptoms of Dementia: The RECage Project. J Alzheimers Dis 2021; 80:1613-1627. [PMID: 33720887 PMCID: PMC8203243 DOI: 10.3233/jad-201215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are quite challenging problems during the dementia course. Special Care Units for people with dementia (PwD) and BPSD (SCU-B) are residential medical structures, where BPSD patients are temporarily admitted, in case of unmanageable behavioral disturbances at home. OBJECTIVE RECage (REspectful Caring for AGitated Elderly) aspires to assess the short and long-term effectiveness of SCU-Bs toward alleviating BPSD and improving the quality of life (QoL) of PwD and their caregivers. METHODS RECage is a three-year, prospective study enrolling 500 PwD. Particularly, 250 community-dwelling PwDs presenting with severe BPSD will be recruited by five clinical centers across Europe, endowed with a SCU-B, for a short period of time; a second similar group of 250 PwD will be followed by six other no-SCU-B centers solely via outpatient visits. RECage's endpoints include short and long-term SCU-B clinical efficacy, QoL of patients and caregivers, cost-effectiveness of the SCU-B, psychotropic drug consumption, caregivers' attitude toward dementia, and time to nursing home placement. RESULTS PwD admitted in SCU-Bs are expected to have diminished rates of BPSD and better QoL and their caregivers are also expected to have better QoL and improved attitude towards dementia, compared to those followed in no-SCU-Bs. Also, the cost of care and the psychotropic drug consumption are expected to be lower. Finally, PwD followed in no-SCU-Bs are expected to have earlier admission to nursing homes. CONCLUSION The cohort study results will refine the SCU-B model, issuing recommendations for implementation of SCU-Bs in the countries where they are scarce or non-existent.
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Affiliation(s)
- Eleni Poptsi
- Laboratory of Psychology, Section of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), Macedonia, Hellas.,Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Makedonia, Hellas
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Makedonia, Hellas.,1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Macedonia, Hellas
| | - Sverre Bergh
- Research centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics"Giulio A. Maccacaro" Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Alfonso Ciccone
- Department of Neurology with Neurosurgical Activity "Carlo Poma" Hospital, ASST di Mantova, Mantua, Italy
| | - Andrea Fabbo
- Direttore UOC di Geriatria-Disturbi Cognitivi e Demenze, Dipartimento Cure Primarie AUSL, Modena, Italy
| | - Giovanni B Frisoni
- Memory Clinic, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sara Lavolpe
- Department of Neurology and CDCD Centre Humanitas Gavazzeni, Bergamo, Italy
| | - Anna Giulia Guazzarini
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Italy
| | - Jacques Hugon
- Center of Cognitive Neurology Université de Paris, Paris, France
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Menczel Schrire Z, Phillips CL, Duffy SL, Marshall NS, Mowszowski L, La Monica HM, Gordon CJ, Chapman JL, Saini B, Lewis SJG, Naismith SL, Grunstein RR, Hoyos CM. Feasibility of 3-month melatonin supplementation for brain oxidative stress and sleep in mild cognitive impairment: protocol for a randomised, placebo-controlled study. BMJ Open 2021; 11:e041500. [PMID: 33568368 PMCID: PMC7878132 DOI: 10.1136/bmjopen-2020-041500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Melatonin has multiple proposed therapeutic benefits including antioxidant properties, synchronisation of the circadian system and lowering of blood pressure. In this protocol, we outline a randomised controlled trial to assess the feasibility, acceptability and tolerability of higher dose (25 mg) melatonin to target brain oxidative stress and sleep disturbance in older adults with mild cognitive impairment (MCI). METHODS AND ANALYSIS The study design is a randomised double-blind, placebo-controlled, parallel group trial. Forty individuals with MCI will be recruited from the Healthy Brain Ageing Clinic, University of Sydney and from the community, and randomised to receive either 25 mg oral melatonin or placebo nightly for 12 weeks. The primary outcomes are feasibility of recruitment, acceptability of intervention and adherence to trial medication at 12 weeks. Secondary outcomes will include the effect of melatonin on brain oxidative stress as measured by magnetic resonance spectroscopy, blood pressure, blood biomarkers, mood, cognition and sleep. Outcomes will be collected at 6 and 12 weeks. The results of this feasibility trial will inform a future conclusive randomised controlled trial to specifically test the efficacy of melatonin on modifiable risk factors of dementia, as well as cognition and brain function. This will be the first trial to investigate the effect of melatonin in the population with MCI in this way, with the future aim of using this approach to reduce progression to dementia. ETHICS AND DISSEMINATION This protocol has been approved by the Sydney Local Health District Ethics Committee (X18-0077). This randomised controlled trial will be conducted in compliance with the protocol published in the registry, the International Conference for Harmonisation on Good Clinical Practice and all other applicable regulatory requirements. The findings of the trial will be disseminated via conferences, publications and media, as applicable. Participants will be informed of results of the study at the conclusion of the trial. Eligible authors will include investigators who are involved in the conception and design of the study, the conduct of the trial, the analysis of the results, and reporting and presentation of study findings. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ANZCTRN 12619000876190). PROTOCOL VERSION V.8 15 October 2020.
