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Huang ST, Loh CH, Lin CH, Hsiao FY, Chen LK. Trends in dementia incidence and mortality, and dynamic changes in comorbidity and healthcare utilization from 2004 to 2017: A Taiwan national cohort study. Arch Gerontol Geriatr 2024; 121:105330. [PMID: 38341955 DOI: 10.1016/j.archger.2024.105330] [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: 02/16/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/13/2024]
Abstract
AIMS This study aims to ascertain dementia incidence from 2004 to 2017 in Taiwan, and to examine the disease course in comorbidity, treatments, healthcare usage, and mortality among older people with incident dementia preceding the diagnosis of dementia and afterwards. METHODS Taiwan National Health Insurance data on people aged ≥ 65 years with incident dementia from January 2004 to December 2017 were excerpted to estimate annual incidence rates and annualized percentage changes(APCs). For people diagnosed before 2013, annual mortality rates and causes of death during 5-years' follow-up were determined. Changes in 22 diseases/conditions, hospital visits and admissions, and psychotropic medication prescriptions commonly associated with dementia, were examined from 3 years preceding the index diagnosis until 5 years afterwards. RESULTS From 2004 to 2017, the annual incidence of dementia in Taiwan increased from 30,606 to 50,651, and by > 90 % in women; age-standardized annual incidence increased significantly, with an APC of 0.4 %(p = 0.02). For 372,203 incident cases from 2004 to 2013, annual mortality was∼12 % during 5-years' follow-up. The prevalence of most comorbidities increased by 65-150 % after being diagnosed with dementia. People with incident dementia had increased healthcare usage 1 year before diagnosis, which peaked 1 year afterwards. Psychotropic medication prescriptions increased gradually over 3 years before diagnosis, peaked 3 months afterwards, gradually declined during the next 2 years, then remained stable. CONCLUSION The incidence of dementia in Taiwan has increased gradually over time, with an annual mortality risk of∼12 %. Older people with dementia had more healthcare needs and comorbid conditions after dementia diagnosis, highlighting the exigency of person-centered dementia care.
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Affiliation(s)
- Shih-Tsung Huang
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Hui Loh
- Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chi-Hung Lin
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
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Ahmed T. Lipid nanoparticle mediated small interfering RNA delivery as a potential therapy for Alzheimer's disease. Eur J Neurosci 2024; 59:2915-2954. [PMID: 38622050 DOI: 10.1111/ejn.16336] [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: 09/18/2023] [Revised: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 04/17/2024]
Abstract
Alzheimer's disease (AD) is a neurodegenerative condition that exhibits a gradual decline in cognitive function and is prevalent among a significant number of individuals globally. The use of small interfering RNA (siRNA) molecules in RNA interference (RNAi) presents a promising therapeutic strategy for AD. Lipid nanoparticles (LNPs) have been developed as a delivery vehicle for siRNA, which can selectively suppress target genes, by enhancing cellular uptake and safeguarding siRNA from degradation. Numerous research studies have exhibited the effectiveness of LNP-mediated siRNA delivery in reducing amyloid beta (Aβ) levels and enhancing cognitive function in animal models of AD. The feasibility of employing LNP-mediated siRNA delivery as a therapeutic approach for AD is emphasized by the encouraging outcomes reported in clinical studies for other medical conditions. The use of LNP-mediated siRNA delivery has emerged as a promising strategy to slow down or even reverse the progression of AD by targeting the synthesis of tau phosphorylation and other genes linked to the condition. Improvement of the delivery mechanism and determination of the most suitable siRNA targets are crucial for the efficacious management of AD. This review focuses on the delivery of siRNA through LNPs as a promising therapeutic strategy for AD, based on the available literature.
