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Peng J, Mai Y, Liu J. Guideline for the cognitive assessment and follow-up in the Guangdong-Hong Kong-Macao Greater Bay Area (2024 edition). Aging Med (Milton) 2024; 7:258-268. [PMID: 38975298 PMCID: PMC11222743 DOI: 10.1002/agm2.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/10/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024] Open
Abstract
This practice guideline focuses on the cognitive assessment for mild cognitive impairment in the Guangdong-Hong Kong-Macao Greater Bay Area. To achieve the standardization and normalization of its clinical practice and generate individualized intervention, the National Core Cognitive Center of the Second Affiliated Hospital of Guangzhou Medical University, the Cognitive Disorders Branch of Chinese Geriatic Society, the Dementia Group of Neurology Branch of Guangdong Medical Association and specialists from Hong Kong and Macao developed guidelines based on China's actual conditions and efficiency, economic cost and accuracy. The article addresses the significance, background, and the process of the assessment and follow-up to realize the promotion and dissemination of cognitive assessment.
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Affiliation(s)
- Jialing Peng
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina
| | - Yingreng Mai
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina
| | - Jun Liu
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina
- National Core Cognitive CenterThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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Patel KJ, Yang D, Feldman HH, Hsiung GR, Nygaard HB, Best JR, Dwosh E, Robillard JM, DeMarco ML. Personal value of Alzheimer's disease biomarker testing and result disclosure from the patient and care partner perspective. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12463. [PMID: 38596482 PMCID: PMC10999946 DOI: 10.1002/trc2.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION We described patients' and care partners' experiences with Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarker testing and result disclosure in routine care. METHODS IMPACT-AD BC is an observational study of clinic patients who underwent AD CSF biomarker testing as part of their routine medical care (n = 142). In the personal utility arm of the study, semi-structured phone interviews were conducted with a subset of patients (n = 34), and separately with their care partners (n = 31). Post-disclosure interviews were conducted ∼1 month and ∼6 months after biomarker result disclosure and investigated the patients' decision-making process around testing, impact of receiving results, wellness and lifestyle changes, and future planning. RESULTS A majority of patients (90%) rated their decision to undergo testing as "easy." Post-disclosure, the majority (82%) reported overall positive feelings from having greater certainty and the ability to plan ahead, and results spurred them to adopt/continue healthy behaviors such as exercise (84%) and cognitive activities (54%). Care partners expressed relief from having more diagnostic certainty, increased appreciation of future caregiving responsibilities, and a desire to connect with support resources. DISCUSSION Perspectives of persons with lived experience in dementia provide new insight into the value of biomarker testing and should be included as part of evidence-guided considerations for pre-test counseling and result disclosure. Moreover, study findings identify an interval when patients and care partners are highly receptive to positive lifestyle and medical interventions.
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Affiliation(s)
- Khushbu J. Patel
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
| | - David Yang
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
| | - Howard H. Feldman
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
- Alzheimer Disease Cooperative Study, University of California San DiegoSan DiegoCaliforniaUSA
- Alzheimer's and Related Neurodegenerative Research, University of California San DiegoSan DiegoCaliforniaUSA
| | - Ging‐Yuek R. Hsiung
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- UBC Hospital Clinic for Alzheimer Disease and Related Disorders, University of British ColumbiaVancouverCanada
| | - Haakon B. Nygaard
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- UBC Hospital Clinic for Alzheimer Disease and Related Disorders, University of British ColumbiaVancouverCanada
| | - John R. Best
- Gerontology Research Centre, Simon Fraser UniversityVancouverCanada
| | - Emily Dwosh
- UBC Hospital Clinic for Alzheimer Disease and Related Disorders, University of British ColumbiaVancouverCanada
- Department of Medical GeneticsUniversity of British ColumbiaVancouverCanada
| | - Julie M. Robillard
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
| | - Mari L. DeMarco