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Affiliation(s)
- Zoe Menczel Schrire
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
| | - Craig L Phillips
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Shantel L Duffy
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Haley M La Monica
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Julia L Chapman
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
| | - Bandana Saini
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hosptial, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
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BACE1 and cholinesterase inhibitory activities of compounds from Cajanus cajan and Citrus reticulata: an in silico study. In Silico Pharmacol 2021; 9:14. [PMID: 33520593 DOI: 10.1007/s40203-020-00067-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022] Open
Abstract
Alzheimer's disease (AD) is one of the major neurodegenerative diseases whose underlying risk factors are yet to be fully understood. However, reduced cellular level of cholinesterase, as well as formation and deposition of amyloid plaques (Aβ) are thought to play critical roles in the pathogenesis of AD. Therefore, increases in cholinergic transmitter levels via cholinesterase (ChE) inhibitors as well as inhibition of amyloid plaques formation and aggregation via beta secretase-1 (BACE1) inhibitors have been proposed as treatment for this disease. This study was aimed at investigating the BACE1 and ChE inhibitory properties of compounds from Cajanus cajan and Citrus reticulata based on their traditional connection with the management of neurodegenerative diseases, coupled with their protective effects on chemical-induced cognitive impairment. Using in silico methods, one hundred and nineteen compounds from C. cajan and C. reticulata were docked with acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and BACE1 using Vina. Molecular interactions of the top-ranked compounds for the 3 protein targets were viewed with Discovery Studio, followed by characterization of their ADME properties using the Swiss online ADME web tool. Among the one hundred and ninety nine compounds screened, 3 compounds, genistin (76), naphthalen-2-yl-acetic acid, 6-hydroxy-6-methyl-cyclodecyl ester (94) and vitexin (119) have remarkable binding affinity for the three protein targets and passed the oral drugability test, while only naphthalen-2-yl-acetic acid, 6-hydroxy-6-methyl-cyclodecyl ester (94) exhibited BBB permeation property. Genistin and vitexin from C. cajan and naphthalen-2-yl-acetic acid, 6-hydroxy-6-methyl-cyclodecyl ester from C. reticulata possibly contributed, at least in part, to the neurotherapeutic potentials of these plants.
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Chan HYL, Yau YM, Li SF, Kwong KS, Chong YY, Lee IFK, Yu DSF. Effects of a culturally adapted group based Montessori based activities on engagement and affect in Chinese older people with dementia: a randomized controlled trial. BMC Geriatr 2021; 21:24. [PMID: 33413153 PMCID: PMC7791677 DOI: 10.1186/s12877-020-01967-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/16/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The Montessori Method underpinned by the principle of person-centered care has been widely adopted to design activities for people with dementia. However, the methodological quality of the existing evidence is fair. The objectives of this study are to examine the feasibility and effects of a culturally adapted group-based Montessori Method for Dementia program in Chinese community on engagement and affect in community-dwelling people with dementia. METHODS This was a two-arm randomized controlled trial. People who were aged 60 years or over and with mild to moderate dementia were recruited and randomly assigned to the intervention group to receive Montessori-based activities or the comparison group to receive conventional group activities over eight weeks. The attendance rates were recorded for evaluating the feasibility. The Menorah Park Engagement Scale and the Apparent Affect Rating Scale were used to assess the engagement and affect during the activities based on observations. Generalized Estimating Equation model was used to examine the intervention effect on the outcomes across the sessions. RESULTS A total of 108 people with dementia were recruited. The average attendance rate of the intervention group (81.5%) was higher than that of the comparison group (76.3%). There was a significant time-by-group intervention effect on constructive engagement in the first 10 minutes of the sessions (Wald χ2 = 15.21-19.93, ps = 0.006-0.033), as well as on pleasure (Wald χ2 = 25.37-25.73, ps ≤ 0.001) and interest (Wald χ2 = 19.14-21.11, ps = 0.004-0.008) in the first and the middle 10 minutes of the sessions, adjusted for cognitive functioning. CONCLUSIONS This study provide evidence that Montessori-based group activities adapted to the local cultural context could effectively engage community-dwelling Chinese older people with mild to moderate dementia in social interactions and meaningful activities and significantly increase their positive affect. TRIAL REGISTRATION ClinicalTrials.gov, NCT04352387. Registered 20 April 2020. Retrospectively registered.
