1
|
Yuan M, Rong M, Long X, Lian S, Fang Y. Trajectories of cognitive decline in different domains prior to AD onset in persons with mild cognitive impairment. Arch Gerontol Geriatr 2024; 122:105375. [PMID: 38431989 DOI: 10.1016/j.archger.2024.105375] [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: 11/10/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To explore the trajectories and the change-points of global and five domain-specific cognitive functions before the onset of Alzheimer's disease (AD). METHODS Data was retrieved from the Alzheimer's Disease Neuroimaging Initiative with follow-up from 2005 to 2022. Participants with mild cognitive impairment (MCI) at baseline and those who progressed to AD during follow-up were included. The time of AD onset was defined as the visit time when participant was first diagnosed as AD during follow-up. Global and five domain-specific cognitive functions (immediate memory, visuospatial ability, language, processing speed and executive function) were assessed by Mini-Mental State Examination, Immediate recalling trials of Rey Auditory Verbal Learning Test, Clock Drawing Test, Animal Fluency Test, Part A and B of Trail Making Test, respectively. Their trajectories and change-points before AD onset were explored by generalized additive mixed models and piecewise linear regression models, respectively. RESULTS 349 participants were diagnosed as MCI at baseline and converted to AD during follow-up, who were included in this study. They had been visited on an average of 4.6 times (SD = 2.1, range = 2.0-13.0), with a total of 1593 visits. Their mean baseline age and AD onset age were 74.4 (SD = 6.4, range = 60.0-88.4) and 77.0 (SD = 6.8, range = 60.5-94.7) years, respectively. Baseline age and educational year were significantly associated with global cognitive, immediate memory, language and executive function. Men presented better global cognitive function (β = 0.54, p < 0.05) but poorer immediate memory (β = -1.72, p < 0.05) than women. Immediate memory and visuospatial ability showed the earliest change-points at 4 years before the onset of AD (Note as T-4years), followed by language (T-3.5years), executive function (T-2.5 years), processing speed (T-2.0 years), and finally the global cognitive function (T-1.5years). CONCLUSIONS The trajectories of the six neuropsychological scores were non-linear and showed deterioration in functions over time. Immediate memory and visuospatial ability showed the earliest change-points prior to AD onset.
Collapse
Affiliation(s)
- Manqiong Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Meng Rong
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Xianxian Long
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Shuli Lian
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China.
| |
Collapse
|
2
|
Huan G, Heyong S. Longitudinal Invariance and Construct Validity of the Chinese Version of the Mini-Mental State Examination Across 10 Years in the Elderly Population. J Nurs Meas 2024; 32:4-17. [PMID: 37348896 DOI: 10.1891/jnm-2021-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: In this study, we investigate the longitudinal measurement invariance of the Chinese version of the mini-mental state examination (CMMSE). Methods: The factor structure and longitudinal equivalence of the CMMSE were examined by confirmatory factor analysis. Four CMMSE measurements of 13,132 participants from the China Longitudinal Health and Longevity Study between 2008 and 2018 were included. The nested model of longitudinal invariance proves the existence of strict longitudinal invariance. Results: It showed that the factor structure, factor loadings, intercept error variance, and latent factor means of the CMMSE were invariant across four measurements. Conclusion: These findings indicate that the changes in CMMSE scores can be attributed to real structural change, indicating that the CMMSE is a reliable measurement tool for the study of cognitive aging.
Collapse
Affiliation(s)
- Guo Huan
- School of Human Resources, Guangdong University of Finance and Economics, Guangzhou, China
| | - Shen Heyong
- Institute of Analytical Psychology, City University of Macau, Macau, China
| |
Collapse
|
3
|
Mehta T, Cleland B, Madhavan S. Barriers to Enrollment in a Post-Stroke Neuromodulation and Walking Study: Implications for Recruiting Women. Neurorehabil Neural Repair 2024; 38:207-213. [PMID: 38314561 PMCID: PMC10939762 DOI: 10.1177/15459683241230028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Women have a higher risk of stroke and related disability than men but are underrepresented in stroke clinical trials. Identifying modifiable recruitment and enrollment barriers for women can improve study generalizability, statistical power, and resource utilization. OBJECTIVE In a post-stroke neuromodulation study, we determined the impact of sex on the occurrence of exclusion criteria and compared the sex distribution of screened and enrolled individuals with a broader stroke-affected population. METHODS A total of 335 individuals with chronic stroke were screened for a study examining how neuromodulation and high-intensity treadmill training affect walking speed and corticomotor excitability. Demographics and exclusions were retrospectively gathered as a secondary dataset. Exclusion criteria consisted of 6 categories (not target population, unable to do treadmill protocol, unable to do non-invasive brain stimulation, insufficient ankle motion and disinterest, and cognitive impairment). Incidence of each exclusion criterion was compared between women and men. The sex distribution was compared to a dataset from Chicago primary stroke centers. RESULTS A total of 81 individuals were enrolled and 254 were not. The percentage of women excluded was significantly greater than that of men (P = .04). No individual exclusion criterion or categories excluded women more frequently than men. Screened and enrolled individuals had a lower proportion of women and younger age than a representative stroke population (P < .001). CONCLUSIONS We identified exclusion criteria (ie, headaches, cognitive scores, and age) that are modifiable barriers to enrollment of women in this post-stroke neuromodulation study. Addressing underrepresentation of women in stroke research is pivotal for enhancing generalizability, achieving statistical power, and optimizing resources.
Collapse
Affiliation(s)
- Twinkle Mehta
- Chicago Medical School, Rosalind Franklin University
| | - Brice Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
4
|
Saffari SE, Soo SA, Mohammadi R, Ng KP, Greene W, Kandiah N. Modelling the Distribution of Cognitive Outcomes for Early-Stage Neurocognitive Disorders: A Model Comparison Approach. Biomedicines 2024; 12:393. [PMID: 38397995 PMCID: PMC10886528 DOI: 10.3390/biomedicines12020393] [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: 12/13/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Cognitive assessments for patients with neurocognitive disorders are mostly measured by the Montreal Cognitive Assessment (MoCA) and Visual Cognitive Assessment Test (VCAT) as screening tools. These cognitive scores are usually left-skewed and the results of the association analysis might not be robust. This study aims to study the distribution of the cognitive outcomes and to discuss potential solutions. Materials and Methods: In this retrospective cohort study of individuals with subjective cognitive decline or mild cognitive impairment, the inverse-transformed cognitive outcomes are modelled using different statistical distributions. The robustness of the proposed models are checked under different scenarios: with intercept-only, models with covariates, and with and without bootstrapping. Results: The main results were based on the VCAT score and validated via the MoCA score. The findings suggested that the inverse transformation method improved the modelling the cognitive scores compared to the conventional methods using the original cognitive scores. The association of the baseline characteristics (age, gender, and years of education) and the cognitive outcomes were reported as estimates and 95% confidence intervals. Bootstrap methods improved the estimate precision and the bootstrapped standard errors of the estimates were more robust. Cognitive outcomes were widely analysed using linear regression models with the default normal distribution as a conventional method. We compared the results of our suggested models with the normal distribution under various scenarios. Goodness-of-fit measurements were compared between the proposed models and conventional methods. Conclusions: The findings support the use of the inverse transformation method to model the cognitive outcomes instead of the original cognitive scores for early-stage neurocognitive disorders where the cognitive outcomes are left-skewed.
Collapse
Affiliation(s)
- Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore;
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore;
| | - See Ann Soo
- Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (S.A.S.); (N.K.)
| | - Raziyeh Mohammadi
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore;
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore;
- Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| | - William Greene
- Stern School of Business (Emeritus), New York University, New York, NY 10012, USA;
| | - Negaenderan Kandiah
- Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (S.A.S.); (N.K.)
- Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| |
Collapse
|
5
|
Ferretti MT, Ding H, Au R, Liu C, Devine S, Auerbach S, Mez J, Gurnani A, Liu Y, Santuccione A, Ang TFA. Maximizing utility of neuropsychological measures in sex-specific predictive models of incident Alzheimer's disease in the Framingham Heart Study. Alzheimers Dement 2024; 20:1112-1122. [PMID: 37882354 PMCID: PMC10917035 DOI: 10.1002/alz.13500] [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: 02/21/2023] [Revised: 08/23/2023] [Accepted: 09/17/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Sex differences in neuropsychological (NP) test performance might have important implications for the diagnosis of Alzheimer's disease (AD). This study investigates sex differences in neuropsychological performance among individuals without dementia at baseline. METHODS Neuropsychological assessment data, both standard test scores and process coded responses, from Framingham Heart Study participants were analyzed for sex differences using regression model and Cox proportional hazards model. Optimal NP profiles were identified by machine learning methods for men and women. RESULTS Sex differences were observed in both summary scores and composite process scores of NP tests in terms of adjusted means and their associations with AD incidence. The optimal NP profiles for men and women have 10 and 8 measures, respectively, and achieve 0.76 mean area under the curve for AD prediction. DISCUSSION These results suggest that NP tests can be leveraged for developing more sensitive, sex-specific indices for the diagnosis of AD.
Collapse
Affiliation(s)
- Maria Teresa Ferretti
- Institute for Regenerative Medicine (IREM)University of ZurichZurichSwitzerland
- Women's Brain ProjectGuntershausenSwitzerland
| | - Huitong Ding
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Rhoda Au
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Chunyu Liu
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Sherral Devine
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Sanford Auerbach
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Jesse Mez
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Ashita Gurnani
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Yulin Liu
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | | | - Ting Fang Alvin Ang
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| |
Collapse
|
6
|
Park SA, Byeon G, Jhoo JH, Kim HC, Lim MN, Jang JW, Bae JB, Han JW, Kim TH, Kwak KP, Kim BJ, Kim SG, Kim JL, Moon SW, Park JH, Ryu SH, Youn JC, Lee DW, Lee SB, Lee JJ, Lee DY, Kim KW. A Preliminary Study on the Potential Protective Role of the Antioxidative Stress Markers of Cognitive Impairment: Glutathione and Glutathione Reductase. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:758-768. [PMID: 37859449 PMCID: PMC10591176 DOI: 10.9758/cpn.23.1053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 10/21/2023]
Abstract
Objective : To investigate the relationship between reduced glutathione (GSH), a key molecule of the antioxidant defense system in the blood, and glutathione reductase (GR), which reduces oxidized glutathione (glutathione disulfide [GSSG]) to GSH and maintains the redox balance, with the prevalence of Alzheimer's dementia and cognitive decline. Methods : In all, 20 participants with Alzheimer's dementia who completed the third follow-up clinical evaluation over 6 years were selected, and 20 participants with normal cognition were selected after age and sex matching. The GSH and GR concentrations were the independent variables. Clinical diagnosis and neurocognitive test scores were the dependent variables indicating cognitive status. Results : The higher the level of GR, the greater the possibility of having normal cognition than of developing Alzheimer's dementia. Additionally, the higher the level of GR, the higher the neurocognitive test scores. However, this association was not significant for GSH. After 6 years, the conversion rate from normal cognition to cognitive impairment was significantly higher in the lower 50th percentile of the GR group than in the upper 50th percentile. Conclusion : The higher the GR, the lower the prevalence of Alzheimer's dementia and incidence of cognitive impairment and the higher the cognitive test scores. Therefore, GR is a potential protective biomarker against Alzheimer's dementia and cognitive decline.