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
- Department of Pathology and Laboratory MedicineSt. Paul's Hospital, Providence Health CareVancouverCanada
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Mohamad RM, Alsaeed MSA, Merdad AH, Alghaith DM, Binnshwan FM, Albusaad RA, Almuslem MY, Alamri RA, Hussan Awaji HH, Alqahtani MN, Alamrani AA. Evaluating the General Population of Saudi Arabia for Their Knowledge, Attitudes, and Practices Towards Dementia. Cureus 2023; 15:e49865. [PMID: 38170079 PMCID: PMC10760348 DOI: 10.7759/cureus.49865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Dementia, a prevalent neurological condition, has a significant global impact on individuals and communities. Despite affecting approximately 50 million people worldwide, with an expected tripling by 2050, there are currently no widely available disease-modifying treatments. Recent efforts have concentrated on strategies involving legislation, regulations, and population-wide initiatives to address dementia risk, diagnosis, and care. Methods This cross-sectional survey engaged 6123 participants in Saudi Arabia, utilizing a multistage sampling design across provinces and cities. The study aimed to investigate the knowledge, attitudes, and practices of the Saudi Arabian general population regarding dementia. Results Participants displayed diverse opinions on dementia knowledge, with females exhibiting higher rates of knowledge, attitudes, and practices than males. Notably, 97.2% of females were aware of dementia compared to 78% of males. The perception of dementia as a healthcare priority was significantly higher in females (84.1%) than in males (59.6%). Older females (≥65) were identified as the age group most associated with dementia (92.50%) compared to males (71.10%). Conclusion While participants demonstrated excellent knowledge of hearing about dementia, understanding symptoms, and identifying modifiable factors, their knowledge regarding prevention and curability was found to be inadequate. A significant gender association was observed, with females exhibiting higher knowledge, attitudes, and practices than males.
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Affiliation(s)
- Rofayda M Mohamad
- Department of Preventive Medicine, King Salman Armed Forces Hospital in Northwestern Region, Tabuk, SAU
| | | | - Abdulrahman H Merdad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Deemah M Alghaith
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Aldharman SS, Alayed FT, Aljohani BS, Aladwani AM, Alyousef MA, Hakami KM, Albalawi DM, Alnaaim SA. An Assessment of Dementia Knowledge and Its Associated Factors Among Health College Students in Saudi Arabia. Cureus 2023; 15:e34578. [PMID: 36874297 PMCID: PMC9981551 DOI: 10.7759/cureus.34578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Background Dementia is a public health concern and the main cause of impairment and dependency among the elderly worldwide. It is characterized by a progressive decline in cognition, memory, and all domains of quality of life with preserving the level of consciousness. Accurate measurement of dementia knowledge among future health professionals is required to improve targeted educational initiatives and supportive care of patients. This study aimed to assess knowledge of dementia and its associated factors among health college students in Saudi Arabia. Methods A descriptive, cross-sectional study was conducted among health college students from various regions in Saudi Arabia. Data on sociodemographic characteristics and dementia knowledge were gathered using a standardized study questionnaire Dementia Knowledge Assessment Scale (DKAS) distributed on different social media platforms. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA) statistical software. A P-value of <0.05 was considered significant. Results A total of 1,613 participants were included in the study. The mean age was 20.5 ± 2.5 years (range 18-25 years). The majority of them were males (64.9%), and females represented 35.1%. The mean knowledge score of the participants was 13.68 ± 3.18 (out of 25). According to DKAS subscales, we found that the respondents scored the highest in care considerations (4.17 ± 1.30) and the lowest in risks and health promotion (2.89 ± 1.96). Furthermore, we found that the participants with no previous dementia exposure had a significantly higher level of knowledge than those with previous dementia exposure. In addition, we found that both genders, aged 19, 21, 22, 23, 24, and 25 years; the geographic distribution of respondents; and previous dementia exposure significantly affected the DKAS score. Conclusions Our findings showed that health college students in Saudi Arabia had poor knowledge about dementia. Ongoing health education and comprehensive academic training are recommended to improve their knowledge and provide competent care for dementia patients.
