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Cummings J, Hahn-Pedersen JH, Eichinger CS, Freeman C, Clark A, Tarazona LRS, Lanctôt K. Exploring the relationship between patient-relevant outcomes and Alzheimer's disease progression assessed using the clinical dementia rating scale: a systematic literature review. Front Neurol 2023; 14:1208802. [PMID: 37669257 PMCID: PMC10470645 DOI: 10.3389/fneur.2023.1208802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/21/2023] [Indexed: 09/07/2023] Open
Abstract
Background People with Alzheimer's disease (AD) have difficulties in performing activities of daily living (ADLs) as the disease progresses, commonly experience neuropsychiatric symptoms (NPS), and often have comorbidities such as cardiovascular disease. These factors all contribute to a requirement for care and considerable healthcare costs in AD. The Clinical Dementia Rating (CDR) scale is a widely used measure of dementia staging, but the correlations between scores on this scale and patient-/care partner-relevant outcomes have not been characterized fully. We conducted a systematic literature review to address this evidence gap. Methods Embase, MEDLINE, and the Cochrane Library were searched September 13, 2022, to identify published studies (no restriction by date or country) in populations with mild cognitive impairment due to AD or AD dementia. Studies of interest reported data on the relationships between CDR Global or CDR-Sum of Boxes (CDR-SB) scores and outcomes including NPS, comorbidities, ADLs, nursing home placement, healthcare costs, and resource use. Results Overall, 58 studies met the inclusion criteria (42 focusing on comorbidities, 14 on ADLs or dependence, five on nursing home placement, and six on economic outcomes). CDR/CDR-SB scores were correlated with the frequency of multiple NPS and with total scores on the Neuropsychiatric Inventory. For cardiovascular comorbidities, no single risk factor was consistently linked to AD progression. Increasing CDR/CDR-SB scores were correlated with decline in multiple different measures of ADLs and were also associated with nursing home placement and increasing costs of care. Conclusion NPS, ADLs, and costs of care are clearly linked to AD progression, as measured using CDR Global or CDR-SB scores, from the earliest stages of disease. This indicates that scores derived from the CDR are a meaningful way to describe the severity and burden of AD for patients and care partners across disease stages.
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Affiliation(s)
- Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, United States
| | | | | | | | | | | | - Krista Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Jiang X, Cai Y, Zhao Y, Gao X, Peng D, Zhang H, Deng W, Fu W, Qin N, Chang R, Manor B, Zhou J. The Complexity of Blood Pressure Fluctuation Mediated the Effects of Hypertension on Walking Speed in Older Adults. Front Aging Neurosci 2021; 13:640942. [PMID: 33994993 PMCID: PMC8118160 DOI: 10.3389/fnagi.2021.640942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Older adults with hypertension often had diminished walking performance. The underlying mechanism through which hypertension affects walking performance, however, has not been fully understood. We here measured the complexity of the continuous systolic (SBP) and diastolic (DBP) blood pressure fluctuation, grade of white matter lesions (WMLs), and cognitive function and used structural equation modeling (SEM) to examine the interrelationships between hypertension, BP complexity, WMLs, cognitive function, and walking speed in single- and dual-task conditions. Methods: A total of 152 older adults with age > 60 years (90 hypertensive and 62 normotensive participants) completed one MRI scan of brain structure, a finger BP assessment of at least 10 min, Mini-Mental State Examination (MMSE) to assess cognitive function, and 10-meter walking tests in single (i.e., normal walking) and dual tasks (i.e., walking while performing a serial subtraction of three from a random three-digit number). The grade of WMLs was assessed using the total score of Fazekas scale; the complexity of SBP and DBP was measured using multiscale entropy (MSE), and the walking performance was assessed by walking speed in single- and dual-task conditions. Results: As compared to normotensives, hypertensive older adults had significantly slower walking speed, lower complexity of SBP and DBP, greater grade of WMLs, and poorer cognitive function (p < 0.03). Those with lower BP complexity (β > 0.31, p < 0.003), greater WML grade (β < −0.39, p < 0.0002), and/or poorer cognitive function (β < −0.39, p < 0.0001) had slower walking speed in single- and/or dual-task conditions. The SEM model demonstrated significant total effects of hypertension on walking speed, and such effects were mediated by BP complexity only, or BP complexity, WML grade, and cognitive function together. Conclusion: This study demonstrates the cross-sectional association between the complexity of continuous beat-to-beat BP fluctuation, WML grade, cognitive function, and walking speed in hypertensive and normotensive older adults, revealing a potential mechanism that hypertension may affect walking performance in older adults through diminished BP complexity, increased WML grade, and decreased cognitive function, and BP complexity is an important factor for such effects. Future longitudinal studies are warranted to confirm the findings in this study.
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Affiliation(s)
- Xin Jiang
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yue Zhao
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NJ, United States
| | - Xia Gao
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Dan Peng
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Hui Zhang
- The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Department of Neurology, Shenzhen People's Hospital, Shenzhen, China
| | - Wuhong Deng
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Wen Fu
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Na Qin
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Ruizhen Chang
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Marras C, Mestre T, McDermott MP. Huntington's Disease and Hypertension: Sorting Out Mixed Messages. Mov Disord 2020; 35:915-917. [PMID: 32562461 DOI: 10.1002/mds.28076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Connie Marras
- The Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tiago Mestre
- Parkinson's Disease and Movement Disorders Clinic, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
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