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Kang M, Li C, Mahajan A, Spat-Lemus J, Durape S, Chen J, Gurnani AS, Devine S, Auerbach SH, Ang TFA, Sherva R, Qiu WQ, Lunetta KL, Au R, Farrer LA, Mez J. Subjective Cognitive Decline Plus and Longitudinal Assessment and Risk for Cognitive Impairment. JAMA Psychiatry 2024:2820771. [PMID: 38959008 PMCID: PMC11223054 DOI: 10.1001/jamapsychiatry.2024.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/17/2024] [Indexed: 07/04/2024]
Abstract
Importance Subjective cognitive decline (SCD) is recognized to be in the Alzheimer disease (AD) cognitive continuum. The SCD Initiative International Working Group recently proposed SCD-plus (SCD+) features that increase risk for future objective cognitive decline but that have not been assessed in a large community-based setting. Objective To assess SCD risk for mild cognitive impairment (MCI), AD, and all-cause dementia, using SCD+ criteria among cognitively normal adults. Design, Setting, and Participants The Framingham Heart Study, a community-based prospective cohort study, assessed SCD between 2005 and 2019, with up to 12 years of follow-up. Participants 60 years and older with normal cognition at analytic baseline were included. Cox proportional hazards (CPH) models were adjusted for baseline age, sex, education, APOE ε4 status, and tertiles of AD polygenic risk score (PRS), excluding the APOE region. Data were analyzed from May 2021 to November 2023. Exposure SCD was assessed longitudinally using a single question and considered present if endorsed at the last cognitively normal visit. It was treated as a time-varying variable, beginning at the first of consecutive, cognitively normal visits, including the last, at which it was endorsed. Main Outcomes and Measures Consensus-diagnosed MCI, AD, and all-cause dementia. Results This study included 3585 participants (mean [SD] baseline age, 68.0 [7.7] years; 1975 female [55.1%]). A total of 1596 participants (44.5%) had SCD, and 770 (21.5%) were carriers of APOE ε4. APOE ε4 and tertiles of AD PRS status did not significantly differ between the SCD and non-SCD groups. MCI, AD, and all-cause dementia were diagnosed in 236 participants (6.6%), 73 participants (2.0%), and 89 participants (2.5%), respectively, during follow-up. On average, SCD preceded MCI by 4.4 years, AD by 6.8 years, and all-cause dementia by 6.9 years. SCD was significantly associated with survival time to MCI (hazard ratio [HR], 1.57; 95% CI, 1.22-2.03; P <.001), AD (HR, 2.98; 95% CI, 1.89-4.70; P <.001), and all-cause dementia (HR, 2.14; 95% CI, 1.44-3.18; P <.001). After adjustment for APOE and AD PRS, the hazards of SCD were largely unchanged. Conclusions and Relevance Results of this cohort study suggest that in a community setting, SCD reflecting SCD+ features was associated with an increased risk of future MCI, AD, and all-cause dementia with similar hazards estimated in clinic-based settings. SCD may be an independent risk factor for AD and other dementias beyond the risk incurred by APOE ε4 and AD PRS.
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Affiliation(s)
- Moonil Kang
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Clara Li
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arnav Mahajan
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jessica Spat-Lemus
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychology, Montclair State University, Montclair, New Jersey
| | - Shruti Durape
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Jiachen Chen
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Ashita S. Gurnani
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Sherral Devine
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Sanford H. Auerbach
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ting Fang Alvin Ang
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Richard Sherva
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Wei Qiao Qiu
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Pharmacology & Experimental Therapeutics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Kathryn L. Lunetta
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Rhoda Au
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lindsay A. Farrer
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Ophthalmology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Jesse Mez
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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2
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Neale ZE, Fonda JR, Miller MW, Wolf EJ, Zhang R, Sherva R, Harrington KM, Merritt V, Panizzon MS, Hauger RL, Gaziano JM, Logue MW. Subjective cognitive concerns, APOE ε4, PTSD symptoms, and risk for dementia among older veterans. Alzheimers Res Ther 2024; 16:143. [PMID: 38951900 PMCID: PMC11218206 DOI: 10.1186/s13195-024-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with self-reported problems with cognition as well as risk for Alzheimer's disease and related dementias (ADRD). Overlapping symptom profiles observed in cognitive disorders, psychiatric disorders, and environmental exposures (e.g., head injury) can complicate the detection of early signs of ADRD. The interplay between PTSD, head injury, subjective (self-reported) cognitive concerns and genetic risk for ADRD is also not well understood, particularly in diverse ancestry groups. METHODS Using data from the U.S. Department of Veterans Affairs (VA) Million Veteran Program (MVP), we examined the relationship between dementia risk factors (APOE ε4, PTSD, TBI) and subjective cognitive concerns (SCC) measured in individuals of European (n = 140,921), African (n = 15,788), and Hispanic (n = 8,064) ancestry (EA, AA, and HA, respectively). We then used data from the VA electronic medical record to perform a retrospective survival analysis evaluating PTSD, TBI, APOE ε4, and SCC and their associations with risk of conversion to ADRD in Veterans aged 65 and older. RESULTS PTSD symptoms (B = 0.50-0.52, p < 1E-250) and probable TBI (B = 0.05-0.19, p = 1.51E-07 - 0.002) were positively associated with SCC across all three ancestry groups. APOE ε4 was associated with greater SCC in EA Veterans aged 65 and older (B = 0.037, p = 1.88E-12). Results of Cox models indicated that PTSD symptoms (hazard ratio [HR] = 1.13-1.21), APOE ε4 (HR = 1.73-2.05) and SCC (HR = 1.18-1.37) were positively associated with risk for ADRD across all three ancestry groups. In the EA group, probable TBI also contributed to increased risk of ADRD (HR = 1.18). CONCLUSIONS The findings underscore the value of SCC as an indicator of ADRD risk in Veterans 65 and older when considered in conjunction with other influential genetic, clinical, and demographic risk factors.