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Affiliation(s)
- Sarah S Aldharman
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal T Alayed
- College of Medicine, Al-Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
| | - Badr S Aljohani
- Department of Medicine, Alrayan Medical College, Madinah, SAU
| | | | - Meshal A Alyousef
- College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | | | - Saud A Alnaaim
- Department of Neurology, King Faisal University, Al-Ahsa, SAU
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Fan J, Bai J, Liu W, Cai J. Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP randomized controlled trial. Front Neurol 2023; 14:1042637. [PMID: 36816574 PMCID: PMC9930906 DOI: 10.3389/fneur.2023.1042637] [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: 09/12/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
Background The STEP (Strategy of Blood Pressure Intervention in the older Hypertensive Patients) trial showed that intensive systolic blood pressure (SBP) control resulted in a lower incidence of cardiovascular events than standard treatment. This study analyzed the effects of intensive SBP lowering on cognitive function. Methods STEP was a multicenter, randomized controlled trial of hypertensive patients aged 60-80 years. Participants were randomly assigned (1:1) to SBP goals of 110-130 mmHg (intensive treatment) or 130-150 mmHg (standard treatment). Each individual was asked to complete a cognitive function test (Mini-Mental State Examination; MMSE) at baseline and during follow-up. The primary outcome for this study was the annual change in MMSE score. Subjects with a score less than education-specific cutoff point were categorized as cognitive decline. Results The analysis enrolled 6,501 participants (3,270 participants in the intensive-treatment and 3,231 participants in the standard-treatment groups). Median follow-up was 3.34 years. There was a minor change in MMSE score, with an annual change of -0.001 [95% confidence interval [CI] -0.020, 0.018] and 0.030 (95% CI 0.011, 0.049) in the intensive- and standard-treatment groups, respectively (p = 0.052). Cognitive decline occurred in 46/3,270 patients (1.4%) in the intensive-treatment group and 42/3,231 (1.3%) in the standard-treatment group (hazard ratio 0.005, 95% CI 0.654, 1.543, p = 0.983). Conclusions Compared with standard treatment, intensive SBP treatment did not result in a significant change in cognitive function test score. The impact of intensive blood pressure lowering was not evident using this global cognitive function test. Trial registration ClinicalTrials.gov. Unique identifier: NCT03015311.
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Affiliation(s)
- Jiali Fan
- Department of Hypertension, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jingjing Bai
- Department of Hypertension, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Liu
- Department of Cardiology, Beijing Jishuitan Hospital, Peking University Fourth Hospital, Beijing, China,Wei Liu ✉
| | - Jun Cai
- Department of Hypertension, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,*Correspondence: Jun Cai ✉
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Yang Y, Liu S, Gan J, Zhu H, Du X, Chen Z, Ma L, Meng Q, Yang F, Chen H, Ji Y. Association between hemoglobin level and cognitive profile in old adults: A cross-sectional survey. Int J Geriatr Psychiatry 2022; 37. [PMID: 36040716 DOI: 10.1002/gps.5806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In the present study, the association between Hemoglobin (HGB) level and cognitive profile was investigated and whether it affected the dementia risk in older adults. METHODS A cross-sectional population-based survey that included 3519 individuals ≥65 years of age was conducted in 2019. Basic demographic characteristics were collected. The neuropsychological assessments and blood tests were administered to evaluate cognition and HGB level. Generalized additive models were used to analyze the non-linear association between HGB levels and cognitive function. Logistics regression models were utilized to analyze the associations between HGB level and dementia risk. RESULTS Overall, 459 (12.7%) participants were diagnosed with dementia and there were more females (54.7%) than males (45.3%). The number of subjects with anemia (3%) or hyperhemoglobinemia (5.2%) was higher than participants with normal HGB level. A visual representation of the relationship between HGB level and Mini-Mental State Examination (MMSE) score showed an inverted U-curve, which is more evident in female. Logistics regression models showed that anemia (odds ratio, OR = 1.826, 95% confidence interval, CI: 1.166-2.860, p < 0.01), but not hyperhemoglobinemia, significantly increased the risk of dementia. These trends were not the same for males and females. An abnormal HGB level had greater effects in females, resulting in higher risk of dementia for females with anemia or hyperhemoglobinemia than subjects with normal HGB level including males. CONCLUSION Both low and high HGB levels can lead to cognitive decline in the incidence of dementia, indicating an inverted U-shaped curve association may exist between HGB level and global cognitive profile.