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Affiliation(s)
- Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Yee-Man Yau
- Social Services Department, The Salvation Army, Hong Kong and Macau Command, Hong Kong SAR, China
| | - Si-Fan Li
- Social Services Department, The Salvation Army, Hong Kong and Macau Command, Hong Kong SAR, China
| | - Ka-Shi Kwong
- Social Services Department, The Salvation Army, Hong Kong and Macau Command, Hong Kong SAR, China
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Iris Fung-Kam Lee
- Nethersole Institute of Continuing Holistic Health Education, Hong Kong SAR, China
| | - Doris Sau-Fung Yu
- School of Nursing, Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Debas K, Beauchamp J, Ouellet C. Toward Optimal Management of Behavioral and Psychological Symptoms of Dementia: Insights From a COVID-19 Pandemic Experience. Front Psychiatry 2021; 12:634398. [PMID: 34025468 PMCID: PMC8132471 DOI: 10.3389/fpsyt.2021.634398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
The first wave of SARS-CoV-2 has deeply affected long term care facilities in the province of Quebec. In response, governmental officials took protective measures, such as suspending visits and activities and even requiring residents to self-isolate to their room. Consequently, residents with major cognitive impairments were cut from their routine as well as from significant social interactions, support, and stimulation essential to their well-being. This isolation negatively affected many residents. For some of them, the loss of bearings resulted in newly or deteriorated behavioral and psychological symptoms of dementia (BPSD). These residents were then more at risk of contracting the virus or contaminating others. To face this challenge, hotels in the Greater Montreal area were transformed into temporary care facilities. As members of a multidisciplinary team specialized in the management of BPSD, we were asked to support the redeployed staff who had little experience in this domain. In this paper, we present the innovative tools implemented in this uncommon work setting. We also discuss factors identified as facilitating the care and treatment of people with BPSD. This experience leads us to propose avenues toward better BPSD management.
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Affiliation(s)
- Karen Debas
- Institut universitaire en santé mentale de Montréal, Integrated University Health and Social Services of the East-Island of Montreal, Montreal, QC, Canada
| | - Joanny Beauchamp
- Institut universitaire en santé mentale de Montréal, Integrated University Health and Social Services of the East-Island of Montreal, Montreal, QC, Canada
| | - Christine Ouellet
- Institut universitaire en santé mentale de Montréal, Integrated University Health and Social Services of the East-Island of Montreal, Montreal, QC, Canada
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29
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Bateman DR, Gill S, Hu S, Foster ED, Ruthirakuhan MT, Sellek AF, Mortby ME, Matušková V, Ng KP, Tarawneh RM, Freund-Levi Y, Kumar S, Gauthier S, Rosenberg PB, Ferreira de Oliveira F, Devanand DP, Ballard C, Ismail Z. Agitation and impulsivity in mid and late life as possible risk markers for incident dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12016. [PMID: 32995467 PMCID: PMC7507499 DOI: 10.1002/trc2.12016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
To identify knowledge gaps regarding new-onset agitation and impulsivity prior to onset of cognitive impairment or dementia the International Society to Advance Alzheimer's Research and Treatment Neuropsychiatric Syndromes (NPS) Professional Interest Area conducted a scoping review. Extending a series of reviews exploring the pre-dementia risk syndrome Mild Behavioral Impairment (MBI), we focused on late-onset agitation and impulsivity (the MBI impulse dyscontrol domain) and risk of incident cognitive decline and dementia. This scoping review of agitation and impulsivity pre-dementia syndromes summarizes the current biomedical literature in terms of epidemiology, diagnosis and measurement, neurobiology, neuroimaging, biomarkers, course and prognosis, treatment, and ongoing clinical trials. Validations for pre-dementia scales such as the MBI Checklist, and incorporation into longitudinal and intervention trials, are needed to better understand impulse dyscontrol as a risk factor for mild cognitive impairment and dementia.
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Affiliation(s)
- Daniel R Bateman
- Department of Psychiatry Indiana University School of Medicine Indianapolis Indiana
- Indiana University Center for Aging Research Regenstrief Institute Indianapolis Indiana
| | - Sascha Gill
- Department of Clinical Neurosciences; and the Ron and Rene Ward Centre for Healthy Brain Aging Research; Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | - Sophie Hu
- Community Health Sciences, and O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
| | - Erin D Foster
- Ruth Lilly Medical Library Indiana University School of Medicine Indianapolis Indiana
- University of California Berkeley Berkeley CA
| | - Myuri T Ruthirakuhan
- Hurvitz Brain Sciences Research Program Sunnybrook Research Institute Toronto Ontario Canada
- Department of Pharmacology and Toxicology University of Toronto Ontario Canada
| | | | - Moyra E Mortby
- School of Psychology University of New South Wales Sydney New South Wales Australia
- Neuroscience Research Australia University of New South Wales Sydney New South Wales Australia
| | - Veronika Matušková
- International Clinical Research Center St. Anne's University Hospital Brno Brno Czech Republic
- Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital Prague Czech Republic
| | - Kok Pin Ng
- Department of Neurology National Neuroscience Institute Singapore Singapore
| | - Rawan M Tarawneh
- Department of Neurology, College of Medicine The Ohio State University Columbus Ohio USA
| | - Yvonne Freund-Levi
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden
- School of Medical Sciences Örebro University Örebro Sweden
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health Toronto Ontario Canada
- Department of Psychiatry University of Toronto Ontario Canada