Collapse
Affiliation(s)
- Sang-a Park
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Korea
| | - Gihwan Byeon
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Korea
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hyung-Chun Kim
- College of Pharmacy, Kangwon National University, Chuncheon, Korea
| | - Myoung-Nam Lim
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeonju Hospital, Gyeongju, Korea
| | - Bong Jo Kim
- Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Seok Woo Moon
- Department of Psychiatry, Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Seung-Ho Ryu
- Department of Neuropsychiatry, Konkuk University Hospital, Seoul, Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
| |
Collapse
|
7
|
Lutshumba J, Wilcock DM, Monson NL, Stowe AM. Sex-based differences in effector cells of the adaptive immune system during Alzheimer's disease and related dementias. Neurobiol Dis 2023; 184:106202. [PMID: 37330146 PMCID: PMC10481581 DOI: 10.1016/j.nbd.2023.106202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/19/2023] Open
Abstract
Neurological conditions such as Alzheimer's disease (AD) and related dementias (ADRD) present with many challenges due to the heterogeneity of the related disease(s), making it difficult to develop effective treatments. Additionally, the progression of ADRD-related pathologies presents differently between men and women. With two-thirds of the population affected with ADRD being women, ADRD has presented itself with a bias toward the female population. However, studies of ADRD generally do not incorporate sex-based differences in investigating the development and progression of the disease, which is detrimental to understanding and treating dementia. Additionally, recent implications for the adaptive immune system in the development of ADRD bring in new factors to be considered as part of the disease, including sex-based differences in immune response(s) during ADRD development. Here, we review the sex-based differences of pathological hallmarks of ADRD presentation and progression, sex-based differences in the adaptive immune system and how it changes with ADRD, and the importance of precision medicine in the development of a more targeted and personalized treatment for this devastating and prevalent neurodegenerative condition.
Collapse
Affiliation(s)
- Jenny Lutshumba
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States of America; Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Nancy L Monson
- Department of Neurology and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ann M Stowe
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, United States of America; Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, United States of America.
| |
Collapse
|
8
|
Abuelezz NZ, Nasr FE, Abdel Aal WM, Molokhia T, Zaky A. Sera miR-34a, miR-29b and miR-181c as potential novel diagnostic biomarker panel for Alzheimers in the Egyptian population. Exp Gerontol 2022; 169:111961. [PMID: 36155067 DOI: 10.1016/j.exger.2022.111961] [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: 04/18/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Till date, there is an obvious obscurity of specific and early diagnostic biomarkers for Alzheimer's disease (AD). The promising diagnostic potential of serum miRNAs is increasingly emerging; however, rare miRNAs data originates from middle and low-income countries to provide proper validation in these highly affected populations. This study evaluated the diagnostic value of serum miR-34a, miR-29b and miR-181c in Egyptian AD patients. METHODS Expression levels of serum miR-34a, miR-29b and miR-181c were determined using quantitative real time PCR in AD patients versus healthy controls. Amyloid Beta 42 (Aβ42), Phosphorylated Tau (p-Tau) and TNF-α levels were also detected as distinctive AD markers. We further explored the correlation between miRNAs levels and Mini mental state examination (MMSE) scores. Finally, we conducted logistic regression and ROC curve analyses to evaluate the diagnostic values of the measured parameters. RESULTS Sera miR-34a, miR-29b and miR-181c were significantly downregulated in AD patients and this decrease was associated with cognitive decline. AD patients manifested significant elevation of Aβ42, pTau and TNF-α levels. The measured miRNAs showed good AD diagnostic value solely and when used together (AUC = 0.77, 95 % C·I. 0.62-0.93 at p < 0.01). Interestingly, combining miRNAs panel with Aβ42, TNF-α and pTau levels remarkably increased the diagnostic power (AUC = 0.97, 95 % C·I. 0.94-1.00 at p < 0.001) achieving sensitivity 88.2 % and specificity 91.4 %. CONCLUSION This study spots for the first time the diagnostic potential of serum miR-34a, miR-29b and miR-181c as minimally invasive AD biomarker panel in Egyptian patients and highlights their contribution in AD pathogenesis.
Collapse
Affiliation(s)
- Nermeen Z Abuelezz
- Biochemistry Department, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza, Egypt.
| | - Fayza Eid Nasr
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| | | | - Tarek Molokhia
- Department of Psychiatry, School of Medicine, Alexandria University, Alexandria, Egypt
| | - Amira Zaky
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| |
Collapse
|
9
|
Nishita Y, Makizako H, Jeong S, Otsuka R, Kim H, Obuchi S, Fujiwara Y, Ohara Y, Awata S, Yamada M, Iijima K, Shimada H, Suzuki T. Temporal trends in cognitive function among community-dwelling older adults in Japan: Findings from the ILSA-J integrated cohort study. Arch Gerontol Geriatr 2022; 102:104718. [DOI: 10.1016/j.archger.2022.104718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 11/02/2022]
|
10
|
Salwierz P, Davenport C, Sumra V, Iulita MF, Ferretti MT, Tartaglia MC. Sex and gender differences in dementia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:179-233. [PMID: 36038204 DOI: 10.1016/bs.irn.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The dementia landscape has undergone a striking paradigm shift. The advances in understanding of neurodegeneration and proteinopathies has changed our approach to patients with cognitive impairment. Firstly, it has recently been shown that the various proteinopathies that are the cause of the dementia begin to build up long before the appearance of any obvious symptoms. This has cemented the idea that there is an urgency in diagnosis as it occurs very late in the pathophysiology of these diseases. Secondly, that accurate diagnosis is required to deliver targeted therapies, that is precision medicine. With this latter point, the realization that various factors of a person need to be considered as they may impact the presentation and progression of disease has risen to the forefront. Two of these factors aside from race and age are biological sex and gender (social construct), as both can have tremendous impact on manifestation of disease. This chapter will cover what is known and remains to be known on the interaction of sex and gender with some of the major causes of dementia.
Collapse
Affiliation(s)
- Patrick Salwierz
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Carly Davenport
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Vishaal Sumra
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - M Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain; Women's Brain Project, Guntershausen, Switzerland
| | | | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada; Memory Clinic, Krembil Brain Institute, University Health Network, Toronto, ON, Canada.
| |
Collapse
|
11
|
Scharre DW, Chang SI, Nagaraja HN, Wheeler NC, Kataki M. Self-Administered Gerocognitive Examination: longitudinal cohort testing for the early detection of dementia conversion. Alzheimers Res Ther 2021; 13:192. [PMID: 34872596 PMCID: PMC8650250 DOI: 10.1186/s13195-021-00930-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/02/2021] [Indexed: 12/21/2022]
Abstract
Background Significant cognitive changes as individuals’ age are not being identified in a timely manner, delaying diagnosis and treatments. Use of brief, multi-domain, self-administered, objective cognitive assessment tools may remove some barriers in assessing and identifying cognitive changes. We compared longitudinal Self-Administered Gerocognitive Examination (SAGE) test scores to non-self-administered Mini-Mental State Examination (MMSE) scores in 5 different diagnostic subgroups. Methods A cohort study evaluating annual rates of change was performed on 665 consecutive patients from Ohio State University Memory Disorders Clinic. Patients with at least two visits 6 months apart evaluated with SAGE and MMSE and classified according to standard clinical criteria as subjective cognitive decline (SCD), mild cognitive impairment (MCI), or Alzheimer’s disease (AD) dementia were included. The pattern of change in SAGE scores was compared to MMSE. One way and repeated measures ANOVA and linear regression models were used. Results Four hundred twenty-four individuals (40 SCD, 94 MCI non-converters to dementia, 70 MCI converters to dementia (49 to AD dementia and 21 to non-AD dementia), 220 AD dementia) met inclusion criteria. SAGE and MMSE scores declined respectively at annual rates of 1.91 points/year (p < 0.0001) and 1.68 points/year (p < 0.0001) for MCI converters to AD dementia, and 1.82 points/year (p < 0.0001) and 2.38 points/year (p < 0.0001) for AD dementia subjects. SAGE and MMSE scores remained stable for SCD and MCI non-converters. Statistically significant decline from baseline scores in SAGE occurred at least 6 months earlier than MMSE for MCI converters to AD dementia (14.4 vs. 20.4 months), MCI converters to non-AD dementia (14.4 vs. 32.9 months), and AD dementia individuals (8.3 vs. 14.4 months). Conclusions SAGE detects MCI conversion to dementia at least 6 months sooner than MMSE. Being self-administered, SAGE also addresses a critical need of removing some barriers in performing cognitive assessments. Limitations of our single-site cohort study include potential referral and sampling biases. Repetitively administering SAGE and identifying stability or decline may provide clinicians with an objective cognitive biomarker impacting evaluation and management choices.
Collapse
Affiliation(s)
- Douglas W Scharre
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA.
| | - Shu Ing Chang
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA
| | - Haikady N Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Cunz Hall, Columbus, OH, 43210, USA
| | - Natalie C Wheeler
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA.,Present Address: Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Maria Kataki
- Division of Cognitive Neurology, Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA
| |
Collapse
|
12
|
Pellicer-Espinosa I, Díaz-Orueta U. Cognitive Screening Instruments for Older Adults with Low Educational and Literacy Levels: A Systematic Review. J Appl Gerontol 2021; 41:1222-1231. [PMID: 34856843 PMCID: PMC8966106 DOI: 10.1177/07334648211056230] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study presents a systematic review on existing cognitive screening tools for mild cognitive impairment and dementia in populations with low education and literacy levels. Cochrane Library, PubMed and LILACS databases were examined for studies including adults aged 50 years old or older with low educational level. 61 articles were included. Despite its frequent use, studies on Mini-Mental State Examination (MMSE) revealed that educational level biased the score obtained, regardless of other factors. Separately, the Informant Questionnaire on Cognitive Decline in the Elderly, the Fototest, or the Eurotest, appear to minimize the effect of education and literacy. MMSE is unreliable for individuals with low literacy. Tasks involving reading, writing, arithmetics, drawing, praxis, visuospatial, and visuoconstructive skills have a greater educational bias than naming, orientation, or memory. An adequate determination of educational level and validation of instruments in populations with heterogeneous levels of literacy requires further research.