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Affiliation(s)
- Zoe E Neale
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Institute for Genomics in Health (IGH), SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jennifer R Fonda
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
| | - Erika J Wolf
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
| | - Rui Zhang
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
| | - Richard Sherva
- Biomedical Genetics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
| | - Kelly M Harrington
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
| | - Victoria Merritt
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - Matthew S Panizzon
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Richard L Hauger
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - J Michael Gaziano
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark W Logue
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA.
- Biomedical Genetics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA.
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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Rohn TT, Radin D, Brandmeyer T, Seidler PG, Linder BJ, Lytle T, Mee JL, Macciardi F. Intranasal delivery of shRNA to knockdown the 5HT-2A receptor enhances memory and alleviates anxiety. Transl Psychiatry 2024; 14:154. [PMID: 38509093 PMCID: PMC10954635 DOI: 10.1038/s41398-024-02879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Short-hairpin RNAs (shRNA), targeting knockdown of specific genes, hold enormous promise for precision-based therapeutics to treat numerous neurodegenerative disorders. However, whether shRNA constructed molecules can modify neuronal circuits underlying certain behaviors has not been explored. We designed shRNA to knockdown the human HTR2A gene in vitro using iPSC-differentiated neurons. Multi-electrode array (MEA) results showed that the knockdown of the 5HT-2A mRNA and receptor protein led to a decrease in spontaneous electrical activity. In vivo, intranasal delivery of AAV9 vectors containing shRNA resulted in a decrease in anxiety-like behavior in mice and a significant improvement in memory in both mice (104%) and rats (92%) compared to vehicle-treated animals. Our demonstration of a non-invasive shRNA delivery platform that can bypass the blood-brain barrier has broad implications for treating numerous neurological mental disorders. Specifically, targeting the HTR2A gene presents a novel therapeutic approach for treating chronic anxiety and age-related cognitive decline.
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Affiliation(s)
- Troy T Rohn
- Department of Biological Sciences, Boise State University, Boise, ID, USA.
- Cognigenics Inc., 1372 S. Eagle Road, Suite 197, Eagle, ID, USA.
| | - Dean Radin
- Cognigenics Inc., 1372 S. Eagle Road, Suite 197, Eagle, ID, USA
| | | | - Peter G Seidler
- Cognigenics Inc., 1372 S. Eagle Road, Suite 197, Eagle, ID, USA
| | - Barry J Linder
- Cognigenics Inc., 1372 S. Eagle Road, Suite 197, Eagle, ID, USA
| | - Tom Lytle
- Cognigenics Inc., 1372 S. Eagle Road, Suite 197, Eagle, ID, USA
| | - John L Mee
- Cognigenics Inc., 1372 S. Eagle Road, Suite 197, Eagle, ID, USA
| | - Fabio Macciardi
- Cognigenics Inc., 1372 S. Eagle Road, Suite 197, Eagle, ID, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
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4
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Wu Y, Wang X, Fang Y. Predicting mild cognitive impairment in older adults: A machine learning analysis of the Alzheimer's Disease Neuroimaging Initiative. Geriatr Gerontol Int 2024; 24 Suppl 1:96-101. [PMID: 37734954 DOI: 10.1111/ggi.14670] [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: 07/13/2023] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
AIM Mild cognitive impairment (MCI) in older adults is potentially devastating, but an accurate prediction model is still lacking. We hypothesized that neuropsychological tests and MRI-related markers could predict the onset of MCI early. METHODS We analyzed data from 306 older adults who were cognitive normal (CN) attending the Alzheimer's Disease Neuroimaging Initiative sequentially (474 pairs of visits) within 3 years. There were 231 pairs of MCI conversion (CN to MCI), and 242 pairs of CN maintenance (CN to CN). Variables on demographic, neuropsychological tests, genetic, and MRI-related markers were collected. Machine learning was used to construct MCI prediction models, comparing the area under the receiver operating characteristic curve (AUC) as the primary metric of performance. Important predictors were ranked for the optimal model. RESULTS The baseline age of the study sample was 74.8 years old. The best-performing model (gradient boosting decision tree) with 13 variables predicted MCI with an AUC of 0.819, and the rank of variable importance showed that intracranial volume, hippocampal volume, and score from task 4 (word recognition) of the Alzheimer's Disease Assessment Scale were important predictors of MCI. CONCLUSIONS With the help of machine learning, fewer neuropsychological tests and MRI-related markers are required to accurately predict MCI within 3 years, thereby facilitating targeted intervention. Geriatr Gerontol Int 2024; 24: 96-101.