| | - Serge Gauthier
- McGill Center for Studies in Aging McGill University Montreal Quebec Canada
| | - Paul B Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral, Sciences Johns Hopkins University School of Medicine Baltimore Maryland
| | - Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina Federal University of São Paulo (UNIFESP), São Paulo São Paulo Brazil
| | - D P Devanand
- New York State Psychiatric Institute and Department of Psychiatry and Department of Psychiatry, College of Physicians and Surgeons Columbia University New York New York
| | - Clive Ballard
- College of Medicine and Health The University of Exeter Exeter UK
| | - Zahinoor Ismail
- Department of Clinical Neurosciences; and the Ron and Rene Ward Centre for Healthy Brain Aging Research; Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- Community Health Sciences, and O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
- Department of Psychiatry, and the Mathison Centre for Mental Health Research & Education Cumming School of Medicine, University of Calgary Calgary Alberta Canada
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30
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Zhang Z, Yu P, Chang HCR, Lau SK, Tao C, Wang N, Yin M, Deng C. Developing an ontology for representing the domain knowledge specific to non-pharmacological treatment for agitation in dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12061. [PMID: 32995470 PMCID: PMC7507392 DOI: 10.1002/trc2.12061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/19/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION A large volume of clinical care data has been generated for managing agitation in dementia. However, the valuable information in these data has not been used effectively to generate insights for improving the quality of care. Application of artificial intelligence technologies offers us enormous opportunities to reuse these data. For health data science to achieve this, this study focuses on using ontology to coding clinical knowledge for non-pharmacological treatment of agitation in a machine-readable format. METHODS The resultant ontology-Dementia-Related Agitation Non-Pharmacological Treatment Ontology (DRANPTO)-was developed using a method adopted from the NeOn methodology. RESULTS DRANPTO consisted of 569 concepts and 48 object properties. It meets the standards for biomedical ontology. DISCUSSION DRANPTO is the first comprehensive semantic representation of non-pharmacological management for agitation in dementia in the long-term care setting. As a knowledge base, it will play a vital role to facilitate the development of intelligent systems for managing agitation in dementia.
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Affiliation(s)
- Zhenyu Zhang
- Centre for Digital Transformation School of Computing and Information Technology University of Wollongong Wollongong New South Wales Australia
| | - Ping Yu
- Centre for Digital Transformation School of Computing and Information Technology University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Hui Chen Rita Chang
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
- School of Nursing University of Wollongong Wollongong New South Wales Australia
| | - Sim Kim Lau
- Centre for Digital Transformation School of Computing and Information Technology University of Wollongong Wollongong New South Wales Australia
| | - Cui Tao
- School of Biomedical Informatics University of Texas Health Science Center Houston Texas USA
| | - Ning Wang
- PR China Southern Centre for Evidence Based Nursing and Midwifery Practice School of Nursing Southern Medical University Guangzhou City PR China
| | - Mengyang Yin
- Systems and Reporting Residential Care Catholic Healthcare Ltd Macquarie Park New South Wales Australia
| | - Chao Deng
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
- School of Medicine University of Wollongong Wollongong New South Wales Australia
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Hodge G, Froggatt K, Limmer M, Bingley A. Exploring the barriers and gateways to intersubjectivity in dementia care: A meta-ethnography. J Clin Nurs 2020; 31:1947-1959. [PMID: 32757338 DOI: 10.1111/jocn.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Behaviours that challenge in dementia, often described and diagnosed as behavioural psychological symptoms of dementia, are experienced by 75% of people living with dementia in care homes or hospital environments, with 43% of nurses and care providers reporting these behaviours as moderately or severely distressing to them. During behaviours that challenge moments in dementia, there is the potential for an intersubjective relationship to take place between the people living with dementia and the nurse. AIMS This review explores and synthesises literature to consider the presence of intersubjectivity in people living with dementia. If the ability to be intersubjective remains present for people living with dementia, it will consider how its presence can be nurtured to offer a positive intersubjective communication between the person living with dementia and their carer/nurse. METHODS The review used meta-ethnography methodology to develop concepts that help us to understand the implications of existing research on the presence of intersubjectivity in people living with dementia, and its relationship to those providing their care. Sixteen electronic databases (including MEDLINE/PubMed, Wiley Online Library and Sage publications) and grey literature such as Alzheimer's Society and Department of Health across journals dating from 2000-2020 were searched. Eight studies were selected and reviewed for quality and relevance for a meta-ethnographic literature synthesis of intersubjectivity in dementia. CONCLUSION The meta-ethnography concluded that people living with dementia continue to have the capacity to be intersubjective on an emotional level. Nurses and other care providers need to acknowledge the presence of "personhood" and "personness" in people living with dementia to nurture positive intersubjective care relationships. The meta-ethnography has also been reviewed for reporting clarity against the EQUATOR checklist in the form of the eMERGe guideline (France et al., 2019).