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Affiliation(s)
- Tanvir Ahmed
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
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Xu H, Bayless TM, Østbye T, Dupre ME. Care sequences leading to the diagnosis of Alzheimer's disease and related dementias: An analysis of electronic health records. Alzheimers Dement 2024; 20:2155-2164. [PMID: 38270269 PMCID: PMC10984433 DOI: 10.1002/alz.13669] [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: 06/14/2023] [Revised: 10/24/2023] [Accepted: 12/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND We examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center. METHODS We included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis. RESULTS Of 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (n = 322, 8.9%) and multiple (n = 416, 11.5%) outpatient visits to primary care and having one (n = 395, 10.9%), multiple (n = 469, 13.0%), or highly frequent (n = 357, 10.7%) outpatient visits to other specialties. Patients' sociodemographic traits contributed to the variability in care sequences. CONCLUSIONS Several distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD. HIGHLIGHTS Dementia patients followed distinct care pathways prior to their dementia diagnoses. Key sociodemographic traits contributed to the variation in the sequences of care. Racial differences in the sequencing of care were also found, but only in women.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Teah M. Bayless
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
| | - Truls Østbye
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Matthew E. Dupre
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
- Department of SociologyDuke UniversityDurhamNorth CarolinaUSA
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Ullah A, Lee GJ, Kwon HT, Lim SI. Covalent immobilization of human serum albumin on cellulose acetate membrane for scavenging amyloid beta - A stepping extracorporeal strategy for ameliorating Alzheimer's disease. Colloids Surf B Biointerfaces 2024; 234:113753. [PMID: 38241888 DOI: 10.1016/j.colsurfb.2024.113753] [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: 10/29/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder characterized by interrupted neurocognitive functions and impaired mental development presumably caused by the accumulation of amyloid beta (Aβ) in the form of plaques. Targeting Aβ has been considered a promising approach for treating AD. In the current study, human serum albumin (HSA), a natural Aβ binder, is covalently immobilized onto the surface of a cellulose acetate (CA) membrane to devise an extracorporeal Aβ sequester. The immobilization of HSA at 3.06 ± 0.22 μg/mm2 of the CA membrane was found to be active functionally, as evidenced by the esterase-like activity converting p-nitrophenyl acetate into p-nitrophenol. The green fluorescent protein-Aβ (GFP-Aβ) fusion protein, recombinantly produced as a model ligand, exhibited characteristics of native Aβ. These features include the propensity to form aggregates or fibrils and an affinity for HSA with a dissociation constant (KD) of 0.91 μM. The HSA on the CA membrane showed concentration-dependent sequestration of GFP-Aβ in the 1-10-μM range. Moreover, it had a greater binding capacity than HSA immobilized on a commercial amine-binding plate. Results suggest that the covalent immobilization of HSA on the CA surface can be used as a potential platform for sequestering Aβ to alleviate AD.
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Affiliation(s)
- Aziz Ullah
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea; Gomal Centre of Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, Dera Ismail Khan 29050, Khyber Pakhtunkhwa, Pakistan
| | - Gyu-Jin Lee
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea
| | - Hyuk Taek Kwon
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea.
| | - Sung In Lim
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea.
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Couret A, Lapeyre-Mestre M, Gombault-Datzenko E, Renoux A, Villars H, Gardette V. Which factors preceding dementia identification impact future healthcare use trajectories: multilevel analyses in administrative data. BMC Geriatr 2024; 24:89. [PMID: 38263052 PMCID: PMC10807194 DOI: 10.1186/s12877-023-04643-1] [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: 07/17/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare use patterns preceding a diagnosis of Alzheimer's Disease and Related Diseases (ADRD) may be associated with the quality of healthcare use trajectories (HUTs) after diagnosis. We aimed to identify determinants of future favorable HUTs, notably healthcare use preceding ADRD identification. METHODS This nationwide retrospective observational study was conducted on subjects with incident ADRD identified in 2012 in the French health insurance database. We studied the 12-month healthcare use ranging between 18 and 6 months preceding ADRD identification. The five-year HUTs after ADRD identification were qualified by experts as favorable or not. In order to take into account geographical differences in healthcare supply, we performed mixed random effects multilevel multivariable logistic regression model to identify determinants of future favorable HUTs. Analyses were stratified by age group (65-74, 75-84, ≥ 85). RESULTS Being a woman, and preventive and specialist care preceding ADRD identification increased the probability of future favorable HUT, whereas institutionalization, comorbidities, medical transportation and no reimbursed drug during [-18;-6] months decreased it. Besides, some specificities appeared according to age groups. Among the 65-74 years subjects, anxiolytic dispensing preceding ADRD identification decreased the probability of future favorable HUT. In the 75-84 years group, unplanned hospitalization and emergency room visit preceding ADRD identification decreased this probability. Among subjects aged 85 and older, short hospitalization preceding ADRD identification increased the probability of future favorable HUTs. CONCLUSION Regular healthcare use with preventive and specialist care preceding ADRD identification increased the probability of future favorable HUTs whereas dependency decreased it.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France.