Collapse
Affiliation(s)
| | - Unai Díaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Ireland
| |
Collapse
|
13
|
Cognitive function, daily function and physical and mental health in older adults: A comparison of venue and home-visit community surveys in Metropolitan Tokyo. Arch Gerontol Geriatr 2021; 100:104617. [DOI: 10.1016/j.archger.2021.104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
|
14
|
Koskas P, Bourdonnec L, Kohler S, Romdhani M, Drunat O. Factors influencing length of hospital stay in an acute psychogeriatric unit. Psychogeriatrics 2021; 21:478-482. [PMID: 33821512 DOI: 10.1111/psyg.12691] [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: 07/28/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia patients represent a significant volume of hospital admissions and impose a high cost on the health system. There is a significantly higher length of hospital stay (LOHS) for elderly demented patients. METHODS This study was carried out in an acute psychogeriatric unit specialising in behavioural and psychological symptoms in dementia. Socio-demographic, cognitive and nutritional variables were taken into account. We first compared the patients returning home (group 1) after hospital discharge with those transferred to the rehabilitation psychogeriatric unit (group 2). We secondarily explored the correlation of LOHS with the variables described above for the two groups. RESULTS We retained 92 patients (of 375 admitted) for our study, mean age 83.9 ± 6.6, Mini-Mental State Examination 12.8 ± 9.6, initial weight 61.7 ± 13.2 kg and body mass index 24.8 ± 4.7. We noticed significant differences in cognitive status but not in nutritional variables or in socio-demographic characteristics between the two groups. Only weight in nutritional variables was significantly associated with LOHS in the acute psychogeriatric unit. CONCLUSIONS Our main finding underlined the key role of cognitive factors in patient discharge home. And only initial weigh seems have an influence in LOHS instead of cognitive status or socio-demographic characteristics.
Collapse
Affiliation(s)
- Pierre Koskas
- Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lauriane Bourdonnec
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samuel Kohler
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mouna Romdhani
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Drunat
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
15
|
Gallini A, Jegou D, Lapeyre-Mestre M, Couret A, Bourrel R, Ousset PJ, Fabre D, Andrieu S, Gardette V. Development and Validation of a Model to Identify Alzheimer's Disease and Related Syndromes in Administrative Data. Curr Alzheimer Res 2021; 18:142-156. [PMID: 33882802 DOI: 10.2174/1567205018666210416094639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Administrative data are used in the field of Alzheimer's Disease and Related Syndromes (ADRS), however their performance to identify ADRS is unknown. OBJECTIVE i) To develop and validate a model to identify ADRS prevalent cases in French administrative data (SNDS), ii) to identify factors associated with false negatives. METHODS Retrospective cohort of subjects ≥ 65 years, living in South-Western France, who attended a memory clinic between April and December 2013. Gold standard for ADRS diagnosis was the memory clinic specialized diagnosis. Memory clinics' data were matched to administrative data (drug reimbursements, diagnoses during hospitalizations, registration with costly chronic conditions). Prediction models were developed for 1-year and 3-year periods of administrative data using multivariable logistic regression models. Overall model performance, discrimination, and calibration were estimated and corrected for optimism by resampling. Youden index was used to define ADRS positivity and to estimate sensitivity, specificity, positive predictive and negative probabilities. Factors associated with false negatives were identified using multivariable logistic regressions. RESULTS 3360 subjects were studied, 52% diagnosed with ADRS by memory clinics. Prediction model based on age, all-cause hospitalization, registration with ADRS as a chronic condition, number of anti-dementia drugs, mention of ADRS during hospitalizations had good discriminative performance (c-statistic: 0.814, sensitivity: 76.0%, specificity: 74.2% for 2013 data). 419 false negatives (24.0%) were younger, had more often ADRS types other than Alzheimer's disease, moderate forms of ADRS, recent diagnosis, and suffered from other comorbidities than true positives. CONCLUSION Administrative data presented acceptable performance for detecting ADRS. External validation studies should be encouraged.
Collapse
Affiliation(s)
- Adeline Gallini
- CERPOP, Universite de Toulouse, Inserm, UPS, Toulouse, France
| | - David Jegou
- CERPOP, Universite de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Anaïs Couret
- CERPOP, Universite de Toulouse, Inserm, UPS, Toulouse, France
| | - Robert Bourrel
- Caisse Nationale d'Assurance Maladie des Travailleurs Salaries (CNAMTS), Echelon Regional du Service Medical Midi-Pyrenees - F31000 Toulouse, France
| | - Pierre-Jean Ousset
- CHU Toulouse, Centre Memoire de Ressources et de Recherches - F31000 Toulouse, France
| | - D Fabre
- CHU Toulouse, Departement D'information Medicale - F31000 Toulouse, France
| | | | | |
Collapse
|
16
|
Garnier-Crussard A, Vernaudon J, Auguste N, Dauphinot V, Krolak-Salmon P. What Could Be the Main Levers to Promote a Timely Diagnosis of Neurocognitive Disorders? J Alzheimers Dis 2021; 75:201-210. [PMID: 32280094 DOI: 10.3233/jad-191253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive disorders (NCD) are a growing health issue and the importance of diagnosis is still debated despite the benefits of making a diagnosis appearing to be greater than the risks. OBJECTIVE The aim of the present study was to explore the perception of the main benefits and risks to perform a diagnosis workup of NCD in a population of general practitioners (GPs), specialized physicians (SPs), other healthcare professionals (OHPs), and informal caregivers (ICs), and to identify the lowest perceived benefits and the highest perceived risks that could be levers to promote a diagnosis of NCD. METHODS A standardized questionnaire was submitted to GPs, SPs, OHPs, and ICs aiming to evaluate the importance of eight benefits and eight risks related to NCD diagnosis (selected from the literature) for four prototypical clinical cases at different stages of the disease: subjective cognitive impairment/mild NCD, major NCD at mild/moderate stage, moderate stage with behavioral and psychotic symptoms, and severe stage. RESULTS The lowest perceived benefits of making an NCD diagnosis were "access to medical research", "patient's right to know", and "initiation of symptomatic drug treatment". The highest perceived risks of making an NCD diagnosis were "negative psychological impact for the patient", "absence of disease-modifying treatment", and "absence of suitable institution". CONCLUSION This study highlights the lowest perceived benefits and the highest perceived risks of making an NCD diagnosis. These benefits and risks could be modified to become levers to promote a personalized diagnosis of NCD.
Collapse
Affiliation(s)
- Antoine Garnier-Crussard
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France
| | - Julien Vernaudon
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France.,Centre de Recherche Clinique CRC - VCF (Vieillissement - Cerveau - Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Auguste
- Centre Mutualiste de Consultation Mémoire, Saint-Étienne, France
| | - Virginie Dauphinot
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France.,Centre de Recherche Clinique CRC - VCF (Vieillissement - Cerveau - Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,INSERM, U1028; CNRS, UMR5292; Lyon Centre de Recherche en Neurosciences de Lyon, Dynamique Cérébrale et Cognition, Lyon, France
| |
Collapse
|
17
|
Popovac A, Mladenović I, Krunić J, Trifković B, Todorović A, Milašin J, Despotović N, Stančić I. Apolipoprotein ɛ4 Allele and Dental Occlusion Deficiency as Risk Factors for Alzheimer's Disease. J Alzheimers Dis 2021; 74:797-802. [PMID: 32116259 DOI: 10.3233/jad-191283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Compromised dentition has been suggested to pose a significant risk factor for dementia. It was mainly investigated through insufficient tooth number, disregarding contact between opposing teeth (dental occlusion). The ɛ4 allele of apolipoprotein (APOE4) is the primary genetic marker for the late onset of Alzheimer's disease (AD). However, APOE4 and dental occlusion have not yet been investigated as possible associated risk factors for AD. The study was aimed to examine the impact of dental status and different APOE gene variants on AD occurrence. Secondly, sociodemographic variables were investigated as factors potentially associated with AD. The case-control study included two groups: 116 patients with AD (according to the NINDS-ADRDA criteria) and 63 controls (Mini-Mental State Examination scores ≥24). The analysis of APOE gene polymorphism was conducted through PCR reaction. Dental examination included recording of number of teeth, presence of fixed or removable dentures, and number of functional tooth units (FTU). Regression analysis was used to investigate the joint effect of the clinical and genetic variables on AD. Results showed that patients with AD were more often carriers of ɛ3/ɛ4 genotype and ɛ4 allele, had lower number of teeth and FTU, and were less likely to be married, live in home, and had less chronic diseases, compared to the controls. Regression analysis showed that presence of APOE4 allele and the number of total FTU remained associated with AD, even when adjusted for age, sex, and level of education. In conclusion, deficient dental occlusion and presence of APOE4 may independently increase risk for AD.
Collapse
Affiliation(s)
- Aleksandra Popovac
- Department for Prosthetic Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Irena Mladenović
- Department of Oral Rehabilitation, Faculty of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina
| | - Jelena Krunić
- Department of Dental Pathology, Faculty of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina
| | - Branka Trifković
- Department for Prosthetic Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Todorović
- Department for Prosthetic Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Milašin
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Nebojša Despotović
- Department of Geriatric Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivica Stančić
- Department for Prosthetic Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
18
|
Dennison JL, Ricciardi NR, Lohse I, Volmar CH, Wahlestedt C. Sexual Dimorphism in the 3xTg-AD Mouse Model and Its Impact on Pre-Clinical Research. J Alzheimers Dis 2021; 80:41-52. [PMID: 33459720 PMCID: PMC8075398 DOI: 10.3233/jad-201014] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Female sex is a leading risk factor for developing Alzheimer’s disease (AD). Sexual dimorphism in AD is gaining attention as clinical data show that women are not only more likely to develop AD but also to experience worse pathology and faster cognitive decline. Pre-clinical AD research in animal models often neglects to address sexual dimorphism in evaluation of behavioral or molecular characteristics and outcomes. This can compromise its translation to a clinical setting. The triple-transgenic AD mouse model (3xTg-AD) is a commonly used but unique AD model because it exhibits both amyloid and tau pathology, essential features of the human AD phenotype. Mounting evidence has revealed important sexually dimorphic characteristics of this animal model that have yet to be reviewed and thus, are often overlooked in studies using the 3xTg-AD model. In this review we conduct a thorough analysis of reports of sexual dimorphism in the 3xTg-AD model including findings of molecular, behavioral, and longevity-related sex differences in original research articles through August 2020. Importantly, we find results to be inconsistent, and that strain source and differing methodologies are major contributors to lack of consensus regarding traits of each sex. We first touch on the nature of sexual dimorphism in clinical AD, followed by a brief summary of sexual dimorphism in other major AD murine models before discussing the 3xTg-AD model in depth. We conclude by offering four suggestions to help unify pre-clinical mouse model AD research inspired by the NIH expectations for considering sex as a biological variable.