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Affiliation(s)
- Yaqi Yang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Han Zhu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Xiaoshan Du
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Zhichao Chen
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lingyun Ma
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Qingbo Meng
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Fan Yang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Hui Chen
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
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Knowledge, attitudes, and practice of general practitioners toward community detection and management of mild cognitive impairment: a cross-sectional study in Shanghai, China. BMC PRIMARY CARE 2022; 23:114. [PMID: 35545764 PMCID: PMC9092880 DOI: 10.1186/s12875-022-01716-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/21/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China. METHODS An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and practice was tested using the PROCESS model 4 macro with 5000 bootstrap samples through linear regression modelling. RESULTS A total of 1253 GPs completed the questionnaire, with an average score of 54.51 ± 18.18, 57.31 ± 7.43, and 50.05 ± 19.80 for knowledge, attitudes, and practice, respectively. More than 12% of respondents scored zero in knowledge, 28.4% tended not to consider MCI as a disease, and 19.1% completely rejected MCI screening. Higher levels of knowledge were associated with more favourable attitudes toward community management of MCI (AOR = 1.974, p < 0.001). Higher compliance with practice guidelines was associated with both higher levels of knowledge (AOR = 1.426, p < 0.01) and more favourable attitudes (AOR = 2.095, p < 0.001). The association between knowledge and practice was partially mediated by attitudes (p < 0.001). Training was associated with higher levels of knowledge (AOR = 1.553, p < 0.01), while past experience in MCI management was associated with more favourable attitudes (AOR = 1.582, p < 0.05) and higher compliance with practice guidelines (AOR = 3.034, p < 0.001). MCI screening qualification was associated with higher compliance with practice guidelines (AOR = 2.162, p < 0.05), but less favourable attitudes (AOR = 0.452, p < 0.05). CONCLUSION The MCI knowledge of GPs in Shanghai is low, and is associated with less favourable attitudes toward MCI management and low compliance with practice guidelines. Attitudes mediate the association between knowledge and practice. Training is a significant predictor of knowledge. Further studies are needed to better understand how the attitudes of GPs in Shanghai are shaped by the environments in which they live and work.
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Braley MS, Thornton AE, Loken Thornton W. Anxiety symptoms and theory of mind in older and younger adults: curvilinearity moderated by age group. Aging Ment Health 2022; 27:829-837. [PMID: 35475407 DOI: 10.1080/13607863.2022.2060183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Theory of mind (ToM), the ability to reason about mental states, declines in later life. While anxiety symptoms may predict ToM abilities, the nature of associations requires more elucidation. Further, it is unknown whether age group moderates associational patterns. We examined associations between anxiety symptoms (linear and curvilinear) and cognitive ToM (C-ToM) and affective ToM (A-ToM); and moderation by age group (older vs. younger adults). METHODS In a sample of healthy younger (n = 90, Mage = 20.17 years) and older adults (n = 87, Mage = 71.52), we used hierarchical regressions with polynomial and interaction terms to assess the association between anxiety symptoms and ToM in younger and older adults. RESULTS Anxiety symptoms were associated with C-ToM but not A-ToM. Age group interacted linearly with anxiety (β = -1.64, p = .02), and with anxiety's quadratic polynomial (β = .84, p = .04). The inverted-U shaped association in younger adults (highest C-ToM at moderate anxiety) contrasted with older adults' linear decline in C-ToM with increasing anxiety. CONCLUSION We highlight the importance of anxiety symptoms for predicting ToM, and clarify that associations vary by age. Elucidating associations may be critical to developing interventions that improve social wellbeing.