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France.
- Faculté de médecine, 37 allées Jules Guesde, Toulouse, 31000, France.
| | - Maryse Lapeyre-Mestre
- Department of Pharmacology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Department of Medical Information (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Villars
- Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Chatzikostopoulos T, Gialaouzidis M, Koutoupa A, Tsolaki M. The Effects of Pomegranate Seed Oil on Mild Cognitive Impairment. J Alzheimers Dis 2024; 97:1961-1970. [PMID: 38306046 DOI: 10.3233/jad-231100] [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: 02/03/2024]
Abstract
Background In recent years, there has been a growing interest, supported by many experimental and clinical studies, about the benefits of pomegranate in preventing various pathologic conditions, including brain neurodegeneration. The pomegranate seed oil (PSO) contains high levels of fatty acids that have antioxidant and anti-inflammatory properties. Objective Due to the lack of clinical trials, the aim of the present study was to investigate the effects of PSO on cognition of people with mild cognitive impairment (MCI). Methods Eighty people with the diagnosis of MCI were randomized forty to take 5 drops of PSO and follow the Mediterranean Diet (MeDi) and forty just followed MeDi. All were examined with an extensive neuropsychological assessment before and after one year of treatment. Results The results showed that the participants who took the PSO had statistically significantly better global cognition (p = 0.004), verbal episodic memory (p = 0.009), and processing and executive functions (p < 0.001) in contrast with the participants who did not take it. Conclusions In conclusion, the PSO can be beneficial for people with MCI as it is helpful for some important cognitive domains. As PSO is a natural product that does not burden the human body, it can be used by people with MCI and be a significant and promising part of holistic approaches for the prevention of dementia.
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Affiliation(s)
- Thanos Chatzikostopoulos
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University, Thessaloniki, Greece
| | - Moses Gialaouzidis
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University, Thessaloniki, Greece
| | - Anna Koutoupa
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University, Thessaloniki, Greece
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University, Thessaloniki, Greece
- First Department of Neurology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kosteniuk JG, Morgan DG, Osman BA, Islam N, O’Connell ME, Kirk A, Quail JM, Osman M. Utilization of Health Services Before and After Diagnosis in a Specialist Rural and Remote Memory Clinic. Can Geriatr J 2023; 26:350-363. [PMID: 37662065 PMCID: PMC10444530 DOI: 10.5770/cgj.26.653] [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: 09/05/2023] Open
Abstract
Background Limited research exists on the use of specific health services over an extended time among rural persons with dementia. The study objective was to examine health service use over a 10-year period, five years before until five years after diagnosis in the specialist Rural and Remote Memory Clinic (RRMC). Methods Clinical and administrative health data of RRMC patients were linked. Annual health service utilization of the cohort (N = 436) was analyzed for 416 patients pre-index (57.5% female, mean age 71.2 years) and 419 post-index (56.3% female, mean age 70.8 years). Approximately 40% of memory clinic diagnoses were Alzheimer's disease (AD), 20% non-AD dementia, and 40% mild or subjective cognitive impairment or other condition. Post-index, 188 patients (44.9%) moved to permanent long-term care and were retained in the sample; 121 patients died (28.9%) and were removed yearly. Results Over the ten-year study period, a significant increase occurred in the average number of FP visits, all-type drug prescriptions, and dementia-specific drug prescriptions (all p <.001). The highest proportion of patients hospitalized was observed one year pre-index, the highest average number of specialist visits was observed one year post-index, and both demonstrated a significant decreasing trend in the five-year post-index period (p = .037). Conclusions A pattern of increasing FP visits and drug prescriptions over an extended period before and after diagnosis in a specialist rural and remote memory clinic highlights a need to support FPs in post-diagnostic management. Further research of longitudinal patterns in health service utilization is merited.