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Affiliation(s)
- Yafei Wu
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen, China
| | - Xing Wang
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen, China
| | - Ya Fang
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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5
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Vipin A, Lee BTK, Kumar D, Soo SA, Leow YJ, Ghildiyal S, Lee FPHE, Hilal S, Kandiah N. The role of perfusion, grey matter volume and behavioural phenotypes in the data-driven classification of cognitive syndromes. Alzheimers Res Ther 2024; 16:40. [PMID: 38368378 PMCID: PMC10874041 DOI: 10.1186/s13195-024-01410-1] [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: 07/23/2023] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The use of structural and perfusion brain imaging in combination with behavioural information in the prediction of cognitive syndromes using a data-driven approach remains to be explored. Here, we thus examined the contribution of brain structural and perfusion imaging and behavioural features to the existing classification of cognitive syndromes using a data-driven approach. METHODS Study participants belonged to the community-based Biomarker and Cognition Cohort Study in Singapore who underwent neuropsychological assessments, structural-functional MRI and blood biomarkers. Participants had a diagnosis of cognitively normal (CN), subjective cognitive impairment (SCI), mild cognitive impairment (MCI) and dementia. Cross-sectional structural and cerebral perfusion imaging, behavioural scale data including mild behaviour impairment checklist, Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress scale data were obtained. RESULTS Three hundred seventy-three participants (mean age 60.7 years; 56% female sex) with complete data were included. Principal component analyses demonstrated that no single modality was informative for the classification of cognitive syndromes. However, multivariate glmnet analyses revealed a specific combination of frontal perfusion and temporo-frontal grey matter volume were key protective factors while the severity of mild behaviour impairment interest sub-domain and poor sleep quality were key at-risk factors contributing to the classification of CN, SCI, MCI and dementia (p < 0.0001). Moreover, the glmnet model showed best classification accuracy in differentiating between CN and MCI cognitive syndromes (AUC = 0.704; sensitivity = 0.698; specificity = 0.637). CONCLUSIONS Brain structure, perfusion and behavioural features are important in the classification of cognitive syndromes and should be incorporated by clinicians and researchers. These findings illustrate the value of using multimodal data when examining syndrome severity and provide new insights into how cerebral perfusion and behavioural impairment influence classification of cognitive syndromes.
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Affiliation(s)
- Ashwati Vipin
- Dementia Research Centre (Singapore), 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - Bernett Teck Kwong Lee
- Centre for Biomedical Informatics, 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
| | - Dilip Kumar
- Dementia Research Centre (Singapore), 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - See Ann Soo
- Dementia Research Centre (Singapore), 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - Yi Jin Leow
- Dementia Research Centre (Singapore), 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - Smriti Ghildiyal
- Dementia Research Centre (Singapore), 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - Faith Phemie Hui En Lee
- Dementia Research Centre (Singapore), 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - Saima Hilal
- Saw Swee Hock School of Public Health, Tahir Foundation Building, 12 Science Drive 2, National University of Singapore and National University Health System, Singapore, 117549, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Nagaendran Kandiah
- Dementia Research Centre (Singapore), 11 Mandalay Road, Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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6
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Paban V, Mheich A, Spieser L, Sacher M. A multidimensional model of memory complaints in older individuals and the associated hub regions. Front Aging Neurosci 2023; 15:1324309. [PMID: 38187362 PMCID: PMC10771290 DOI: 10.3389/fnagi.2023.1324309] [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: 10/19/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Memory complaints are highly prevalent among middle-aged and older adults, and they are frequently reported in individuals experiencing subjective cognitive decline (SCD). SCD has received increasing attention due to its implications for the early detection of dementia. This study aims to advance our comprehension of individuals with SCD by elucidating potential cognitive/psychologic-contributing factors and characterizing cerebral hubs within the brain network. To identify these potential contributing factors, a structural equation modeling approach was employed to investigate the relationships between various factors, such as metacognitive beliefs, personality, anxiety, depression, self-esteem, and resilience, and memory complaints. Our findings revealed that self-esteem and conscientiousness significantly influenced memory complaints. At the cerebral level, analysis of delta and theta electroencephalographic frequency bands recorded during rest was conducted to identify hub regions using a local centrality metric known as betweenness centrality. Notably, our study demonstrated that certain brain regions undergo changes in their hub roles in response to the pathology of SCD. Specifically, the inferior temporal gyrus and the left orbitofrontal area transition into hubs, while the dorsolateral prefrontal cortex and the middle temporal gyrus lose their hub function in the presence of SCD. This rewiring of the neural network may be interpreted as a compensatory response employed by the brain in response to SCD, wherein functional connectivity is maintained or restored by reallocating resources to other regions.
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Affiliation(s)
- Véronique Paban
- Aix-Marseille Université, CNRS, LNC (Laboratoire de Neurosciences Cognitives–UMR 7291), Marseille, France
| | - A. Mheich
- CHUV-Centre Hospitalier Universitaire Vaudois, Service des Troubles du Spectre de l’Autisme et Apparentés, Lausanne University Hospital, Lausanne, Switzerland
| | - L. Spieser
- Aix-Marseille Université, CNRS, LNC (Laboratoire de Neurosciences Cognitives–UMR 7291), Marseille, France
| | - M. Sacher
- University of Toulouse Jean-Jaurès, CNRS, LCLLE (Laboratoire Cognition, Langues, Langage, Ergonomie–UMR 5263), Toulouse, France
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7
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Chan FHF, Goh ZZS, Zhu X, Tudor Car L, Newman S, Khan BA, Griva K. Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis. Health Psychol Rev 2023; 17:614-640. [PMID: 36200562 DOI: 10.1080/17437199.2022.2132980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients' subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference -0.20, 95% confidence interval -0.38 to -0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.