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Affiliation(s)
- Gary Hodge
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK.,School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Katherine Froggatt
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Mark Limmer
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Amanda Bingley
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK
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Bahji A, Meyyappan AC, Hawken ER. Cannabinoids for the Neuropsychiatric Symptoms of Dementia: A Systematic Review and Meta-Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:365-376. [PMID: 31835954 PMCID: PMC7265608 DOI: 10.1177/0706743719892717] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND In 2016, the global number of individuals living with dementia was 43.8 million, representing a 117% increase from 1990-mainly due to increases in aging and population growth. Up to 90% of individuals with dementia experience neuropsychiatric symptoms (NPS). However, the limitations of current treatments for NPS have drivent he search for safer pharmacotherapies-including cannabinoids. AIM To assess the efficacy and acceptability of cannabinoids for the treatment of NPS in individuals with dementia. DESIGN Systematic review and meta-analysis of clinical trials. SETTING AND PARTICIPANTS Of 6,902 papers, 9 were eligible (n = 205, 44% female, 78 ± 7 years, 85% Alzheimer disease). Trials were in North America and Europe and explored tetrahydrocannabinol (n = 3), dronabinol (n = 5), or nabilone (n = 1). MEASUREMENT Titles/abstracts were independently screened by one reviewer and reviewed by a second. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on the standardized mean difference (SMD) for several NPS instruments, trial completion, and adverse events. Data were pooled using random-effects models. FINDINGS Cannabinoids led to significant improvements across NPS instruments, including the Cohen Mansfield Agitation Inventory (SMD = -0.80; 95% confidence interval [CI], -1.45 to -0.16), the Neuropsychiatric Inventory (SMD = -0.61; CI, -1.07 to -0.15), and nocturnal actigraphy (SMD = -1.05; CI, -1.56 to -0.54h). Cannabinoids were well-tolerated, with an overall trial completion rate of 93% (193/205) and no serious treatment-related adverse events. Treatment efficacy was associated with baseline dementia severity and dose, but not dementia subtype, age, or sex. The overall study quality was rated as low. CONCLUSIONS There is preliminary evidence for the efficacy and tolerability of cannabinoids as treatments for NPS. Population-based studies are needed to characterize their real-world effectiveness and acceptability.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Arthi Chinna Meyyappan
- Providence Care Hospital, Kingston, Ontario, Canada.,Centre for Neurosciences, Queen's University, Kingston, Ontario, Canada
| | - Emily R Hawken
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Providence Care Hospital, Kingston, Ontario, Canada
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Xu X, Li W, Mei J, Tao M, Wang X, Zhao Q, Liang X, Wu W, Ding D, Wang P. Feature Selection and Combination of Information in the Functional Brain Connectome for Discrimination of Mild Cognitive Impairment and Analyses of Altered Brain Patterns. Front Aging Neurosci 2020; 12:28. [PMID: 32140102 PMCID: PMC7042199 DOI: 10.3389/fnagi.2020.00028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 01/28/2020] [Indexed: 12/28/2022] Open
Abstract
Mild cognitive impairment (MCI) is often considered a critical time window for predicting early conversion to Alzheimer’s disease (AD). Brain functional connectome data (i.e., functional connections, global and nodal graph metrics) based on resting-state functional magnetic resonance imaging (rs-fMRI) provides numerous information about brain networks and has been used to discriminate normal controls (NCs) from subjects with MCI. In this paper, Student’s t-tests and group-least absolute shrinkage and selection operator (group-LASSO) were used to extract functional connections with significant differences and the most discriminative network nodes, respectively. Based on group-LASSO, the middle temporal, inferior temporal, lingual, posterior cingulate, and middle frontal gyri were the most predominant brain regions for nodal observation in MCI patients. Nodal graph metrics (within-module degree, participation coefficient, and degree centrality) showed the maximum discriminative ability. To effectively combine the multipattern information, we employed the multiple kernel learning support vector machine (MKL-SVM). Combined with functional connectome information, the MKL-SVM achieved a good classification performance (area under the receiving operating characteristic curve = 0.9728). Additionally, the altered brain connectome pattern revealed that functional connectivity was generally decreased in the whole-brain network, whereas graph theory topological attributes of some special nodes in the brain network were increased in MCI patients. Our findings demonstrate that optimal feature selection and combination of all connectome features (i.e., functional connections, global and nodal graph metrics) can achieve good performance in discriminating NCs from MCI subjects. Thus, the combination of functional connections and global and nodal graph metrics of brain networks can predict the occurrence of MCI and contribute to the early clinical diagnosis of AD.