Collapse
Affiliation(s)
- Jessica L Dennison
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natalie R Ricciardi
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ines Lohse
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Claude-Henry Volmar
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Claes Wahlestedt
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Center for Therapeutic Innovation, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
19
|
Shan G, Bernick C, Caldwell JZK, Ritter A. Machine learning methods to predict amyloid positivity using domain scores from cognitive tests. Sci Rep 2021; 11:4822. [PMID: 33649452 PMCID: PMC7921140 DOI: 10.1038/s41598-021-83911-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/09/2021] [Indexed: 01/31/2023] Open
Abstract
Amyloid-[Formula: see text] (A[Formula: see text]) is the target in many clinical trials for Alzheimer's disease (AD). Preclinical AD patients are heterogeneous with regards to different backgrounds and diagnosis. Accurately predicting A[Formula: see text] status of participants by using machine learning (ML) models based on easily accessible data, could improve the effectiveness of AD clinical trials. We will develop optimal ML models for each subpopulation stratified by sex and disease stages using sub scores from screening neurological tests. Data from the AD Neuroimaging Initiative (ADNI) were used to build the ML models, for three groups: individuals with significant memory concern, early mild cognitive impairment (MCI), and late MCI. Data were further separated into 6 groups by disease stage (3 levels) and sex (2 categories). The outcome was defined as the A[Formula: see text] status confirmed by the PET imaging, and the features include demographic data, newly identified risk factors, screening tests, and the domain scores from screening tests. Monte Carlo simulation studies were used together with k-fold cross-validation technique to compute model performance metric. We also develop a new feature selection method based on the stochastic ordering to avoiding searching all possible combinations of features. Accuracy of the identified optimal model for SMC male was over 90% by using domain scores, and accuracy for LMCI female was above 86%. Domain scores can improve the ML model prediction as compared to the total scores. Accurate ML prediction models can identify the proper population for AD clinical trials.
Collapse
Affiliation(s)
- Guogen Shan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, 89154, USA.
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV, 89106, USA
| | - Jessica Z K Caldwell
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV, 89106, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV, 89106, USA
| |
Collapse
|
20
|
Severini C, Barbato C, Di Certo MG, Gabanella F, Petrella C, Di Stadio A, de Vincentiis M, Polimeni A, Ralli M, Greco A. Alzheimer's Disease: New Concepts on the Role of Autoimmunity and NLRP3 Inflammasome in the Pathogenesis of the Disease. Curr Neuropharmacol 2021; 19:498-512. [PMID: 32564756 PMCID: PMC8206463 DOI: 10.2174/1570159x18666200621204546] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/27/2020] [Accepted: 06/17/2020] [Indexed: 01/14/2023] Open
Abstract
Alzheimer's disease (AD), recognized as the most common neurodegenerative disorder, is clinically characterized by the presence of extracellular beta-amyloid (Aβ) plaques and by intracellular neurofibrillary tau tangles, accompanied by glial activation and neuroinflammation. Increasing evidence suggests that self-misfolded proteins stimulate an immune response mediated by glial cells, inducing the release of inflammatory mediators and the recruitment of peripheral macrophages into the brain, which in turn aggravate AD pathology. The present review aims to update the current knowledge on the role of autoimmunity and neuroinflammation in the pathogenesis of the disease, indicating a new target for therapeutic intervention. We mainly focused on the NLRP3 microglial inflammasome as a critical factor in stimulating innate immune responses, thus sustaining chronic inflammation. Additionally, we discussed the involvement of the NLRP3 inflammasome in the gut-brain axis. Direct targeting of the NLRP3 inflammasome and the associated receptors could be a potential pharmacological strategy since its inhibition would selectively reduce AD neuroinflammation.
Collapse
Affiliation(s)
- Cinzia Severini
- Address correspondence to this author at the Institute of Biochemistry and Cell Biology, National Research Council of Italy, Viale del Policlinico, 155, 00161 Rome, Italy; E-mail:
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Subramaniapillai S, Almey A, Natasha Rajah M, Einstein G. Sex and gender differences in cognitive and brain reserve: Implications for Alzheimer's disease in women. Front Neuroendocrinol 2021; 60:100879. [PMID: 33137359 DOI: 10.1016/j.yfrne.2020.100879] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
Women represent ⅔ of the cases of Alzheimer's disease (AD). Current research has focused on differential risks to explain higher rates of AD in women. However, factors that reduce risk for AD, like cognitive/brain reserve, are less well explored. We asked: what is known about sex and gender differences in how reserve mitigates risk for AD? We conducted a narrative review of the literature, with keywords: "sex/gender differences", "cognitive/brain reserve", "Alzheimer's Disease", and the following cognitive reserve contributors: "education", "IQ", "occupation", "cognitive stimulation", "bilingualism", "socioeconomic status", "physical activity", "social support". Sixteen papers disaggregated their data by sex. Those papers observed sex and gender differences in reserve contributors. There is also evidence that greater reserve may be more beneficial in lowering AD risk in women, although more research is needed. We discuss how traditional reserve contributors are gendered and may not capture factors that support cognition in aging women.
Collapse
Affiliation(s)
- Sivaniya Subramaniapillai
- Department of Psychology, McGill University, 2001 Avenue McGill College, Montréal, QC H3A 1G1, Canada; Brain Imaging Centre, Douglas Institute Research Centre, 6875 LaSalle Blvd Verdun, Montréal, QC H4H 1R3, Canada.
| | - Anne Almey
- Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada
| | - M Natasha Rajah
- Brain Imaging Centre, Douglas Institute Research Centre, 6875 LaSalle Blvd Verdun, Montréal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, 1033 Avenue des Pins, Montréal, QC H3A 1A1, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada; Rotman Research Institute, Baycrest Hospital, 3560 Bathurst St, Toronto, ON M6A 2E1, Canada; Tema Genus, Linköping University, TEMA-huset, Entrance 37, Room E433, Campus Valla, Linköping, Sweden
| |
Collapse
|
22
|
Kvello-Alme M, Bråthen G, White LR, Sando SB. Time to Diagnosis in Young Onset Alzheimer's Disease: A Population-Based Study from Central Norway. J Alzheimers Dis 2021; 82:965-974. [PMID: 34120901 PMCID: PMC8461696 DOI: 10.3233/jad-210090] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Young onset dementia is associated with a longer time to diagnosis compared to late onset dementia. Earlier publications have indicated that atypical presentation is a key contributing factor to the diagnostic delay. Our hypothesis was that even the most common presentation of Alzheimer's disease is associated with a substantial diagnostic delay in patients < 65 years. OBJECTIVE To determine the time to diagnosis, and time lags in the diagnostic pathway in typical young onset Alzheimer's disease in central Norway. METHODS The main sources of patients were the databases at the Department of Neurology, University Hospital of Trondheim (St. Olav's Hospital), and Department of Psychiatry, Levanger Hospital. Other sources included key persons in the communities, collaborating hospital departments examining patients with suspected cognitive impairment, and review of hospital records of all three hospitals in the area. Information on the time lags, and the clinical assessment, including the use of biomarkers, was collected from hospital notes. Caregivers were interviewed by telephone. RESULTS Time from first symptom to diagnosis in typical young onset Alzheimer's disease was 5.5 years (n = 223, SD 2.8). Time from onset to contact with healthcare services (usually a general practitioner) was 3.4 years (SD 2.3). Time from contact with healthcare services to the first visit at a hospital was 10.3 months (SD 15.5). Time from first visit at a hospital to diagnosis was 14.8 months (SD 22.6). The analysis of cerebrospinal fluid core biomarkers was performed after 8.3 months (SD 20.9). CONCLUSION Typical Alzheimer's disease is associated with a substantial diagnostic delay in younger patients. Raising public awareness, and education of healthcare professionals on the aspects of young onset Alzheimer's disease is warranted. CSF core biomarkers should be performed earlier in the hospital evaluation process.
Collapse
Affiliation(s)
- Marte Kvello-Alme
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
- Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Geir Bråthen
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim, Norway
| | - Linda R. White
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Sigrid Botne Sando
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim, Norway
| |
Collapse
|
23
|
Bertsias AK, Tsiligianni I, Papadakis S, Zaganas I, Duijker G, Symvoulakis EK, Papadokostakis P, Makri K, Iatraki E, Tziraki C, Basta M, Panagiotakis S, Boumpas D, Moschandreas J, Simos P, Vgontzas A, Lionis C. Cognitive impairment in a primary healthcare population: a cross-sectional study on the island of Crete, Greece. BMJ Open 2020; 10:e035551. [PMID: 32973052 PMCID: PMC7517574 DOI: 10.1136/bmjopen-2019-035551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/21/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Cognitive impairment is known to have a significant impact on the quality of life of individuals and their caregivers, yet it is often underdiagnosed. The objective of this study is to assess the extent of cognitive impairment among elders visiting primary healthcare (PHC) practice settings, to explore associated risk factors and discuss current care challenges for PHC providers. DESIGN A cross-sectional study was conducted between March 2013 and May 2014. SETTING Fourteen PHC units located in rural and urban areas of the Heraklion district in Crete, Greece. PARTICIPANTS Consecutive visitors aged at least 60 years attending selected PHC practices. PRIMARY AND SECONDARY OUTCOME MEASURES The Mini-Mental State Examination (MMSE) was used to indicate cognitive status. Associations of low MMSE scores (≤23/24, adjusted for education level) with 12 socio-demographic factors, comorbidities and lifestyle factors were assessed. RESULTS A total of 3140 PHC patients met inclusion criteria (43.2% male; mean age 73.7±7.8 years). The average MMSE score was 26.0±3.8; 26.7±3.5 in male and 25.4±3.9 in female participants (p<0.0001). Low MMSE scores were detected in 20.2% of participants; 25.9% for females vs 12.8% for males; p<0.0001. Female gender (adjusted OR (AOR)=2.72; 95% CI 2.31 to 3.47), age (AOR=1.11; 95% CI 1.10 to 1.13), having received only primary or no formal education (AOR=2.87; 95% CI 2.26 to 3.65), alcohol intake (AOR=1.19; 95% CI 1.03 to 1.37), reporting one or more sleep complaints (AOR 1.63; 95% CI 1.14 to 2.32), dyslipidaemia (AOR=0.80; 95% CI 0.65 to 0.98) and history of depression (AOR=1.90; 95% CI 1.43 to 2.52) were associated with low MMSE scores. CONCLUSIONS This study identified a relatively high prevalence of low MMSE scores among persons attending PHC practices in a southern European community setting and associations with several known risk factors.