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Affiliation(s)
- Frederick H F Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zack Z S Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaoli Zhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Nursing Services, National Healthcare Group Polyclinics, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Stanton Newman
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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8
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Pang T, Xia B, Zhao X, Zhang Y, Ni Kan C, Hilal S, Chen C, Venketasubramanian N, Yin WT, Cheng CY, Yuan C, Xu X. Cost-benefit and discriminant validity of a stepwise dementia case-finding approach in an Asian older adult community. Gen Psychiatr 2023; 36:e101049. [PMID: 37920408 PMCID: PMC10618984 DOI: 10.1136/gpsych-2023-101049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/27/2023] [Indexed: 11/04/2023] Open
Abstract
Background Case-finding is a recommended approach for dementia early detection in the community. Aims To investigate the discriminant validity and cost-effectiveness of a stepwise dementia case-finding approach in a Singaporean older adult community. Methods The two-phase study was conducted in the community from 2009 to 2015 in Singapore. A total of 3780 participants (age ≥60 years) completed phase I (a brief cognitive screening); 918 completed phase II and were included in the final analysis. In phase I, all participants were administered the Abbreviated Mental Test (AMT) and the Progressive Forgetfulness Question (PFQ). Those who screened positive on either test were invited to phase II, whereby the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery were administered, followed by the research diagnosis of no cognitive impairment, cognitive impairment no dementia (CIND)-Mild (≤2 impaired cognitive domains), CIND-Moderate (>2 impaired domains) or dementia. Receiver operating characteristic curve analyses were conducted for the different cognitive instruments. All discriminant indices were calculated, including sensitivity, specificity, positive and negative predictive values (NPV) and accuracy. Cost-effectiveness analysis was conducted by estimating the amount of screening time needed and the number of older adults requiring re-evaluation in two case-finding scenarios, ie, with or without preselection by the PFQ. Results The stepwise case-finding approach (preselection by the PFQ, then MMSE or MoCA or AMT) showed an excellent NPV (>99%) and accuracy (>86%) for excluding dementia-free cases. Without preselection by the PFQ, screening time for the three cognitive tools were 317.5, 317.5 and 254 hours, with 159, 302 and 175 screen-positive older adults involved in further evaluation. By adopting the stepwise case-finding approach, total screening time were 156.5, 156.5 and 126.2 hours, which decreased by 50.7%, 50.7% and 50.3% as compared with those without preselection. Furthermore, after preselection, only 98, 167 and 145 screen-positive older adults required further evaluation, corresponding to a reduction of 38.4%, 44.7% and 17.1% in the numbers compared with those without preselection. Conclusions A stepwise approach for dementia case-finding should be implemented in the community to minimise the time and resources needed for large-scale early detection of dementia.
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Affiliation(s)
- Ting Pang
- School of Public Health, the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Binte Xia
- School of Public Health, the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xuhao Zhao
- School of Public Health, the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yaping Zhang
- School of Public Health, the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Cheuk Ni Kan
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Saima Hilal
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Chen
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Narayanaswamy Venketasubramanian
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Raffles Neuroscience Centre, Raffles Hospital, Singapore
| | - Wong Tien Yin
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
- School of Clinical Medicine, Beijing Tsinghua Changgang Hospital, Beijing, China
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Changzheng Yuan
- School of Public Health, the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xin Xu
- School of Public Health, the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
- Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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9
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Hill NL, Bratlee-Whitaker E, Jang H, Bhargava S, Sillner AY, Do J, Mogle J. Patient-provider communication about cognition and the role of memory concerns: a descriptive study. BMC Geriatr 2023; 23:342. [PMID: 37259029 PMCID: PMC10233998 DOI: 10.1186/s12877-023-04053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns. METHODS We conducted an online survey with individuals aged 65 + years (n = 409; mean age = 71.4(4.73); 54% female; 79% non-Hispanic White), purposively sampled to include those with and without memory concerns. Questionnaires included measures of subjective memory decline (SMD), memory concerns, past healthcare experiences, as well as open-ended questions regarding patient-provider communication about cognition. Content analysis was used to code open-ended responses. Logistic regression was used to examine differences in facilitators and barriers to communication among three groups: no SMD (n = 130), SMD without memory concerns (n = 143), and SMD with memory concerns (n = 136). RESULTS Only 16.6% of participants reported discussing cognition with a healthcare provider. Of the remaining 83.4%, approximately two-thirds would be open to such discussions in certain circumstances, most frequently if they had worsening memory problems. Over half of participants reported that their provider had never offered cognitive testing. Compared to the no SMD and SMD without memory concerns groups, participants reporting SMD with memory concerns were more likely to: (1) discuss cognition if their healthcare provider initiated the conversation, and (2) avoid discussions of cognitive problems due to fears of losing independence. CONCLUSIONS We found that most participants, including those reporting SMD with memory concerns, had never discussed cognition with their healthcare providers. Patient-reported barriers and facilitators to communication about cognition differed in several areas based on SMD status and the presence or absence of memory concerns. Consideration of these differences can guide future efforts to improve early identification of subtle cognitive changes that would benefit from further monitoring or intervention.
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Affiliation(s)
- Nikki L Hill
- Ross and Carol Nese College of Nursing, Penn State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA.
| | - Emily Bratlee-Whitaker
- RTI Health Solutions, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709, USA
| | - Heejung Jang
- Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC, 29634, USA
| | - Sakshi Bhargava
- RTI Health Solutions, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709, USA
| | - Andrea Yevchak Sillner
- Ross and Carol Nese College of Nursing, Penn State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Justin Do
- Sidney Kimmel Medical College, 1025 Walnut St, Philadelphia, PA, 19107, USA
| | - Jacqueline Mogle
- Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC, 29634, USA
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10
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Pai M, Lu W, Chen M, Xue B. The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter? Arch Gerontol Geriatr 2023; 111:104992. [PMID: 36934694 DOI: 10.1016/j.archger.2023.104992] [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: 12/23/2022] [Revised: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships. METHODS Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD. RESULTS SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD. CONCLUSION Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.