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Affiliation(s)
- Xiaowen Xu
- Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weikai Li
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jian Mei
- Physical Education College, Soochow University, Suzhou, China
| | - Mengling Tao
- Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiangbin Wang
- Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wanqing Wu
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Peijun Wang
- Department of Medical Imaging, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Effects of Art and Reminiscence Therapy on Agitated Behaviors Among Older Adults With Dementia. J Nurs Res 2020; 28:e100. [PMID: 31985558 DOI: 10.1097/jnr.0000000000000373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cognitive degeneration and agitated behavior symptoms of dementia in older adults are the main causes of disability and inability and increase the cost of medical care. Agitated behavior symptoms of dementia are the main causes of early institutionalization and make caregivers exhausted. PURPOSE The aim of this study was to examine the effects of art therapy and reminiscence therapy on the alleviation of agitated behaviors in older adults with dementia. METHODS An experimental research design with two experimental groups and one comparison group was conducted to examine the effects for each group on agitated behaviors. Participants were recruited from two dementia care centers in central and northern Taiwan. The study included 54 older individuals who met the sampling criteria and completed the data collection process. The participants were randomly allocated into the art therapy group (n = 24), the reminiscence therapy group (n = 22), and the comparison group (n = 8). The intervention consisted of 50-minute sessions conducted weekly for 12 weeks. Regular activities were continued in the comparison group. The structured questionnaires were completed, and observations of agitated behaviors were collected before the intervention and at 1 and 6 weeks after the intervention. RESULTS Significant differences were found in agitated behavior symptoms at the three time points in the art therapy group, whereas reminiscence therapy was found to have had a clear and immediate effect on decreasing agitated behavior. The generalized estimating equation exchange model test revealed a significant and sustained, postintervention effect of art therapy on agitated behavior. In contrast, no significant and sustained effect on agitated behavior was observed in the reminiscence therapy group. CONCLUSIONS The findings of this study support that art therapy may have a positive effect on dementia-associated agitated behaviors in institutionalized older adults. Reminiscence therapy activities conducted weekly for 50 minutes each session did not reach statistically significant implications. It is suggested that future studies consider conducting art and reminiscence therapies for a 16-week duration with two weekly sessions to evaluate the effectiveness of the therapy. The duration of follow-up should be extended as well in future studies.
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Song DY, Wang XW, Wang S, Ge SQ, Ding GY, Chen XY, Chen YR, Liu HM, Xie XM, Xing WJ, Li D, Zhou Y. Jidong cognitive impairment cohort study: objectives, design, and baseline screening. Neural Regen Res 2020; 15:1111-1119. [PMID: 31823892 PMCID: PMC7034269 DOI: 10.4103/1673-5374.266070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The risk of dementia increases in patients with cognitive impairment. However, it is not clear what factors contribute to the onset of dementia in those with cognitive impairment. In this prospective cohort study, we will investigate the every-five-year incidence of cognitive impairment and prognostic factors for cognitive impairment. The Jidong cognitive impairment cohort was established from April 2012 to August 2015, during which we recruited 5854 healthy participants (55.1% male) older than 45 years (mean, 57 years). Participants received a health examination in the Staff Hospital, Jidong Oilfield Branch, China National Petroleum Corporation. Baseline data and blood samples were collected. Cognitive impairment was evaluated using the Mini-Mental State Examination, and was defined as a Mini-Mental State Examination score of less than 24. Dementia was assessed using the criteria of Diagnostic and Statistical Manual of Mental Disorders (Fourth edition), the International Working Group criteria, and the Mini-Mental State Examination score. The follow-up will continue until December 2024, during which a prognostic model will be constructed. The primary outcome is the presence/absence of dementia and the secondary outcome is quality of life. Baseline screening results showed the following: (1) Cognitive impairment was apparent in 320 participants (5.5%). These participants will be excluded from the Jidong cohort study, and the remaining participants will be followed up. (2) Of the 320 participants with cognitive impairment, there was a significantly higher prevalence of illiteracy than other education levels (35.9%, P < 0.05). Age, arterial hypertension, alcohol consumption, and passive smoking differed significantly between the cognitive impairment and healthy groups (P < 0.05). Multivariate logistic regression models showed that age (odds ratio [OR] = 1.059, 95% confidence interval [CI]: 1.044–1.074) and arterial hypertension (OR = 1.665, 95% CI: 1.143–2.427) were risk factors for mild cognitive impairment. With the increase of educational level (illiteracy, primary school, junior high school, high school, university, and above), cognitive impairment gradually decreased (OR < 1, P < 0.05). (3) This cohort study has initially screened for several risk factors for cognitive impairment at baseline, and subsequent prospective data will further describe, validate, and evaluate the effects of these risk factors on cognitive impairment and dementia. These results can provide clinical evidence for the early prevention of cognitive impairment and dementia. The study was approved by the Ethics Committee of Kailuan General Hospital of Tangshan City and the Medical Ethics Committee, Staff Hospital, Jidong Oilfield Branch, China National Petroleum Corporation on July 12, 2013 (approval No. 2013 YILUNZI 1).