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Affiliation(s)
- McKenzie S Braley
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
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Bouwman FH, Frisoni GB, Johnson SC, Chen X, Engelborghs S, Ikeuchi T, Paquet C, Ritchie C, Bozeat S, Quevenco F, Teunissen C. Clinical application of CSF biomarkers for Alzheimer's disease: From rationale to ratios. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12314. [PMID: 35496374 PMCID: PMC9044123 DOI: 10.1002/dad2.12314] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Femke H. Bouwman
- Alzheimer Center Amsterdam Amsterdam Neuroscience Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | | | - Sterling C. Johnson
- University of Wisconsin‐Madison, and Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
| | | | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N) Vrije Universiteit Brussel, and Department of Neurology/Brussels Integrated Center for Brain and Memory (Bru‐BRAIN) Universitair Ziekenhuis Brussel, Brussels, and Department of Biomedical Sciences University of Antwerp Antwerp Belgium
| | | | - Claire Paquet
- Université de Paris Cognitive Neurology Center Lariboisière Hospital GHU APHP Nord INSERMU1144 Paris France
| | - Craig Ritchie
- University of Edinburgh, and Brain Health Scotland Edinburgh UK
| | | | | | - Charlotte Teunissen
- Department of Clinical Chemistry Neurochemistry Laboratory Amsterdam Neuroscience Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
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Spargo C, Laver K, Adey-Wakeling Z, Berndt A, George S. Mild cognitive impairment and fitness to drive: An audit of practice in a driving specialist clinic in Australia. Australas J Ageing 2021; 41:282-292. [PMID: 34939739 DOI: 10.1111/ajag.13024] [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: 03/26/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe current practice and outcomes relating to fitness to drive for people with mild cognitive impairment (MCI) attending a specialist driving clinic. METHODS Retrospective medical record audit from a driving fitness assessment clinic at a tertiary medical centre, South Australia, from 2015 to 2019. RESULTS Of 100 notes audited, n = 40 had a documented diagnosis of MCI and n = 60 had subjective cognitive concerns characteristic of MCI. Participants mean age was 80.0 years (SD 6.7), and mean Mini-Mental State Examination score was 26.1 (SD 2.1). Medical practitioners completed a comprehensive initial assessment relating to medical fitness to drive, considering scores from a cognitive assessment battery and non-cognitive factors (driving history, current driving needs, vision, physical abilities and collateral from family). After the initial assessment, most participants (84%) were referred for a practical on-road assessment, before receiving a final driving recommendation. Over half of participants continued driving (51%), most with conditions, while 35% ceased driving. Outcomes for the remaining 14% are unknown as we were unable to determine whether the practical assessment (11%) or lessons (3%) were completed. CONCLUSIONS Driving outcomes for people with MCI with questionable driving capabilities are variable, with both cognitive and non-cognitive factors important in guiding medical fitness to drive recommendations. There is a need for more driving clinics to provide in-depth assessment for people with MCI who demonstrate uncertain driving capabilities and improved support for decision-making in other non-driving specialist settings.
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Affiliation(s)
- Claire Spargo
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Zoe Adey-Wakeling
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Flinders Medical Centre, Rehabilitation Aged and Palliative Care, Adelaide, South Australia, Australia
| | - Angela Berndt
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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11
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Fogel H, Levy-Lamdan O, Zifman N, Hiller T, Efrati S, Suzin G, Hack DC, Dolev I, Tanne D. Brain Network Integrity Changes in Subjective Cognitive Decline: A Possible Physiological Biomarker of Dementia. Front Neurol 2021; 12:699014. [PMID: 34526957 PMCID: PMC8435601 DOI: 10.3389/fneur.2021.699014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The current study seeks to illustrate potential early and objective neurophysiological biomarkers of neurodegenerative cognitive decline by evaluating features of brain network physiological performance and structure utilizing different modalities. Methods: This study included 17 clinically healthy individuals with self-reported cognitive decline (Subjective Cognitive Decline group, SCD, no objective finding of cognitive decline), 12 individuals diagnosed with amnestic Mild Cognitive Impairment (aMCI), 11 individuals diagnosed with Dementia, and 15 healthy subjects. All subjects underwent computerized cognitive performance testing, MRI scans including T1 for gray matter (GM) volume quantification, DTI for quantification of white matter (WM) microstructure fractional anisotropy (FA) and mean diffusivity (MD), and brain network function evaluation using DELPHI (TMS-EEG) measures of connectivity, excitability, and plasticity. Results: Both DELPHI analysis of network function and DTI analysis detected a significant decrease in connectivity, excitability, and WM integrity in the SCD group compared to healthy control (HC) subjects; a significant decrease was also noted for aMCI and Dementia groups compared to HC. In contrast, no significant decrease was observed in GM volume in the SCD group compared to healthy norms, a significant GM volume decrease was observed only in objectively cognitively impaired aMCI subjects and in dementia subjects. Conclusions: This study results suggest that objective direct measures of brain network physiology and WM integrity may provide early-stage biomarkers of neurodegenerative-related changes in subjects that have not yet displayed any other objective measurable cognitive or GM volume deficits which may facilitate early preventive care for neurodegenerative decline and dementia.