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Affiliation(s)
- Julie G. Kosteniuk
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, Saskatoon
| | - Debra G. Morgan
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, Saskatoon
| | - Beliz Acan Osman
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, Saskatoon
| | - Naorin Islam
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon
| | | | - Andrew Kirk
- Department of Medicine, University of Saskatchewan, Saskatoon
| | - Jacqueline M. Quail
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, Saskatoon
| | - Meric Osman
- Saskatchewan Medical Association, Saskatoon, SK, Canada
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Downer B, Li CY, Snih SA. Hospitalizations and Emergency Room Admissions by Mexican American Older Adults with and without Dementia and Caregiver Mental Health. J Alzheimers Dis 2023; 91:1185-1195. [PMID: 36565125 PMCID: PMC9946698 DOI: 10.3233/jad-220997] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence from predominately non-Hispanic White populations indicates that emergency room (ER) admissions and hospitalizations by older adults with and without dementia are associated with caregiver stress and depressive symptoms. These results may not generalize to Hispanic populations because of cultural differences in caregiving roles, responsibilities, and perspectives about care burden. OBJECTIVE Investigate the association between ER admissions and hospitalizations by Mexican American older adults with and without dementia and symptoms of depression and stress among family caregivers. METHODS Data came from the 2010/11 wave of the Hispanic Established Populations for the Epidemiologic Study of the Elderly and Medicare claims files. The final sample included 326 older adults and their caregivers. Negative binomial regression was used to model the association between hospitalizations and ER admissions by older adults in the previous two years and caregivers' depressive symptoms and stress in 2010/11. RESULTS The number of older adult ER admissions and hospitalizations was not associated with caregiver depressive symptoms. Two or more ER admissions (incident rate ratio [IRR] = 1.26, 95% CI = 1.05-1.51) and two or more hospitalizations (IRR = 1.32, 95% CI = 1.07-1.61) were associated with significantly higher caregiver stress. Additionally, ER admissions and hospitalizations for a circulatory disease or injury and poisoning were associated with significantly higher caregiver stress. These associations were not modified by the care recipient's dementia status. CONCLUSION Hospitalizations and ER admissions by older Mexican Americans were associated with greater caregiver stress but not depressive symptoms. These associations were similar for caregivers to older adults with and without dementia.
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Affiliation(s)
- Brian Downer
- Department of Population Health & Health Disparities, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Department of Population Health & Health Disparities, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Couret A, Lapeyre-Mestre M, Gombault-Datzenko E, Renoux A, Villars H, Gardette V. Healthcare use patterns before Alzheimer's disease and related diseases identification and future healthcare trajectory. Int J Geriatr Psychiatry 2023; 38:e5849. [PMID: 36457190 DOI: 10.1002/gps.5849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A frequent late Alzheimer's Disease and Related Diseases (ADRD) identification is described and may induce erratic health resource use. We aimed to describe healthcare use patterns preceding ADRD identification. METHODS We studied persons aged 65 or older, identified with incident ADRD in 2012 in the French health insurance database. Healthcare use covering a wide range of care in ambulatory and hospital settings during the period ranging from 18 to six months before ADRD identification was studied. The main dimensions of healthcare use patterns before ADRD identification were investigated in three age groups (65-74, 75-84, ≥85) through a multiple correspondence analysis. These dimensions were secondarily interpreted according to the 5-year healthcare trajectory following ADRD identification, qualified as favorable (or not) by experts in the field. RESULTS This research studied 36,990 subjects. Four dimensions raised in each age group. Two dimensions' interpretations were retrieved in all age groups: intensity of healthcare use, functional dependency. However, their rank differed along with the qualification of the future healthcare trajectory. Some specificities appeared in some age group. In the 65-74 and 75-84 years groups, there were dimensions reflecting healthcare use related to psychiatric or psycho-behavioral disorders. In the ≥85 group, two dimensions reflected dependency related to other comorbidities, and organised medical follow-up. CONCLUSION Several dimensions emerged in line with erratic trajectories before ADRD identification. They underlined the need for actions towards ADRD identification.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France.,Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Department of Pharmacology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Centre D'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population CohorteS et BiobanqueS", Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Department of Medical Information (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Axel Renoux
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Villars
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France.,Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France.,Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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10
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Browning JA, Tsang CCS, Dong X, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Liu C, Wang J. Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis. BMC Health Serv Res 2022; 22:159. [PMID: 35130899 PMCID: PMC8822650 DOI: 10.1186/s12913-022-07483-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.
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Affiliation(s)
- Jamie A Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN, 38163, USA
| | - Marie A Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Christopher K Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jack W Tsao
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap St, Memphis, 38105, USA.,Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN, 38163, USA
| | - Colin Liu
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA, 19104, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
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