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Affiliation(s)
- Dai-Yu Song
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China; School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xian-Wei Wang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Sa Wang
- Department of Neurology, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang Province, China
| | - Si-Qi Ge
- Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, Beijing, China
| | - Guo-Yong Ding
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Xue-Yu Chen
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Yan-Ru Chen
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Hua-Min Liu
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Xiao-Mei Xie
- Staff hospital of jidong oilfield, Caofeidian district, Tangshan, Hebei Province, China
| | - Wei-Jia Xing
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Dong Li
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Yong Zhou
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Sivaraman D, Arun M, Kannan R, Pradeep PS, Muralidharan P. Neurocognitive investigation of Morinda tinctoria against amyloid beta-induced oxidative insult and cognitive impairment in albino mice: A phytotherapeutic approach. Pharmacogn Mag 2020. [DOI: 10.4103/pm.pm_284_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maeda Y, Fukushima K, Kyoutani S, Butler JP, Fujii M, Sasaki H. Dramatic Performance by a Professional Actor for the Treatment of Patients with Behavioral and Psychological Symptoms of Dementia. TOHOKU J EXP MED 2020; 252:263-267. [PMID: 33177265 DOI: 10.1620/tjem.252.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) challenge caregivers, leading to caregiver burden and subsequent nursing home or inpatient placement in a psychiatric hospital for dementia. Favorable positive emotions should be an important goal for the treatment of negative emotions of BPSD. Arts are one of the most profound areas to stimulate favorable emotions. We have asked a professional actor, who was not involved in the daily care and regular rehabilitations, to give a dramatic performance by reading selected stories as if the patients with BPSD felt to be in the audiences of a theater. We wondered whether a dramatic performance by the actor might be a way to respond to the complex needs of inpatients with BPSD, especially focused on favorable emotions. New inpatients (Alzheimer's disease, vascular dementia, or dementia with Lewy bodies) were randomly assigned to a control group (n = 20) and a dramatic performance group (n = 14) in Sendai Tomizawa Hospital, a psychiatric hospital for dementia, in Japan. Dramatic performances were performed for one and half hours once per week for 3 months. Neuropsychiatric Inventory for BPSD decreased in both groups and delightful emotional index (DEI) for favorable emotions increased in the intervention group but not in the control group after 3 months. At 3 months, there was an increase of DEI in intervention group compared with control group. We conclude that dramatic performance may be one of the appropriate interventions in patients with BPSD, as it appears to help in their favorable emotional state.
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Affiliation(s)
| | | | | | - James P Butler
- Department of Environmental Health, Harvard T.H. Chan School of Public Health.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital.,Harvard Medical School
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Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits. J Aging Res 2019; 2019:7272067. [PMID: 31929906 PMCID: PMC6942829 DOI: 10.1155/2019/7272067] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/06/2019] [Indexed: 01/02/2023] Open
Abstract
Background Dementia remains a growing concern for societies globally, particularly as people now live longer. About 90% of individuals with advanced dementia suffer from eating problems that lead to general health decline and ultimately impacts upon the physical, psychological, and economic wellbeing of the individuals, caregivers, and the wider society. Objective To evaluate the burdens and perceived benefits of tube feeding in individuals with advanced dementia. Design Narrative review. Methods Computerized databases, including PubMed, Embase, Medline, CINAHL, PsycInfo, and Google Scholar were searched from 2000 to 2019 to identify research papers, originally written in or translated into English language, which investigated oral versus tube feeding outcome in individuals with advanced dementia. Results Over 400 articles were retrieved. After quality assessment and careful review of the identified articles, only those that met the inclusion criteria were included for review. Conclusion Tube feeding neither stops dementia disease progression nor prevents imminent death. Each decision for feeding tube placement in individuals with advanced dementia should be made on a case-by-case basis and involve a multidisciplinary team comprising experienced physicians, nurses, family surrogates, and the relevant allied health professionals. Careful considerations of the benefit-harm ratio should be discussed and checked with surrogate families if they would be consistent with the wishes of the demented person. Further research is required to establish whether tube feeding of individuals with advanced dementia provides more burdens than benefits or vice-versa and evaluate the impacts on quality of life and survival.
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Iqbal J, Zhang K, Jin N, Zhao Y, Liu X, Liu Q, Ni J, Shen L. Alzheimer's Disease Is Responsible for Progressive Age-Dependent Differential Expression of Various Protein Cascades in Retina of Mice. ACS Chem Neurosci 2019; 10:2418-2433. [PMID: 30695639 DOI: 10.1021/acschemneuro.8b00710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease associated with cognitive impairments and memory loss usually in aged people. In the past few years, it has been detected in the eye retina, manifesting the systematic spread of the disease. This might be used for biomarker discovery for early detection and treatment of the disease. Here, we have described the proteomic alterations in retina of 2, 4, and 6 months old 3×Tg-AD mice by using iTRAQ (isobaric tags for relative and absolute quantification) proteomics technology. Out of the total identified proteins, 121 (71 up- and 50 down-regulated), 79 (51 up- and 28 down-regulated), and 153 (37 up- and 116 down-regulated) significantly differentially expressed proteins (DEPs) are found in 2, 4, and 6 month's mice retina (2, 4, and 6 M), respectively. Seventeen DEPs are found common in these three groups with consistent expression behavior or opposite expression in the three groups. Bioinformatics analysis of these DEPs highlighted their involvement in vital AD-related biological phenomenon. To further prompt the results, four proteins from 2 M group, three from 4 M, and four from 6 M age groups are successfully validated with Western blot analysis. This study confirms the retinal involvement of AD in the form of proteomic differences and further explains the protein-based molecular mechanisms, which might be a step toward biomarker discovery for early detection and treatment of the disease.