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Affiliation(s)
| | | | - Noa Zifman
- QuantalX Neuroscience, Beer-Yaacov, Israel
| | - Tal Hiller
- QuantalX Neuroscience, Beer-Yaacov, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Suzin
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
| | - Dallas C Hack
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | | | - David Tanne
- Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Stroke and Cognition Institute, Rambam Healthcare Campus, Haifa, Israel
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12
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Shotgun-based proteomics of extracellular vesicles in Alzheimer's disease reveals biomarkers involved in immunological and coagulation pathways. Sci Rep 2021; 11:18518. [PMID: 34531462 PMCID: PMC8445922 DOI: 10.1038/s41598-021-97969-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia and without readily available clinical biomarkers. Blood-derived proteins are routinely used for diagnostics; however, comprehensive plasma profiling is challenging due to the dynamic range in protein concentrations. Extracellular vesicles (EVs) can cross the blood-brain barrier and may provide a source for AD biomarkers. We investigated plasma-derived EV proteins for AD biomarkers from 10 AD patients, 10 Mild Cognitive Impairment (MCI) patients, and 9 healthy controls (Con) using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The ultracentrifuged EVs were washed and confirmed according to the MISEV2018 guidelines. Some AD patients presented with highly elevated FXIIIA1 (log2 FC: 4.6, p-value: 0.005) and FXIIIB (log2 FC: 4.9, p-value: 0.018). A panel of proteins was identified discriminating Con from AD (AUC: 0.91, CI: 0.67-1.00) with ORM2 (AUC: 1.00, CI: 1.00-1.00), RBP4 (AUC: 0.99, CI: 0.95-1.00), and HYDIN (AUC: 0.89, CI: 0.72-1.00) were found especially relevant for AD. This indicates that EVs provide an easily accessible matrix for possible AD biomarkers. Some of the MCI patients, with similar protein profiles as the AD group, progressed to AD within a 2-year timespan.
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Verma RK, Pandey M, Chawla P, Choudhury H, Mayuren J, Bhattamisra SK, Gorain B, Raja MAG, Amjad MW, Obaidur Rahman S. An insight into the role of Artificial Intelligence in the early diagnosis of Alzheimer's disease. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:901-912. [PMID: 33982657 DOI: 10.2174/1871527320666210512014505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The complication of Alzheimer's disease (AD) has made the development of its therapeutic a challenging task. Even after decades of research, we have achieved no more than a few years of symptomatic relief. The inability to diagnose the disease early is the foremost hurdle behind its treatment. Several studies have aimed to identify potential biomarkers that can be detected in body fluids (CSF, blood, urine, etc) or assessed by neuroimaging (i.e., PET and MRI). However, the clinical implementation of these biomarkers is incomplete as they cannot be validated. METHOD To overcome the limitation, the use of artificial intelligence along with technical tools has been extensively investigated for AD diagnosis. For developing a promising artificial intelligence strategy that can diagnose AD early, it is critical to supervise neuropsychological outcomes and imaging-based readouts with a proper clinical review. CONCLUSION Profound knowledge, a large data pool, and detailed investigations are required for the successful implementation of this tool. This review will enlighten various aspects of early diagnosis of AD using artificial intelligence.