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Affiliation(s)
- Manacy Pai
- Department of Sociology, Kent State University, Kent, OH, United States of America
| | - Wentian Lu
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Miaoqi Chen
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Baowen Xue
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
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11
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Everly J, Plummer J, Lohman M, Neils-Strunjas J. A Tutorial for Speech-Language Pathologists: Physical Activity and Social Engagement to Prevent or Slow Cognitive Decline in Older Adults. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:83-95. [PMID: 36450149 DOI: 10.1044/2022_ajslp-22-00035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This tutorial provides an overview of two behavioral approaches, physical activity and social engagement, to prevent or slow cognitive decline in older adults and to increase awareness in the field of speech-language pathology of the important role that speech-language pathologists (SLPs) play in an interprofessional team working with this population. METHOD A review of exercise science, neuroscience, and social science literature was used to synthesize evidence and to outline the impact of physical activity and social engagement on cognition. The following topics were explored: How do exercise and social engagement support cognition? What are modifiable risk factors of dementia? What is the impact of inactivity and isolation on cognition? What is the potential role of the SLP on an interprofessional team focusing on preventive measures for cognitive decline? What is the impact of physical exercise and social engagement on nursing home residents? RESULTS Research increasingly points to the critical importance of physical activity and social engagement to prevent cognitive decline in normal aging and to slow cognitive decline associated with mild cognitive impairment and dementia. Research suggests that physical activity maintains or improves memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function. Social engagement has been found to maintain and improve general cognitive function. CONCLUSIONS Behavioral interventions are an effective strategy to prevent or slow cognitive decline in the older adult population. SLPs have a role to play on an interprofessional team that works to prevent cognitive decline. By considering factors that play a role in the prevention of cognitive decline, such as physical activity and social engagement, the quality of life and overall health of older adults can be improved. Areas of improvement include memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function.
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Affiliation(s)
- Janet Everly
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jamie Plummer
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
| | - Matthew Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
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12
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Relationship between consistent subjective cognitive decline and occurrence of falls six months later. Arch Gerontol Geriatr 2023; 104:104841. [PMID: 36265390 DOI: 10.1016/j.archger.2022.104841] [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: 08/03/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association between consistent subjective cognitive decline and fall occurrence six months later. METHOD A cohort study was conducted at two time points in community-dwelling older adults. The first survey was conducted from May to July 2020 and the second from November 2020 to January 2021. Older adults without missing data who had not fallen during the past year were analyzed. The questionnaire included sociodemographic data, a questionnaire for medical checkup of older adults, and a frailty screening index. We divided the participants into three groups according to the occurrence of subjective cognitive decline (SCD): 1) no SCD (did not complain of SCD at both time points), 2) unstable SCD (complained of SCD once), and 3) consecutive SCD (consistently complained of SCD). Multiple logistic regression analysis was used to examine the association between fall occurrence and SCD. Fall occurrences were obtained from the second survey. RESULTS In total, 322 participants were included in the analysis. The numbers of patients with no SCD, unstable SCD, and consecutive SCD were 226 (70.2%), 61 (19.0%), and 35 (10.9%), respectively. In the second survey, the number of falls was 26 (8.1%). Multiple logistic regression analysis showed that consecutive SCD was associated with fall occurrence, even after adjusting for age, sex, comorbidity, cohabitants, and frailty status (OR:3.143, 95% CI:1.076-9.388); however, unstable SCD was not (OR:2.348, 95% CI:0.816-6.468). CONCLUSION Consistent complaints of SCD were associated with the occurrence of falls. We highlighted the importance of evaluating SCD over time when considering falls.
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13
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Tanaka S, Saida K, Murayama A, Higuchi D, Shinohara T. Associated factors of new subjective cognitive decline complaints after a 6-month period among community-dwelling older adults during the COVID-19 pandemic in Japan. Psychogeriatrics 2023; 23:136-140. [PMID: 36412008 DOI: 10.1111/psyg.12917] [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: 03/25/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to determine the number of new subjective cognitive decline (SCD) complaints and associated factors in community-dwelling older adults during the COVID-19 pandemic in Japan. METHOD A prospective cohort study was conducted in two periods: May to June 2020, and November 2020 to January 2021. We mailed a questionnaire to 1953 older adults in the first survey, and received 700 responses in the second. We analysed 534 participants without SCD in the first survey. We collected data on sociodemographic characteristics and administered the Questionnaire for Medical Checkup of Old-Old (QMCOO) to assess respondents' health condition. SCD was operationally defined using the QMCOO as reports of (1) forgetfulness, and (2) difficulty in naming dates. The subjects were divided into two groups by their condition at the second survey: an SCD (new SCD complaints) and a no-SCD (no new SCD complaints) group. RESULTS A total of 85 (15.9%) participants had new SCD complaints. The Mann-Whitney U-test and chi-squared test showed that the SCD group had significantly more risk factors of SCD: walking speed (P = 0.001), smoking (P = 0.001), and existence of person with whom the patient could consult when disordered (P = 0.002). Multiple logistic regression analysis revealed that walking speed (odds ratio (OR) = 2.115, 95% confidence interval (CI): 1.259-3.553) and the presence of person to consult (OR = 3.619, 95% CI: 1.553-8.433) were significant related factors of new SCD complaints. CONCLUSION Maintenance of physical condition and social support were associated with new SCD complaints during the COVID-19 pandemic.