Collapse
Affiliation(s)
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Sophia Papadakis
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ioannis Zaganas
- Department of Neurology, University of Crete Faculty of Medicine, Heraklion, Greece
| | - George Duijker
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Polyvios Papadokostakis
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Kornilia Makri
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Eliza Iatraki
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Chariklia Tziraki
- Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel
| | - Maria Basta
- Department of Psychiatry, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Simeon Panagiotakis
- Department of Internal Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Dimitrios Boumpas
- Department of Internal Medicine, National and Kapodistrian University of Athens Faculty of Medicine, Athens, Greece
| | - Joanna Moschandreas
- Department of Social Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Panagiotis Simos
- Department of Psychiatry, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Alexandros Vgontzas
- Department of Psychiatry, University of Crete Faculty of Medicine, Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
| |
Collapse
|
24
|
Ambrosino I, Vacante M, Politi C, Barbagelata E, Ciarambino T. Sexual differences regarding Alzheimer’s disease: a narrative review. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
25
|
Pytka D, Czarkowska-Paczek B. Cognitive Function Is a Prognostic Factor for Mortality of Nursing Home Residents during a 3-Year Observational Period. Dement Geriatr Cogn Dis Extra 2020; 10:163-171. [PMID: 33442393 PMCID: PMC7772873 DOI: 10.1159/000509543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Assessing cognitive function could help to provide appropriate care for nursing home residents. The aim of the study was to identify the factors affecting cognitive function in nursing home residents in Poland and assess how it influenced the mortality rate during a 3-year observational period. Methods This study included 202 elderly individuals from a nursing home in 2015. The investigation included examination of cognitive function using the MMSE and bioelectrical impedance analysis. Collected data included sex, age, blood pressure (BP), heart rate, number of comorbidities, years spent in the nursing home, educational level, and cigarette-smoking. Results The mean MMSE score was 21.36 ± 6.35, which was negatively correlated with age and diastolic BP (p = 0.001 and p = 0.024, respectively) and positively correlated with body mass, BMI, fat-free mass, fat, muscle mass, and education level (p = 0.004, p = 0.004, p = 002, p = 0.049, p = 0.005, and p ˂ 0.001, respectively). Patients who died during the observational period had lower MMSE scores than those who survived (23.34 ± 5.68 vs. 20.16 ± 6.45; p < 0.001). Smokers had better MMSE results than nonsmokers (23.34 ± 5.98 vs. 20.08 ± 4.94; p < 0.001). Discussion Polish nursing home residents had mild cognitive impairment depending on their age, sex, educational level, and nutritional status. Lower MMSE score was a prognostic factor for mortality in the 3-year observational period.
Collapse
Affiliation(s)
- Dorota Pytka
- Department of Clinical Nursing, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
26
|
Saad SHS, Alashwah MMA, Alsafa AA, Dawoud MA. The role of brain structural magnetic resonance imaging in the assessment of hippocampal subfields in Alzheimer’s disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Volumetric MR neuroimaging can visualize the pattern of hippocampal subfield atrophic changes in AD. This can be used as a biomarker in early diagnosis of AD and allow early treatment to improve memory, behavioral symptoms, and delay the cognitive deterioration. The aim of this work is to assess the role of the volumetric study of different hippocampal subfields as a post-processing technique of structural MR imaging in patients with Alzheimer’s disease of different severity of cognitive functions. The regional ethics committee approved the study and written informed consent was obtained from all participants. In the duration from 2016 to 2018, a cross-sectional study was conducted on 30 patients (17 males and 13 females) and 15 healthy elderly controls (9 males and 6 females) referred to the Radiodiagnosis Department from the Neuropsychiatry Department. Patients were diagnosed with AD by clinical examination and using the Mini Mental State Examination (MMSE) and the Clinical Dementia Rating scale (CDR) as a measure of general cognitive performance.
Results
CA1 and subiculum subfields were significantly reduced in size in patients with Alzheimer’s disease in relation to the age-matched control group (P < 0.05). This finding was positively correlated with the MMSE score and negatively correlated with CDR clinical tests. No significant atrophy was found among other hippocampal subfields in the patients’ group.
Conclusion
This study proposed a new approach to detect atrophy in hippocampal subfields, using MR volumetric study of high-resolution T1 images, that can be used as a biomarker in the diagnosis of AD patients and differentiating them from elderly control subjects which is important in early diagnosis of AD and hence the proper treatment to improve the prognosis of the cognitive function.
Collapse
|
27
|
Ferretti MT, Martinkova J, Biskup E, Benke T, Gialdini G, Nedelska Z, Rauen K, Mantua V, Religa D, Hort J, Santuccione Chadha A, Schmidt R. Sex and gender differences in Alzheimer's disease: current challenges and implications for clinical practice: Position paper of the Dementia and Cognitive Disorders Panel of the European Academy of Neurology. Eur J Neurol 2020; 27:928-943. [PMID: 32056347 DOI: 10.1111/ene.14174] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
Abstract
Alzheimer's disease (AD) is characterized by high heterogeneity in disease manifestation, progression and risk factors. High phenotypic variability is currently regarded as one of the largest hurdles in early diagnosis and in the design of clinical trials; there is therefore great interest in identifying factors driving variability that can be used for patient stratification. In addition to genetic and lifestyle factors, the individual's sex and gender are emerging as crucial drivers of phenotypic variability. Evidence exists on sex and gender differences in the rate of cognitive deterioration and brain atrophy, and in the effect of risk factors as well as in the patterns of diagnostic biomarkers. Such evidence might be of high relevance and requires attention in clinical practice and clinical trials. However, sex and gender differences are currently seldom appreciated; importantly, consideration of sex and gender differences is not currently a focus in the design and analysis of clinical trials for AD. The objective of this position paper is (i) to provide an overview of known sex and gender differences that might have implications for clinical practice, (ii) to identify the most important knowledge gaps in the field (with a special regard to clinical trials) and (iii) to provide conclusions for future studies. This scientific statement is endorsed by the European Academy of Neurology.
Collapse
Affiliation(s)
- M T Ferretti
- Institute for Regenerative Medicine - IREM, University of Zurich, Zurich, Switzerland.,Women's Brain Project, Guntershausen, Switzerland
| | - J Martinkova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - E Biskup
- College of Fundamental Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China.,Division of Internal Medicine, University Hospital of Basel, Basel, Switzerland
| | - T Benke
- Neurology Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - G Gialdini
- Neurology - Private Practice, Lucca, Italy
| | - Z Nedelska
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - K Rauen
- Institute for Regenerative Medicine - IREM, University of Zurich, Zurich, Switzerland.,Women's Brain Project, Guntershausen, Switzerland.,Department of Geriatric Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - V Mantua
- Italian Medicines Agency, Rome, Italy
| | - D Religa
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - J Hort
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - A Santuccione Chadha
- Women's Brain Project, Guntershausen, Switzerland.,Global Medical and Scientific Affairs, Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | - R Schmidt
- Department of Neurogeriatrics, University Clinic of Neurology, Medical University Graz, Graz, Austria
| |
Collapse
|
28
|
Abstract
Alzheimer disease (AD) is characterized by wide heterogeneity in cognitive and behavioural syndromes, risk factors and pathophysiological mechanisms. Addressing this phenotypic variation will be crucial for the development of precise and effective therapeutics in AD. Sex-related differences in neural anatomy and function are starting to emerge, and sex might constitute an important factor for AD patient stratification and personalized treatment. Although the effects of sex on AD epidemiology are currently the subject of intense investigation, the notion of sex-specific clinicopathological AD phenotypes is largely unexplored. In this Review, we critically discuss the evidence for sex-related differences in AD symptomatology, progression, biomarkers, risk factor profiles and treatment. The cumulative evidence reviewed indicates sex-specific patterns of disease manifestation as well as sex differences in the rates of cognitive decline and brain atrophy, suggesting that sex is a crucial variable in disease heterogeneity. We discuss critical challenges and knowledge gaps in our current understanding. Elucidating sex differences in disease phenotypes will be instrumental in the development of a 'precision medicine' approach in AD, encompassing individual, multimodal, biomarker-driven and sex-sensitive strategies for prevention, detection, drug development and treatment.
Collapse
|
29
|
Identifying an Optimal Cutoff of the Montreal Cognitive Assessment to Predict Amyloid-PET Positivity in a Referral Memory Clinic. Alzheimer Dis Assoc Disord 2019; 33:194-199. [PMID: 31305321 DOI: 10.1097/wad.0000000000000330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Brain amyloid- positron emission tomography (PET) imaging is highly sensitive for identifying Alzheimer disease. Currently, there is a lack of insight on the association between amyloid-PET status and the widely used Montreal cognitive assessment (MoCA). Studying this relationship may optimize the clinical use of amyloid-PET imaging. OBJECTIVES To evaluate the relationship between amyloid-PET status and MoCA scores and to identify a MoCA score cutoff that translates to amyloid-PET positivity. METHODS Using retrospective chart review, patients from 2010 to 2017 with amyloid-PET scans (positive or negative) and MoCA test scores were included. We studied the relationship between amyloid-PET status and MoCA scores and the influence of age, sex, education, and race. A MoCA score cutoff for amyloid-PET positivity was estimated. RESULTS Among the 684 clinic patients with dementia, 99 fulfilled inclusion criteria. Amyloid-PET positivity was associated significantly with lower MoCA scores (median=19, U=847, P=0.01). The MoCA score cutoff (25) used for minimal cognitive impairment (MCI) predicted amyloid-PET positivity suboptimally (sensitivity=94.6%, specificity=13.9%). A MoCA score cutoff of 20 patients had optimal sensitivity (64.2%) and specificity (67.4%). CONCLUSIONS Amyloid-PET positivity is associated with lower MoCA scores. Clinical utility of amyloid-PET scan is likely to be suboptimal at the MoCA score cutoff for minimal cognitive impairment.
Collapse
|
30
|
Epelbaum S, Paquet C, Hugon J, Dumurgier J, Wallon D, Hannequin D, Jonveaux T, Besozzi A, Pouponneau S, Hommet C, Blanc F, Berly L, Julian A, Paccalin M, Pasquier F, Bellet J, Boutoleau-Bretonniere C, Charriau T, Rouaud O, Madec O, Mouton A, David R, Bekadar S, Fabre R, Liegey E, Deberdt W, Robert P, Dubois B. How many patients are eligible for disease-modifying treatment in Alzheimer's disease? A French national observational study over 5 years. BMJ Open 2019; 9:e029663. [PMID: 31239309 PMCID: PMC6597622 DOI: 10.1136/bmjopen-2019-029663] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to study the epidemiology of the prodromal and mild stages of Alzheimer's disease (AD) patients who are eligible for clinical trials with disease-modifying therapies. SETTINGS We analysed two large complementary databases to study the incidence and characteristics of this population on a nationwide scope in France from 2014 to 2018. The National Alzheimer Database contains data from 357 memory centres and 90 private neurologists. Data from 2014 to 2018 have been analysed. PARTICIPANTS Patients, 50-85 years old, diagnosed with AD who had an Mini-Mental State Exam (MMSE) score of ≥20 were included. We excluded patients with mixed and non-AD neurocognitive disorders. PRIMARY OUTCOME MEASURE Descriptive statistics of the population of interest was the primary measure. RESULTS In the National Alzheimer Database, 550 198 patients were assessed. Among them, 72 174 (13.1%) were diagnosed with AD and had an MMSE ≥20. Using corrections for specificity of clinical diagnosis of AD, we estimated that about 50 000 (9.1%) had a prodromal or mild AD. In the combined electronic clinical records database of 11 French expert memory centres, a diagnosis of prodromal or mild AD, certified by the use of cerebrospinal fluid AD biomarkers, could be established in 195 (1.3%) out of 14 596 patients. CONCLUSIONS AD was not frequently diagnosed at a prodromal or mild dementia stage in France in 2014 to 2018. Diagnosis rarely relied on a pathophysiological marker even in expert memory centres. National databases will be valuable to monitor early stage AD diagnosis efficacy in memory centres when a disease-modifying treatment becomes available.