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Affiliation(s)
- Rohit Kumar Verma
- International Medical University Department of Pharmacy Practice, School of Pharmacy, Malaysia
| | - Manisha Pandey
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University-Bukit Jalil 57000, Kuala Lumpur, Malaysia School of Pharmacy,, Malaysia
| | - Pooja Chawla
- ISF College of Pharmacy, Moga Pharmaceutical Chemistry, India
| | - Hira Choudhury
- International Medical University Pharmaceutical Technology, Malaysia
| | - Jayashree Mayuren
- School of Pharmacy, International Medical University Department of Pharmaceutical Technology,, Malaysia
| | | | - Bapi Gorain
- Lincoln University College Faculty of Pharmacy, Malaysia
| | | | | | - Syed Obaidur Rahman
- Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Humdard, New Delhi India Pharmacology, India
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Ellegaard Nielsen J, Sofie Pedersen K, Vestergård K, Georgiana Maltesen R, Christiansen G, Lundbye-Christensen S, Moos T, Risom Kristensen S, Pedersen S. Novel Blood-Derived Extracellular Vesicle-Based Biomarkers in Alzheimer's Disease Identified by Proximity Extension Assay. Biomedicines 2020; 8:E199. [PMID: 32645971 PMCID: PMC7400538 DOI: 10.3390/biomedicines8070199] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 12/14/2022] Open
Abstract
Easily accessible biomarkers for Alzheimer's dementia (AD) are lacking and established clinical markers are limited in applicability. Blood is a common biofluid for biomarker discoveries, and extracellular vesicles (EVs) may provide a matrix for exploring AD related biomarkers. Thus, we investigated proteins related to neurological and inflammatory processes in plasma and EVs. By proximity extension assay (PEA), 182 proteins were measured in plasma and EVs from patients with AD (n = 10), Mild Cognitive Impairment (MCI, n = 10), and healthy controls (n = 10). Plasma-derived EVs were enriched by 20,000× g, 1 h, 4 °C, and confirmed using nanoparticle tracking analysis (NTA), western blotting, and transmission electron microscopy with immunolabelling (IEM). Presence of CD9+ EVs was confirmed by western blotting and IEM. No group differences in particle concentration or size were detected by NTA. However, significant protein profiles were observed among subjects, particularly for EVs. Several proteins and their ratios could distinguish cognitively affected from healthy individuals. For plasma TGF-α│CCL20 (AUC = 0.96, 95% CI = 0.88-1.00, p = 0.001) and EVs CLEC1B│CCL11 (AUC = 0.95, 95% CI = 0.86-1.00, p = 0.001) showed diagnostic capabilities. Using PEA, we identified protein profiles capable of distinguishing healthy controls from AD patients. EVs provided additional biological information related to AD not observed in plasma alone.
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Affiliation(s)
- Jonas Ellegaard Nielsen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Department of Clinical Biochemistry, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | | | - Karsten Vestergård
- Department of Neurology, Aalborg University Hospital, DK-9000 Aalborg, Denmark;
| | - Raluca Georgiana Maltesen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, DK-9000 Aalborg, Denmark;
| | - Gunna Christiansen
- Department of Biomedicine, Aarhus University, DK-8000 Aarhus, Denmark;
- Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark;
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Unit of Clinical Biostatistics, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Torben Moos
- Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark;
| | - Søren Risom Kristensen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Department of Clinical Biochemistry, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Shona Pedersen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Department of Clinical Biochemistry, Aalborg University Hospital, DK-9000 Aalborg, Denmark
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Wimo A, Handels R, Winblad B, Black CM, Johansson G, Salomonsson S, Eriksdotter M, Khandker RK. Quantifying and Describing the Natural History and Costs of Alzheimer's Disease and Effects of Hypothetical Interventions. J Alzheimers Dis 2020; 75:891-902. [PMID: 32390617 PMCID: PMC7369101 DOI: 10.3233/jad-191055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: A long-term horizon is necessary when the socioeconomic consequences and the potential effects of interventions in Alzheimer’s disease (AD) are estimated. Objectives: To illustrate the potential societal costs of AD across the disease continuum and to illustrate the potential cost-effectiveness of a hypothetical intervention with disease modifying treatment (DMT). Methods: Based on the Swedish dementia registry, a Markov model was used to simulate a virtual cohort of 100,000 people with mild cognitive impairment (MCI) due to AD (AD-MCI) in Sweden for 40 years starting at the age of 60. A simulated hypothetical intervention assumed a 25% reduction in progression rate during AD-MCI and mild AD-dementia. A comprehensive set of sensitivity analyses was included. Results: The cumulative risk to develop dementia was 96%. The mean simulated survival was 19.0 years. The net present value for a person year with dementia was 252,843 SEK (about 29,500 US$). The cost effectiveness model illustrated how the hypothetical scenario of a 25% reduction in progression to AD-dementia would require 41 AD-MCI patients to be treated to prevent one case of AD-dementia (2,447 avoided AD-dementia cases of 100,000 with AD-MCI). Most scenarios illustrated hypothetical cost effectiveness (based on a willingness to pay level of 600,000 SEK (70,000 US$) per gained QALY), but not cost savings. Discussion: Lifetime societal costs of AD are substantial. A future DMT may be potentially cost-effective given assumed treatment effects and costs, but cost savings are unlikely.