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Affiliation(s)
- Shigeya Tanaka
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Kosuke Saida
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Akihiko Murayama
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma University of Health and Welfare, Maebashi, Japan
| | - Daisuke Higuchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan
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14
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Liew TM. Subjective cognitive decline, APOE e4 allele, and the risk of neurocognitive disorders: Age- and sex-stratified cohort study. Aust N Z J Psychiatry 2022; 56:1664-1675. [PMID: 35229693 PMCID: PMC9433458 DOI: 10.1177/00048674221079217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Subjective cognitive decline and APOE e4 allele (APOE4) are known predictors of mild cognitive impairment and dementia (mild cognitive impairment/dementia), with recent evidence showing interaction between subjective cognitive decline and APOE4 in amplifying the risk of mild cognitive impairment/dementia. However, the literature is unclear whether the interaction effect is seen across various age and sex strata. This study examined the interaction between subjective cognitive decline and APOE4-across different age and sex strata-on the risk of mild cognitive impairment/dementia. METHODS This cohort study included 16,221 participants aged ⩾50 years and had normal cognition at baseline. Participants were evaluated for subjective cognitive decline and APOE4 at baseline, and followed-up almost annually for mild cognitive impairment/dementia (median follow-up = 4.5 years). Interaction effects were examined in Cox regression using Relative Excess Risk due to Interaction, stratified by age (⩽70 vs >70 years) and sex. RESULTS Subjective cognitive decline and APOE4 were independently associated with mild cognitive impairment/dementia (hazard ratio: 1.4-1.8), with the highest risk when subjective cognitive decline and APOE4 co-occurred (hazard ratio: 2.6). APOE4 amplified the association between subjective cognitive decline and mild cognitive impairment/dementia in older women (Relative Excess Risk due to Interaction 1.0; 95% confidence interval = [0.3, 1.6]), but not in other age or sex strata. Among older women, half of them developed mild cognitive impairment/dementia by 12.1 years in the absence of subjective cognitive decline or APOE4. This duration shortened to 8.1-10.3 years in the presence of either subjective cognitive decline or APOE4, and to 4.4 years in the presence of both subjective cognitive decline and APOE4. Interaction effect among older women remained consistent when alternate outcomes were used (i.e. mild cognitive impairment and dementia due to Alzheimer's disease; dementia; and Alzheimer's dementia) (Relative Excess Risk due to Interaction 1.2-2.5). CONCLUSIONS APOE4 amplifies the association between subjective cognitive decline and neurocognitive disorders in older women, with the findings suggesting the need for further research to delineate underlying neurobiology. APOE4 may potentially have a role in facilitating further risk stratification of older women with subjective cognitive decline in clinical practice.
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Affiliation(s)
- Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore
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15
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Maffoni M, Pierobon A, Fundarò C. MASCoD-Multidimensional Assessment of Subjective Cognitive Decline. Front Psychol 2022; 13:921062. [PMID: 36533024 PMCID: PMC9748696 DOI: 10.3389/fpsyg.2022.921062] [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: 04/15/2022] [Accepted: 05/30/2022] [Indexed: 09/19/2023] Open
Abstract
Subjective cognitive decline (SCD) is a subclinical cognitive impairment that is complained by the individual without being objectively supported at clinical, diagnostic, and neuropsychological levels. It can negatively impact on patient's frailty and quality of life, as well as on the caregiver's burden. Moreover, it can be prodromal to Mild Cognitive Impairment or dementia. Although the clinical manifestations of SCD can differ along with several cognitive domains, to date there are only screening tools to investigate subjective memory complaints. Thus, the first aim of this paper is to propose a preliminary English and Italian version of a new screening tool called MASCoD (Multidimensional Assessment of Subjective Cognitive Decline); the second aim is to propose its preliminary adoption on a pilot sample. This schedule is a brief test derived from the review of the literature and the clinical experience provided by an experts panelist. From pilot tests, it seems promising as it can help the professional to make differential diagnosis and to predict the risk of developing severe cognitive impairment over time, developing a personalized care path. This screening tool is brief, easily embeddable in usual clinical assessment, and administrable by different professionals. Furthermore, following validation, it will allow to collect manifold cognitive manifestations of SCD, addressing the shortage of previous validated instruments globally assessing cognition affected by this condition.
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Affiliation(s)
- Marina Maffoni
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute, Montescano, Italy
| | - Antonia Pierobon
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute, Montescano, Italy
| | - Cira Fundarò
- Neurophysiopatology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute, Montescano, Italy
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16
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High-resolution NMR metabolomics of patients with subjective cognitive decline plus: Perturbations in the metabolism of glucose and branched-chain amino acids. Neurobiol Dis 2022; 171:105782. [DOI: 10.1016/j.nbd.2022.105782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
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17
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Rotenberg S, Dawson DR. Characterizing Cognition in Everyday Life of Older Adults With Subjective Cognitive Decline. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:269-276. [PMID: 35499254 PMCID: PMC9459355 DOI: 10.1177/15394492221093310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subjective cognitive decline (SCD), the subjective experience of
worsening cognition with no objective cognitive impairment, poses a
heightened risk for dementia. This study aimed to characterize
cognition in the everyday life of people with SCD, is crucial for
understanding and preventing further functional and cognitive decline.
One hundred and thirty-five older adults (age 70.7±6.7) with SCD were
assessed using functional-cognition measures: Multifactorial Memory
Questionnaire (MMQ), Behavior Rating Inventory of Executive
Function–Adult version (BRIEF-A), and Multiple Errands Test (MET). The
resulted showed that older adults with SCD reported lower memory
satisfaction (Hedges’s g = 0.41) on the MMQ, and
worse metacognition on the BRIEF-A (Hedges’s g =
0.63) compared with published normative data. They completed an
average of only 6/12 required tasks on the MET. The findings show
functional difficulties related to SCD and inform the development of
occupational therapy intervention for this population.