Collapse
Affiliation(s)
- Stéphane Epelbaum
- Institute of Memoryand Alzheimer’s Disease (IM2A) and Brain and Spine Institute(ICM) UMR S 1127, Inria, Aramis-Project Team, Department of Neurology, AP-HP, Pitié-Salpêtrière University Hospital, Sorbonne Universities, Pierre et Marie Curie University, Paris 06 and National Reference Center for Rare or Early Dementias and Center of Excellence of Neurodegenerative Disease (CoEN), Paris, France
| | - Claire Paquet
- Neurology Memory Center, Lariboisière FW Saint Louis University Hospital, Paris, France
| | - Jacques Hugon
- Center of Cognitive Neurology, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, France
- Cognitive Neurology Center, CMRR Paris-Nord Ile-de-France, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, France
| | - Julien Dumurgier
- Cognitive Neurology Center, CMRR Paris-Nord Ile-de-France, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, France
- U942 Team Biomarkers and Neurocognition, INSERM/Université Paris Diderot, Paris, France
| | - David Wallon
- Department of Neurology, Rouen University Hospital, Rouen, France
| | | | | | | | | | | | - Frederic Blanc
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | | | | | - Marc Paccalin
- Geriatrics Department University Hospital La Milétrie, Poitiers, France
| | - Florence Pasquier
- Neurology, Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | - Julie Bellet
- Neurology, Centre Hospitalier Regional Universitaire de Lille Pole Neurosciences et Appareil Locomoteur, Lille, France
| | | | | | | | | | - Aurélie Mouton
- Department of Neuropsychiatry, CHU de nice, Nice, France
| | - Renaud David
- Centre Mémoire de Ressources et de Recherche, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Samir Bekadar
- Department of Clinical Research, Institut du cerveau et de la moelle epiniere, Paris, France
| | - Roxane Fabre
- Department of Neuropsychiatry, CHU de nice, Nice, France
| | - Emmanuelle Liegey
- Délégation à la Recherche Clinique et à l’Innovation, Assistance publique–Hôpitaux de Paris, Paris, France
| | - Walter Deberdt
- Medical Department, Eli Lilly and Co, Indianapolis, Indiana, USA
| | | | - Bruno Dubois
- Neurology, CHU de la Pitiè Salpêtrière-AP-HP, Paris, France
| |
Collapse
|
31
|
Garnier-Crussard A, Vernaudon J, Auguste N, Moutet C, Dauphinot V, Krolak-Salmon P. Perception of Benefits and Risks of Neurocognitive Disorders Diagnosis: A French National Survey. J Alzheimers Dis 2019; 67:1267-1275. [DOI: 10.3233/jad-180403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Antoine Garnier-Crussard
- Claude Bernard University Lyon 1, France
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon, France
| | - Julien Vernaudon
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon, France
| | - Nicolas Auguste
- Clinical and Research Memory Center of Saint-Etienne, France
| | - Claire Moutet
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon, France
| | - Virginie Dauphinot
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon, France
| | - Pierre Krolak-Salmon
- Claude Bernard University Lyon 1, France
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon, France
- French Federation of Memory Centers, France
| |
Collapse
|
32
|
Schultz RR, Fernandez PEL, Novo NF, Juliano Y, Wajman JR. Prevalence of dementia among widowed and non-widowed patients and associated clinical and sociodemographic characteristics. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.180122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to verify if the prevalence of dementia differs between widowed and non-widowed elderly persons and between genders, and to analyse if there is an association with sociodemographic and clinical characteristics. Method: a retrospective cross-sectional observational study of patients treated at a Behavioral Neurology outpatient clinic from 1999 to 2009 was carried out, employing anamnesis, physical and neurological examination, the Clinical Dementia Rating Scale (CDR) and the Mini Mental State Examination (MMSE). Sociodemographic (schooling and age) and clinical (age of onset of symptoms and time since onset of symptoms, MMSE and CDR) variables were analyzed. The differences were evaluated by the Mann Whitney test, using a significance value of p<0.05. Results: of 208 patients diagnosed with dementia, 73 (35.1%) were widowed and 135 (64.9%) were non-widowed. Those who were widowed were older than those who were non-widowed (p<0.001) when diagnosed with dementia. This difference in age remained when gender (p<0.001), widowed and widowed women (p<0.001) and widowed and non-widowed men (p<0.001) were compared. The time from onset of symptoms to diagnosis was greater in widowed than in non-widowed men [55.6 (± 86.3) vs. 43.4 (± 44.8) months], although the difference was not statistically significant. Widowed patients with dementia had lower schooling, regardless of gender (p<0.05). Conclusion: the prevalence of dementia differed between widowed and non-widowed individuals, being higher among non-widows. There was an association between widowhood and the clinical and sociodemographic characteristics, with differences between the genders. The loss of a spouse can generate different outcomes among men and women, necessitating measures with a specific focus on prevention and strategies of care in dementia.
Collapse
|
33
|
Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process. Can J Aging 2018; 38:90-99. [PMID: 30404681 DOI: 10.1017/s0714980818000442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs.
Collapse
|
34
|
Koskas P, Pons-Peyneau C, Romdhani M, Houenou-Quenum N, Tigue-Wato A, Galleron S, Drunat O. Effectiveness of multidisciplinary consultation for older adults with Alzheimer's disease in response to acute situations. Encephale 2018; 44:491-495. [PMID: 29887303 DOI: 10.1016/j.encep.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND To avoid emergency hospitalisation of elderly people with dementia, which often has negative consequences, there are two main approaches: consultation and day care hospitalisation. However, it usually takes some time to arrange a consultation, and geriatric day hospital facilities are over-subscribed and costly. In 2014, we created a "consultation de crise" (CMC) programme in our sector of Paris, with several special features: a short wait for an appointment, a consultation involving an interdisciplinary team, a weekly multi-disciplinary meeting to reassess complex patients, and the possibility of a rapid referral to a social worker. METHODS To determine whether the CMC programme is a useful way to minimise hospitalization among elderly community-dwelling populations, and to examine its design criteria. Retrospective review of all CMC requests from April 2014 to January 2017 in comparison with consultation at the Memory Center and geriatric day hospital. CMC patients were followed up at one month after their assessment. RESULTS Mini Mental Status and Neuro Psychiatric Inventory vary significantly different between the 3 groups. The CMC group had the lowest score on the MMSE scale and the highest for NPI. After one month, 60% of CMC patients were still at home (33 patients) or in the same nursing home (6 patients) and about 23% were hospitalized during the follow-up period. CONCLUSION Our study showed the potential value of a less expensive multidisciplinary consultation, and confirmed that collaborative care resulted in a significant improvement in the quality of care.
Collapse
Affiliation(s)
- P Koskas
- Memory Center, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France.
| | - C Pons-Peyneau
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - M Romdhani
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - N Houenou-Quenum
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - A Tigue-Wato
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - S Galleron
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| | - O Drunat
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, 23, rue Joseph-de-Maistre 75018 Paris, France
| |
Collapse
|
35
|
Paraskevaidi M, Martin-Hirsch PL, Martin FL. Progress and Challenges in the Diagnosis of Dementia: A Critical Review. ACS Chem Neurosci 2018; 9:446-461. [PMID: 29390184 DOI: 10.1021/acschemneuro.8b00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Longer life expectancies have led to an increased number of neurodegenerative disease cases globally. Accurate diagnosis of this devastating disorder is of crucial importance but is still feasible only by a brain biopsy after death. An enormous amount of attention and research has been in place over the years toward the better understanding of the mechanisms, as well as the early diagnosis, of neurodegeneration. However, numerous studies have been contradictory from time to time, while new diagnostic methods are constantly developed in a tireless effort to tackle the disease. Nonetheless, there is not yet a conclusive report covering a broader range of techniques for the diagnosis of different types of dementia. In this paper, we critically review current knowledge on the different hypotheses about the pathogenesis of distinct types of dementia, as well as risk factors and current diagnostic approaches in a clinical setting, including neuroimaging, cerebrospinal (CSF), and blood tests. Encouraging research results for the diagnosis and investigation of neurodegenerative disorders are also reported. Particular attention is given to the field of spectroscopy as an emerging tool to detect dementias, follow-up patients, and potentially monitor the patients' response to a therapeutic approach. Spectroscopic techniques, such as infrared and Raman spectroscopy, have facilitated numerous disease-related studies, including neurodegenerative disorders, and are currently undergoing trials for clinical implementation. This review constitutes a comprehensive report with an in-depth focus on promising imaging, molecular biomarker and spectroscopic tests in the field of dementive diseases.
Collapse
Affiliation(s)
- Maria Paraskevaidi
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
| | - Pierre L. Martin-Hirsch
- Department of Obstetrics and Gynaecology, Central Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, United Kingdom
| | - Francis L. Martin
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdon
| |
Collapse
|
36
|
Henneges C, Reed C, Chen YF, Dell'Agnello G, Lebrec J. Describing the Sequence of Cognitive Decline in Alzheimer's Disease Patients: Results from an Observational Study. J Alzheimers Dis 2017; 52:1065-80. [PMID: 27079700 PMCID: PMC4927893 DOI: 10.3233/jad-150852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Improved understanding of the pattern of cognitive decline in Alzheimer’s disease (AD) would be useful to assist primary care physicians in explaining AD progression to patients and caregivers. Objective: To identify the sequence in which cognitive abilities decline in community-dwelling patients with AD. Methods: Baseline data were analyzed from 1,495 patients diagnosed with probable AD and a Mini-Mental State Examination (MMSE) score ≤ 26 enrolled in the 18-month observational GERAS study. Proportional odds logistic regression models were applied to model MMSE subscores (orientation, registration, attention and concentration, recall, language, and drawing) and the corresponding subscores of the cognitive subscale of the Alzheimer’s Disease Assessment Scale (ADAS-cog), using MMSE total score as the index of disease progression. Probabilities of impairment start and full impairment were estimated at each MMSE total score level. Results: From the estimated probabilities for each MMSE subscore as a function of the MMSE total score, the first aspect of cognition to start being impaired was recall, followed by orientation in time, attention and concentration, orientation in place, language, drawing, and registration. For full impairment in subscores, the sequence was recall, drawing, attention and concentration, orientation in time, orientation in place, registration, and language. The sequence of cognitive decline for the corresponding ADAS-cog subscores was remarkably consistent with this pattern. Conclusion: The sequence of cognitive decline in AD can be visualized in an animation using probability estimates for key aspects of cognition. This might be useful for clinicians to set expectations on disease progression for patients and caregivers.