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Affiliation(s)
- Anders Wimo
- Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Neurogeriatrics, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Ron Handels
- Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Neurogeriatrics, Stockholm, Sweden.,Department of Psychiatry and Neuropsychology, Maastricht University, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht, Netherlands
| | - Bengt Winblad
- Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Neurogeriatrics, Stockholm, Sweden
| | - Christopher M Black
- Merck & Co., Inc., Center for Observational and Real World Evidence (CORE), Kenilworth, NJ, USA
| | - Gunilla Johansson
- Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Neurogeriatrics, Stockholm, Sweden
| | - Stina Salomonsson
- Merck Sharp and Dohme, Center for Observational and Real World Evidence (CORE), Stockholm, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Karolinska Institutet, Care Sciences and Society, Division of Clinical Geriatrics, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Rezaul K Khandker
- Merck & Co., Inc., Center for Observational and Real World Evidence (CORE), Kenilworth, NJ, USA
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16
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Zhuang L, Yang Y, Gao J. Cognitive assessment tools for mild cognitive impairment screening. J Neurol 2019; 268:1615-1622. [PMID: 31414193 DOI: 10.1007/s00415-019-09506-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/07/2019] [Accepted: 08/10/2019] [Indexed: 12/31/2022]
Abstract
Mild cognitive impairment (MCI) is a clinical condition with a high risk of progression to dementia. Due to lack of effective disease-modifying therapies for advanced dementia, diagnosis and disease intervention at an early stage, particularly at MCI stage, has been widely accepted as a critical strategy in disease management that could potentially affect long-term outcome. However, there is currently no consensus on guidelines for routine screening of MCI, resulting in a considerable number of patients with undiagnosed MCI from community. In addition, the use of different screening guidelines leads to difficulties in comparing different studies. A variety of screening tools have been utilized; however, the sensitivity and specificity vary greatly among these tools. By summarizing the sensitivity, specificity and time efficiency for common MCI screening tools, which are key factors to be taken into consideration when making selections and combinations of screening tools, this review suggests the use of a combination of two self-administered highly sensitive tools, p-AD8 + IQCODE (informant questionnaire on cognitive decline in the elderly individuals) in initial screening, as well as a combination of two highly specific widely covered tools, DemTect + MoCA (Montreal cognitive assessment) or memory and executive screening (MES) + MoCA in secondary screening. In addition, this review also proposes a screening flowchart for MCI, aiming to build a sensitive and time efficient way for recruiting subjects for subsequent investigation and disease differentiation.
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Affiliation(s)
- Lei Zhuang
- Department of Neurology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Yang
- Department of Nursing, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianqun Gao
- Brain and Mind Centre, Central Clinical School, the University of Sydney, Sydney, Australia.
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Physician Perceptions about the Barriers to Prompt Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease. Int J Alzheimers Dis 2019; 2019:3637954. [PMID: 31263595 PMCID: PMC6556253 DOI: 10.1155/2019/3637954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/12/2019] [Accepted: 04/04/2019] [Indexed: 11/17/2022] Open
Abstract
Prior studies have identified numerous barriers to the prompt diagnosis of patients with suspected Alzheimer's disease (AD). The aim of the study was to evaluate physician's perceptions of the importance of previously identified barriers to diagnosis, but with a specific focus on the presentation of mild cognitive impairment (MCI), which may be indicative of neurodegenerative disorders such as AD. A second aim was to evaluate how the perspective of primary care physicians (PCPs) may differ from that of specialists. A cross-sectional online survey of PCPs and specialists who routinely manage patients with complaints of age-related cognitive impairment was conducted. Participants were asked to identify barriers to prompt diagnosis from prespecified lists of known diagnostic challenges categorized into 4 domains: patient-related, physician-related, setting-related, and those relating to the clinical profile of AD. Physicians report a range of barriers when attempting to diagnose MCI and AD. Major themes included patients seeing cognitive decline as a normal part of aging and not disclosing symptoms, long waiting lists, and a lack of treatment options and definitive biomarker tests. Generally, PCPs and specialists showed broad agreement; however, PCPs were more likely to identify burdens on the healthcare system, such as long waiting lists and inadequate time to evaluate patients. Substantial barriers continue to hinder early diagnosis of MCI and AD. There are numerous areas where improvements might be made but the implementation of potential interventions will likely be associated with financial strain for many healthcare systems.
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