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Affiliation(s)
- Shlomit Rotenberg
- University of Toronto, Ontario, Canada
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Deirdre R. Dawson
- University of Toronto, Ontario, Canada
- Baycrest Health Sciences, Toronto, Ontario, Canada
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18
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Koblinsky ND, Anderson ND, Ajwani F, Parrott MD, Dawson D, Marzolini S, Oh P, MacIntosh B, Middleton L, Ferland G, Greenwood CE. Feasibility and preliminary efficacy of the LEAD trial: a cluster randomized controlled lifestyle intervention to improve hippocampal volume in older adults at-risk for dementia. Pilot Feasibility Stud 2022; 8:37. [PMID: 35139918 PMCID: PMC8826667 DOI: 10.1186/s40814-022-00977-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Healthy diet and exercise are associated with reduced risk of dementia in older adults. The impact of diet and exercise interventions on brain health is less consistent, especially with dietary interventions which rely on varying approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counseling approach to improve hippocampal volume among older adults at-risk for dementia. METHODS Participants with vascular risk factors and subjective cognitive decline or early mild cognitive impairment were cluster randomized in groups of 3-4 to the diet intervention (DIET) or control education (ED) group. All participants engaged in 1 h of supervised exercise per week and additional exercise at home. DIET involved 1 h per week of group-based dietary counseling comprising education, goal setting, and strategy training. ED involved 1 h per week of group-based brain health education classes. Our primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included changes in cognitive function, blood biomarkers, diet, and fitness. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy. RESULTS Of 190 older adults contacted, 14 (7%) were eligible and enrolled, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and DIET/ED sessions on average. All 6-month assessments prior to COVID-19 were completed but disruptions to in-person testing resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the study. Preliminary findings did not identify any significant changes in hippocampal volume; however, substantial improvements in diet and HbA1c were observed with DIET compared to ED (d = 1.75 and 1.07, respectively). CONCLUSIONS High adherence and retention rates were observed among participants and preliminary findings illustrate improvements in diet quality and HbA1c. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03056508 .
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Affiliation(s)
- N D Koblinsky
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - N D Anderson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada.
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Canada.
| | - F Ajwani
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- KITE, Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - M D Parrott
- PERFORM Centre, Concordia University, Montreal, Canada
| | - D Dawson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - S Marzolini
- KITE, Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - P Oh
- KITE, Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - B MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | | | - G Ferland
- Montreal Heart Institute Research Centre, Montreal, Canada
- Department of Nutrition, Université de Montréal, Montreal, Canada
| | - C E Greenwood
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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19
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Liew TM. Neuropsychiatric symptoms in early stage of Alzheimer's and non-Alzheimer's dementia, and the risk of progression to severe dementia. Age Ageing 2021; 50:1709-1718. [PMID: 33770167 DOI: 10.1093/ageing/afab044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) in early dementia have been suggested to predict a higher risk of dementia progression. However, the literature is not yet clear whether the risk is similar across Alzheimer's dementia (AD) and non-Alzheimer's dementia (non-AD), as well as across different NPSs. This study examined the association between NPSs in early dementia and the risk of progression to severe dementia, specifically in AD and non-AD, as well as across various NPSs. METHOD This cohort study included 7,594 participants who were ≥65 years and had early dementia (global Clinical Dementia Rating [CDR] = 1). Participants completed Neuropsychiatric-Inventory-Questionnaire at baseline and were followed-up almost annually for progression to severe dementia (global CDR = 3) (median follow-up = 3.5 years; interquartile range = 2.1-5.9 years). Cox regression was used to examine progression risk, stratified by AD and non-AD. RESULTS The presence of NPSs was associated with risk of progression to severe dementia, but primarily in AD (HR 1.4, 95% confidence interval [CI]: 1.1-1.6) and not in non-AD (HR 0.9, 95% CI: 0.5-1.5). When comparing across various NPSs, seven NPSs in AD were associated with disease progression, and they were depression, anxiety, apathy, delusions, hallucinations, irritability and motor disturbance (HR 1.2-1.6). In contrast, only hallucinations and delusions were associated with disease progression in non-AD (HR 1.7-1.9). CONCLUSIONS NPSs in early dementia-especially among individuals with AD-can be useful prognostic markers of disease progression. They may inform discussion on advanced care planning and prompt clinical review to incorporate evidence-based interventions that may address disease progression.
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Affiliation(s)
- Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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20
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Wang JH, Huang J, Guo FQ, Wang F, Yang S, Yu NW, Zheng B, Wang J. Circulating Neurofilament Light Predicts Cognitive Decline in Patients With Post-stroke Subjective Cognitive Impairment. Front Aging Neurosci 2021; 13:665981. [PMID: 34079450 PMCID: PMC8165181 DOI: 10.3389/fnagi.2021.665981] [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: 02/09/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
Background Subjective cognitive impairment (SCI) is common after acute ischemic stroke and adversely affects the quality of life. SCI is associated with an increased risk of developing mild cognitive impairment and dementia. Identifying biomarkers which could predict long-term cognitive outcomes of post-stroke SCI is of importance for early intervention. This study aims to investigate the association between circulating neurofilament light (NfL) and long-term cognitive function in patients with post-stroke SCI. Methods This longitudinal study recruited 304 patients with post-stroke SCI, and serum NfL levels were determined at baseline. These patients were followed up for 12 months for the observation of cognitive change. Cognitive performances were assessed by a Chinese version of the Telephone Interview of Cognitive Status-40 (TICS-40) scale. Results The patients were divided into a progression group (as determined by decreased TICS-40 scores) and a stable group (as determined by increased or unchanged TICS-40 scores). The progression group had significantly higher serum NfL levels than the stable group at baseline. Serum NfL levels were predictive for longitudinal cognitive decline during follow-up. Conclusion These findings imply that circulating NfL could predict the long-term cognitive change of patients with post-stroke SCI.