Collapse
Affiliation(s)
| | - Catherine Reed
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
| | | | | | | |
Collapse
|
37
|
Sakuma N, Ura C, Miyamae F, Inagaki H, Ito K, Niikawa H, Ijuin M, Okamura T, Sugiyama M, Awata S. Distribution of Mini-Mental State Examination scores among urban community-dwelling older adults in Japan. Int J Geriatr Psychiatry 2017; 32:718-725. [PMID: 27427308 DOI: 10.1002/gps.4513] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The Mini-Mental State Examination (MMSE) is widely used as a cognitive screening test for older adults; however, cognitive performance can be affected by age, education, and sample selection bias, including time and place. The aims of this study were to examine the distribution of scores on the Japanese version of the MMSE in an urban community sample and to provide normative data for older Japanese adults. METHODS A questionnaire survey was conducted on all residents aged 65 years and older living in an urban district in Tokyo (N = 7682). From among this population, 3000 residents were randomly selected to receive visits from trained nurses and to have their health status checked and their cognitive function examined using the MMSE. RESULTS Of the 2786 eligible residents, the MMSE was administered to 1341 (47%) and successfully completed by 1319 (mean age, 74.4 ± 6.4 years; mean years of formal education, 12.6 ± 2.9). The median score was 28. A total of 143 residents (10.8%) had scores below the traditional 23/24 cutoff point. Younger age and higher education were associated with better performance. Greater variation was seen among the oldest and least educated residents, especially among women. CONCLUSION The results of this study confirm that age and education affect MMSE scores. To ensure the effective use of the MMSE, it is recommended to examine scores corresponding to age and education. The normative data presented are expected to be useful for assessing MMSE scores in older individuals both in and out of the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Naoko Sakuma
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Chiaki Ura
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroki Inagaki
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kae Ito
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirotoshi Niikawa
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mutsuo Ijuin
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mika Sugiyama
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| |
Collapse
|
38
|
Factors influencing time between onset of signs/symptoms and referral for dementia in elderly outpatients. Rev Neurol (Paris) 2017; 174:36-43. [PMID: 28595977 DOI: 10.1016/j.neurol.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/09/2017] [Accepted: 04/27/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The few studies that have focused on Time between Onset of Signs and Symptoms and Referral (TOSR) for dementia to a memory center suggest a substantial delay of 1-3 years. This delay has a negative impact on both patients' and their caregivers' quality of life. OBJECTIVE This study aimed to evaluate this delay and the factors associated with it in a cohort of community-dwelling elderly people attending a memory clinic, as well as assess the impact of the Third French National Alzheimer Plan (2008-2012). METHODS All patients referred to the Bretonneau Memory Clinic for the first time between January 2006 (the clinic has maintained a specific database since then) and March 2016 were included in the study. RESULTS Of the 8543 patients attending our Memory Clinic during the study period, 3353 attending for the first time and with complete data were included. Briefly, their ages were 82±7 years, and 67.2% were female; MMSE score was 21.2±6.6, IADL was 4.06±0.78 and the social-needs category of the Groupes Iso Ressources (GIR); Iso-Resource Group (IRG) scale was 4.04±0.37. The TOSR was, on average, 35.4±30.24 months, and increased after implementation of the Third French National Alzheimer Plan, from 26.68±26.28 months before 2009 to 40.08±31.2 months after 2009. Age and MMSE were associated with TOSR, but not the type of dementia, household composition and social characteristics. Also, there was a shorter TOSR for mild cognitive impairment than for dementia patients. CONCLUSION Our results emphasize the need for more education and information among the general public about the early signs of cognitive impairment, especially in elderly people.
Collapse
|
39
|
Hornberger J, Bae J, Watson I, Johnston J, Happich M. Clinical and cost implications of amyloid beta detection with amyloid beta positron emission tomography imaging in early Alzheimer's disease - the case of florbetapir. Curr Med Res Opin 2017; 33:675-685. [PMID: 28035842 DOI: 10.1080/03007995.2016.1277197] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Amyloid beta (Aβ) positron emission tomography (PET) imaging helps estimate Aβ neuritic plaque density in patients with cognitive impairment who are under evaluation for Alzheimer's disease (AD). This study aims to evaluate the cost-effectiveness of the Aβ-PET scan as an adjunct to standard diagnostic assessment for diagnosis of AD in France, using florbetapir as an example. METHODS A state-transition probability analysis was developed adopting the French Health Technology Assessment (HTA) perspective per guidance. Parameters included test characteristics, rate of cognitive decline, treatment effect, costs, and quality of life. Additional scenarios assessed the validity of the analytical framework, including: (1) earlier evaluation/treatment; (2) cerebrospinal fluid (CSF) as a comparator; and (3) use of other diagnostic procedures. Outputs included differences in quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). All benefits and costs were discounted for time preferences. Sensitivity analyses were performed to assess the robustness of findings and key influencers of outcomes. RESULTS Aβ-PET used as an adjunct to standard diagnostic assessment increased QALYs by 0.021 years and 10 year costs by €470 per patient. The ICER was €21,888 per QALY gained compared to standard diagnostic assessment alone. When compared with CSF, Aβ-PET costs €24,084 per QALY gained. In other scenarios, Aβ-PET was consistently cost-effective relative to the commonly used affordability threshold (€40,000 per QALY). Over 95% of simulations in the sensitivity analysis were cost-effective. CONCLUSION Aβ-PET is projected to affordably increase QALYs from the French HTA perspective per guidance over a range of clinical scenarios, comparators, and input parameters.
Collapse
Affiliation(s)
- John Hornberger
- a Cedar Associates , Menlo Park , CA USA
- b Stanford University , Stanford , CA USA
| | - Jay Bae
- c Eli Lilly and Company , Indianapolis , IN USA
| | - Ian Watson
- c Eli Lilly and Company , Indianapolis , IN USA
| | | | | |
Collapse
|
40
|
Huda A, Kartamihardja AHS, Darmawan B, Budiawan H, Wiwie M. Metabolic Activity Value in the Posterior Cingulate Cortex Using F-18 Fluorodeoxyglucose Positron Emission Tomography Brain to Predict the Severity of Alzheimer's. World J Nucl Med 2017; 16:108-113. [PMID: 28553176 PMCID: PMC5436315 DOI: 10.4103/1450-1147.203075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Alzheimer's disease (AD) is a type of dementia which is known as one of a major problem in elderly. Clinicians commonly use mini-mental state examination (MMSE) score to determine the severity of cognitive decline, but MMSE has some limitations such as more subjective, influenced by age, educational degree, and local culture. F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) can be used to assess the process of glucose metabolism in posterior cingulate cortex (PCC) area which endures a central role in supporting cognitive function directly. The purpose of this study is to observe a correlation between metabolic activity value of PCC and MMSE score in predicting the severity of AD. A cross-sectional study was done to 30 subjects suspect AD disease with aged 60 years and older. Characteristic data including gender, age, and education, MMSE scoring by psychiatrist, and imaging of F-18 FDG PET were established. The results of correlation test between the value of FDG metabolic activity and MMSE score shows that the value of metabolic activity in the PCC area tends to increase along with the increase of MMSE score (rs = 0.411, P = 0.024). While from the results of multiple regression test with predictor variable consisting of F-18 FDG metabolic activity in the PCC, gender, age, education level, and the interaction between the metabolic activity of F-18 FDG at PCC and gender, a regression model was obtained. There is a significant correlation observed between the captured of F-18 FDG radioactivity with MMSE score in PCC area which can be used as a tool to predict the severity of AD.
Collapse
Affiliation(s)
- Aulia Huda
- Department of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, Dr. Hasan Sadikin Hospital, Padjadjaran University, Bandung, Jawa Barat, Indonesia
| | - Achmad Hussein Sundawa Kartamihardja
- Department of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, Dr. Hasan Sadikin Hospital, Padjadjaran University, Bandung, Jawa Barat, Indonesia
| | - Budi Darmawan
- Department of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, Dr. Hasan Sadikin Hospital, Padjadjaran University, Bandung, Jawa Barat, Indonesia
| | - Hendra Budiawan
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre, Siloam Hospital Semanggi, Jakarta, Indonesia
| | - Martina Wiwie
- Department of Mental Health, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
41
|
Teichmann M, Epelbaum S, Samri D, Levy Nogueira M, Michon A, Hampel H, Lamari F, Dubois B. Free and Cued Selective Reminding Test - accuracy for the differential diagnosis of Alzheimer's and neurodegenerative diseases: A large-scale biomarker-characterized monocenter cohort study (ClinAD). Alzheimers Dement 2017; 13:913-923. [PMID: 28222300 DOI: 10.1016/j.jalz.2016.12.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/09/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The International Working Group recommended the Free and Cued Selective Reminding Test (FCSRT) as a sensitive detector of the amnesic syndrome of the hippocampal type in typical Alzheimer's disease (AD). But does it differentiate AD from other neurodegenerative diseases? METHODS We assessed the FCSRT and cerebrospinal fluid (CSF) AD biomarkers in 992 cases. Experts, blinded to biomarker data, attributed in 650 cases a diagnosis of typical AD, frontotemporal dementia, posterior cortical atrophy, Lewy body disease, progressive supranuclear palsy, corticobasal syndrome, primary progressive aphasias, "subjective cognitive decline," or depression. RESULTS The FCSRT distinguished typical AD from all other conditions with a sensitivity of 100% and a specificity of 75%. Non-AD neurodegenerative diseases with positive AD CSF biomarkers ("atypical AD") did not have lower FCSRT scores than those with negative biomarkers. DISCUSSION The FCSRT is a reliable tool for diagnosing typical AD among various neurodegenerative diseases. At an individual level, however, its specificity is not absolute. Our findings also widen the spectrum of atypical AD to multiple neurodegenerative conditions.