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Affiliation(s)
- Javed Iqbal
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Kaoyuan Zhang
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
- Department of Dermatology, Peking University Shenzhen Hospital, Guangdong 518036, China
| | - Na Jin
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Yuxi Zhao
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Xukun Liu
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Qiong Liu
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Jiazuan Ni
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Liming Shen
- College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
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Abstract
SUMMARYBaillonet al’s Cochrane review included 430 participants with agitation in dementia from five randomised controlled trials. Overall, the reviewers found that valproate was no better than placebo for the treatment of agitation in people with dementia; however, the quality of the studies included was very variable. Adverse effects and events were higher in the treatment group compared with the controls, although these finding were largely based on low-quality data with incomplete reporting; thus, valproate's safety profile is of concern. This review demonstrates that there is insufficient evidence to change current treatment guidelines.DECLARATION OF INTERESTNone.
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Borah K, Sharma S, Silla Y. Structural bioinformatics-based identification of putative plant based lead compounds for Alzheimer Disease Therapy. Comput Biol Chem 2019; 78:359-366. [DOI: 10.1016/j.compbiolchem.2018.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/25/2018] [Indexed: 12/19/2022]
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Mendelevich EG. Alzheimer's disease: some pharmacological and non-pharmacological approaches to correcting neuropsychiatric disorders. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2018. [DOI: 10.14412/2074-2711-2018-3-129-134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Today, there is no reliable pharmacological correction of dementia, despite its high prevalence worldwide. The clinical presentation of Alzheimer's disease at one or another stage is accompanied by neuropsychiatric disorders (NPDs) in addition to cognitive defect. The intensity and range of NPDs are different. The possibilities of drug therapy for NPDs are demonstrated. The role of akatinol memantine in correcting a number of psychological and behavioral disorders is highlighted. Biological, psychological, social, and environmental factors are identified among those that contribute to or provoke the development of NPDs. Knowledge of the triggers of mental disorders makes it possible to prevent and thereby reduce or eliminate NPDs. Special emphasis is laid on the patient-caregiver relationship. In recent years, non-pharmacological interventions have been increasingly used as priority-line therapy for NPDs. There are data on main methods for non-pharmacological correction and on the efficiency of their application.
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Affiliation(s)
- E. G. Mendelevich
- Kazan State Medical University, Kazan, Republic of Tatarstan, Russia 49, Butlerov St., Kazan, Republic of Tatarstan
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Ray KD, Götell E. The Use of Music and Music Therapy in Ameliorating Depression Symptoms and Improving Well-Being in Nursing Home Residents With Dementia. Front Med (Lausanne) 2018; 5:287. [PMID: 30356835 PMCID: PMC6190855 DOI: 10.3389/fmed.2018.00287] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Studies have shown music therapy can improve depression symptoms in dementia and the use of music activities show promise to have positive impacts on wellbeing. However, few studies show the influence of a music intervention led by certified nursing assistants (CNAs) trained by music therapists to address depression symptoms and wellbeing in individuals with dementia. Methods: Credentialed music therapists (1) administered 2-weeks of music therapy, (2) a 3-days training to CNAs, (3) followed by 2-weeks of music activities, singing and music-with-movement, led by CNAs for 62 nursing home residents with moderate dementia, (4) then measured depression symptoms using the Cornell Scale for Depression. We obtained video consent for 26 of the 62 residents who were video recorded receiving CNA-led music-based caregiving activities. Using the Music in Dementia Scale, over 200 h of video data was observed and raters measured changes in well-being, e.g., levels of enjoyment, mood and engagement in the residents, during the CNA facilitated music activities. Results: A repeated measures ANOVA revealed that mean depression scores differed statistically significantly between time points, p ≤ 0.001. Residents' baseline depression symptoms significantly declined following 2 weeks of music therapy, p ≤ 0.001, increased during a 2-weeks wash-out period, p = 0.389, but appeared to stabilize following the 2-weeks music activity, p = 1.00. A video analysis and paired sampled t-test demonstrated a significant improvement in wellbeing in residents who engaged in music with movement, p = 0.003. Wellbeing improved slightly, but not significantly for residents who participated in the singing intervention, p = 0.165. Conclusion: Findings suggest that music therapy can significantly decrease depression symptoms in nursing home residents with dementia. Music activities designed by music therapists and facilitated by CNAs may help sustain the reduction of depression symptoms and improve wellbeing in nursing home residents with moderate to severe dementia.
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Affiliation(s)
- Kendra D Ray
- Planning and Research Department, Menorah Center for Nursing and Rehabilitation, MJHS, Brooklyn, NY, United States
| | - Eva Götell
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
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