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Affiliation(s)
- Jian-Hong Wang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jie Huang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Fu-Qiang Guo
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Fang Wang
- Innovation Center of Nursing Research, West China Hospital, Nursing Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China
| | - Shu Yang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Neng-Wei Yu
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Bo Zheng
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
| | - Jian Wang
- Department of Neurology, Ya'an People's Hospital, Ya'an, China
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21
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Arlati S, Di Santo SG, Franchini F, Mondellini M, Filiputti B, Luchi M, Ratto F, Ferrigno G, Sacco M, Greci L. Acceptance and Usability of Immersive Virtual Reality in Older Adults with Objective and Subjective Cognitive Decline. J Alzheimers Dis 2021; 80:1025-1038. [DOI: 10.3233/jad-201431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Virtual reality (VR) has recently emerged as a promising means for the administration of cognitive training of seniors at risk of dementia. Immersive VR could result in increased engagement and performances; however, its acceptance in older adults with cognitive deficits still has to be assessed. Objective: To assess acceptance and usability of an immersive VR environment requiring real walking and active participants’ interaction. Methods: 58 seniors with mild cognitive impairment (MCI, n = 24) or subjective cognitive decline (SCD, n = 31) performed a shopping task in a virtual supermarket displayed through a head-mounted display. Subjective and objective outcomes were evaluated. Results: Immersive VR was well-accepted by all but one participant (TAM3 positive subscales > 5.33), irrespective of the extent of cognitive decline. Participants enjoyed the experience (spatial presence 3.51±0.50, engagement 3.85±0.68, naturalness 3.85±0.82) and reported negligible side-effects (SSQ: 3.74; q1-q3:0–16.83). The environment was considered extremely realistic, such as to induce potentially harmful behaviors: one participant fell while trying to lean on a virtual shelf. Older participants needed more time to conclude trials. Participants with MCI committed more errors in grocery items’ selection and experienced less “perceived control” over the environment. Conclusion: Immersive VR was acceptable and enjoyable for older adults in both groups. Cognitive deficits could induce risky behaviors, and cause issues in the interactions with virtual items. Further studies are needed to confirm acceptance of immersive VR in individuals at risk of dementia, and to extend the results to people with more severe symptoms.
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Affiliation(s)
- Sara Arlati
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, Consiglio Nazionale delle Ricerche, Lecco, Italy
- Dipartimento di Elettronica, Informatica e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Simona Gabriella Di Santo
- Laboratorio-servizio di Epidemiologia e Ricerca Clinica, IRCCS Fondazione Santa Lucia, Roma, Italy
- Dipartimento di Medicina dei Sistemi, Universitá degli Studi di Roma ‘Tor Vergata’, Facoltá di Medicina e Chirurgia, Roma, Italy
| | - Flaminia Franchini
- Laboratorio-servizio di Epidemiologia e Ricerca Clinica, IRCCS Fondazione Santa Lucia, Roma, Italy
- Dipartimento di Medicina dei Sistemi, Universitá degli Studi di Roma ‘Tor Vergata’, Facoltá di Medicina e Chirurgia, Roma, Italy
| | - Marta Mondellini
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, Consiglio Nazionale delle Ricerche, Lecco, Italy
| | - Beatrice Filiputti
- Laboratorio-servizio di Epidemiologia e Ricerca Clinica, IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Matilde Luchi
- Laboratorio-servizio di Epidemiologia e Ricerca Clinica, IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Federica Ratto
- Laboratorio-servizio di Epidemiologia e Ricerca Clinica, IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Giancarlo Ferrigno
- Dipartimento di Elettronica, Informatica e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Marco Sacco
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, Consiglio Nazionale delle Ricerche, Lecco, Italy
| | - Luca Greci
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, Consiglio Nazionale delle Ricerche, Milano, Italy
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22
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Olivari BS, Baumgart M, Taylor CA, McGuire LC. Population measures of subjective cognitive decline: A means of advancing public health policy to address cognitive health. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12142. [PMID: 33681450 PMCID: PMC7919133 DOI: 10.1002/trc2.12142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
Subjective cognitive decline (SCD) is receiving increasing attention as studies have suggested that SCD status is associated with risk of future cognitive decline and dementia. Population-based measures of SCD can be extremely useful to the public health community, health-care providers, researchers, and policymakers. A large population-based SCD measure now exists through the state-based Behavioral Risk Factor Surveillance System (BRFSS). All 50 states have included the cognitive decline module, which asks about SCD, to their BRFSS survey one or more times. Population measures of SCD can aid researchers in designing clinical studies by better estimating the populations that may be at risk for more severe cognitive decline based on their SCD status to ensure that the optimal groups are targeted. Population-level estimates of SCD can also help to inform health-care providers' decisions about initiating cognitive assessments, managing other conditions among those with memory problems, and identifying the needs of caregivers.
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Affiliation(s)
- Benjamin S Olivari
- Division of Population Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention (CDC) Atlanta Georgia USA
| | | | - Christopher A Taylor
- Division of Population Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention (CDC) Atlanta Georgia USA
| | - Lisa C McGuire
- Division of Population Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention (CDC) Atlanta Georgia USA
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