Collapse
Affiliation(s)
- Marc Teichmann
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Centre de Référence 'Démences Rares', Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Institut du Cerveau et de la Moelle Epinière (ICM), ICM-INSERM 1127, FrontLab, Paris, France.
| | - Stéphane Epelbaum
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Centre de Référence 'Démences Rares', Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Institut du Cerveau et de la Moelle Epinière (ICM), ICM-INSERM 1127, Team Alzheimer's and Prions Diseases, Paris, France
| | - Dalila Samri
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Centre de Référence 'Démences Rares', Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Marcel Levy Nogueira
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Centre de Référence 'Démences Rares', Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Ecole Polytechnique, LIX, Paris-Saclay University, Palaiseau, France
| | - Agnès Michon
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Centre de Référence 'Démences Rares', Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Harald Hampel
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Centre de Référence 'Démences Rares', Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; AXA Research Fund and UPMC, Sorbonne Universities, Pierre and Marie Curie University, Paris 06, INSERM, CNRS, Brain and Spine Institute (ICM), Paris, France
| | - Foudil Lamari
- Department of Metabolic Biochemistry, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Bruno Dubois
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Centre de Référence 'Démences Rares', Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Institut du Cerveau et de la Moelle Epinière (ICM), ICM-INSERM 1127, FrontLab, Paris, France
| |
Collapse
|
42
|
The association between SBP and mortality risk differs with level of cognitive function in very old individuals. J Hypertens 2016; 34:745-52. [PMID: 26938812 PMCID: PMC4947532 DOI: 10.1097/hjh.0000000000000831] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: Cognitive impairment and dementia are highly prevalent in very old populations. Cardiovascular disease is a common cause of death in people with dementia. This study investigated whether the association of blood pressure (BP) with mortality differed with respect to mini-mental state examination (MMSE) score in a representative sample of very old individuals. Methods: The sample consisted of 1115 participants aged 85, 90, and at least 95 years from the Umeå85+/GErontological Regional DAtabase cohort study. The main outcome was all-cause mortality within 2 years according to BP and MMSE score, using Cox proportional-hazard regression models adjusted for sociodemographic and clinical characteristics associated with death. Results: Mean age, MMSE score, and SBP and DBP were 89.4 ± 4.6 years, 21.1 ± 7.6, 146.1 ± 23.4 mmHg, and 74.1 ± 11.7 mmHg, respectively. Within 2 years, 293 (26%) participants died. BP was not associated independently with mortality risk, except among participants with MMSE scores of 0–10 among whom mortality risk was increased in association with SBP at least 165 mmHg and 125 mmHg or less, compared with 126–139 mmHg (adjusted hazard ratio 4.54, 95% confidence interval = 1.52–13.60 and hazard ratio 2.23, 95% confidence interval = 1.12–4.45, respectively). In age and sex-adjusted analyses, SBP 125 mmHg or less was associated with increased mortality risk in participants with MMSE scores at least 18. Conclusion: In people aged at least 85 years, the association of SBP with mortality appears to differ with respect to MMSE score. Very old individuals with very severe cognitive impairment and low or high BP may have increased mortality risk.
Collapse
|
43
|
Falahati F, Ferreira D, Soininen H, Mecocci P, Vellas B, Tsolaki M, Kłoszewska I, Lovestone S, Eriksdotter M, Wahlund LO, Simmons A, Westman E. The Effect of Age Correction on Multivariate Classification in Alzheimer's Disease, with a Focus on the Characteristics of Incorrectly and Correctly Classified Subjects. Brain Topogr 2015; 29:296-307. [PMID: 26440606 PMCID: PMC4754326 DOI: 10.1007/s10548-015-0455-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Abstract
The similarity of atrophy patterns in Alzheimer’s disease (AD) and in normal aging suggests age as a confounding factor in multivariate models that use structural magnetic resonance imaging (MRI) data. To study the effect and compare different age correction approaches on AD diagnosis and prediction of mild cognitive impairment (MCI) progression as well as investigate the characteristics of correctly and incorrectly classified subjects. Data from two multi-center cohorts were included in the study [AD = 297, MCI = 445, controls (CTL) = 340]. 34 cortical thickness and 21 subcortical volumetric measures were extracted from MRI. The age correction approaches involved: using age as a covariate to MRI-derived measures and linear detrending of age-related changes based on CTL measures. Orthogonal projections to latent structures was used to discriminate between AD and CTL subjects, and to predict MCI progression to AD, up to 36-months follow-up. Both age correction approaches improved models’ quality in terms of goodness of fit and goodness of prediction, as well as classification and prediction accuracies. The observed age associations in classification and prediction results were effectively eliminated after age correction. A detailed analysis of correctly and incorrectly classified subjects highlighted age associations in other factors: ApoE genotype, global cognitive impairment and gender. The two methods for age correction gave similar results and show that age can partially masks the influence of other aspects such as cognitive impairment, ApoE-e4 genotype and gender. Age-related brain atrophy may have a more important association with these factors than previously believed.
Collapse
Affiliation(s)
- Farshad Falahati
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, Plan 5, 141 57, Stockholm, Sweden.
| | - Daniel Ferreira
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, Plan 5, 141 57, Stockholm, Sweden
| | - Hilkka Soininen
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Bruno Vellas
- INSERM U 558, University of Toulouse, Toulouse, France
| | - Magda Tsolaki
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Simon Lovestone
- Institute of Psychiatry, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, Plan 5, 141 57, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, Plan 5, 141 57, Stockholm, Sweden
| | - Andrew Simmons
- Institute of Psychiatry, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Eric Westman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, Plan 5, 141 57, Stockholm, Sweden
| |
Collapse
|
44
|
Lin Q, Cao Y, Gao J. Decreased expression of the APOA1-APOC3-APOA4 gene cluster is associated with risk of Alzheimer's disease. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:5421-31. [PMID: 26491253 PMCID: PMC4598222 DOI: 10.2147/dddt.s89279] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Apolipoprotein is genetically associated with the risk of Alzheimer’s disease (AD). The APOA1, APOC3, and APOA4 genes are closely linked and located on human chromosome 11. Therefore, this gene cluster may be related to the risk of AD. Patients and methods A total of 147 AD patients and 160 healthy controls were randomly recruited from June 2013 to August 2014. APOA1, APOC3, and APOA4 levels were measured using real-time quantitative reverse-transcriptase polymerase chain reaction and enzyme-linked immunosorbent assay. Results APOA1, APOC3 and APOA4 levels were significantly lower in AD patients than controls (P<0.01). APOA1, APOC3, and APOA4 levels were negatively related with the severities of AD determined by Clinical Dementia Rating scores (P<0.01). APOA1, APOC3, and APOA4 levels showed a negative relation with Montgomery–Åsberg Depression Rating Scale scores and a positive relation with RAND 36-item health-survey scores (P<0.01). There was a decreased trend for levels of APOA1, APOC3, and APOA4 in AD patients. Conclusion Low levels of APOA1, APOC3, and APOA4 are associated with risk of AD. APOA1, APOC3, and APOA4 should be developed as combined drugs for the therapy of AD.
Collapse
Affiliation(s)
- Qiao Lin
- Department of Internal Medicine, Fourth Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yunpeng Cao
- Neural Department of Internal Medicine, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jie Gao
- Department of Anatomy, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| |
Collapse
|
45
|
Lin Q, Cao Y, Gao J. The impacts of a GO-game (Chinese chess) intervention on Alzheimer disease in a Northeast Chinese population. Front Aging Neurosci 2015; 7:163. [PMID: 26379544 PMCID: PMC4548213 DOI: 10.3389/fnagi.2015.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/10/2015] [Indexed: 12/25/2022] Open
Abstract
A GO game can enhance mental health, but its effects on Alzheimer Disease (AD) remains unknown. To address the issue, 147 AD patients were randomly assigned into control (without GO-game intervention), Short-time GO-Game Intervention (SGGI, 1 h daily) and Long-time GO-game Intervention (LGGI, 2 h daily) groups. After 6-month follow-up, the game reduced the mean score of Montgomery-Asberg Depression Rating Scales (MADRS) of 4.72 (95% CI, 0.69 to 9.12) and Hospital Anxiety and Depression Scale (HADS) of 1.75 (95% CI, 0.17–3.68), and increased the mean score of Global Assessment of Functioning (GAF) of 4.95 (95% CI, −1.37–9.18) and RAND-36 of 4.61 (95% CI, −2.75–11.32) (P < 0.05 via controls). A GO-game intervention improved 9 of 11 items of KICA-dep (Kimberley Indigenous Cognitive Assessment of Depression). Meanwhile, serum levels of brain derived neurotrophic factor (BDNF) were higher in SGGI and LGGI groups (24.02 ± 7.16 and 28.88 ± 4.12 ng/ml respectively, P = 0.051) than those in controls (17.28 ± 7.75 ng/ml) (P < 0.001). The serum levels of BDNF showed a negative relation with MADRS and a positive relation with RAND-36 (P < 0.01). A GO-game intervention ameliorates AD manifestations by up-regulating BDNF levels.
Collapse
Affiliation(s)
- Qiao Lin
- Department of Internal Medicine, The Fourth Affiliated Hospital of China Medical University Shenyang, China
| | - Yunpeng Cao
- Neural Department of Internal Medicine, The First Affiliated Hospital of China Medical University Shenyang, China
| | - Jie Gao
- Department of Anatomy, The First Affiliated Hospital of China Medical University Shenyang, China
| |
Collapse
|
46
|
Lin Q, Cao Y, Gao J. Serum calreticulin is a negative biomarker in patients with Alzheimer's disease. Int J Mol Sci 2014; 15:21740-53. [PMID: 25429433 PMCID: PMC4284675 DOI: 10.3390/ijms151221740] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/03/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022] Open
Abstract
Calreticulin is down-regulated in the cortical neurons of patients with Alzheimer's disease (AD) and may be a potential biomarker for the diagnosis of AD. A total of 128 AD patients were randomly recruited from May 2012 to July 2013. The mRNA levels of calreticulin were measured from the serum of tested subjects using real-time quantitative reverse transcriptase-PCR (real-time qRT-PCR). Serum levels of calreticulin were determined by ELISA and Western Blot. Serum levels of calreticulin in AD patients were significantly lower than those from a healthy group (p < 0.01). The baseline characters indicated that sample size, gender, mean age, diabetes and BMI (body mass index) were not major sources of heterogeneity. The serum levels of mRNA and protein of calreticulin were lower in AD patients than those from a healthy group, and negatively associated with the progression of AD according to CDR scores (p < 0.01). Thus, there is a trend toward decreased serum levels of calreticulin in the patients with progression of AD. Serum levels of calreticulin can be a negative biomarker for the diagnosis of AD patients.
Collapse
Affiliation(s)
- Qiao Lin
- Department of Internal Medicine, the Fourth Affiliated Hospital of China Medical University, Shenyang 110005, China.
| | - Yunpeng Cao
- Neural Department of Internal Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China.
| | - Jie Gao
- Department of Anatomy, the First Affiliated Hospital of China Medical University, Shenyang 110001, China.
| |
Collapse
|