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Liu JX, Na RS, Yang LJ, Huang XR, Zhao X. Discovery of potential RIPK1 inhibitors by machine learning and molecular dynamics simulations. Phys Chem Chem Phys 2023; 25:31418-31430. [PMID: 37962373 DOI: 10.1039/d3cp03755j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Receptor-interacting serine/threonine-protein kinase 1 (RIPK1) plays a crucial role in inflammation and cell death, so it is a promising candidate for the treatment of autoimmune, inflammatory, neurodegenerative, and ischemic diseases. So far, there are no approved RIPK1 inhibitors available. In this study, four machine learning algorithms were employed (random forest, extra trees, extreme gradient boosting and light gradient boosting machine) to predict small molecule inhibitors of RIPK1. The statistical metrics revealed similar performance and demonstrated outstanding predictive capabilities in all four models. Molecular docking and clustering analysis were employed to confirm six compounds that are structurally distinct from existing RIPK1 inhibitors. Subsequent molecular dynamics simulations were performed to evaluate the binding ability of these compounds. Utilizing the Shapley additive explanation (SHAP) method, the 1855 bit has been identified as the most significant molecular fingerprint fragment. The findings propose that these six small molecules exhibit promising potential for targeting RIPK1 in associated diseases. Notably, the identification of Cpd-1 small molecule (ZINC000085897746) from the Musa acuminate highlights its natural product origin, warranting further attention and investigation.
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Affiliation(s)
- Ji-Xiang Liu
- Institute of Theoretical Chemistry, College of Chemistry, Jilin University, Liutiao Road #2, Changchun 130021, China.
| | - Ri-Song Na
- Collaborative Innovation Center of Henan Grain Crops, National Key Laboratory of Wheat and Maize Crop Science, College of Plant Protection, Henan Agricultural University, Zhengzhou 450002, China
| | - Lian-Juan Yang
- Department of Medical Mycology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Xu-Ri Huang
- Institute of Theoretical Chemistry, College of Chemistry, Jilin University, Liutiao Road #2, Changchun 130021, China.
| | - Xi Zhao
- Institute of Theoretical Chemistry, College of Chemistry, Jilin University, Liutiao Road #2, Changchun 130021, China.
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Aye S, Bouteloup V, Tate A, Wimo A, Handels R, Jean D, Winblad B, Jönsson L. Health-related quality of life in subjective cognitive decline and mild cognitive impairment: a longitudinal cohort analysis. Alzheimers Res Ther 2023; 15:200. [PMID: 37968734 PMCID: PMC10648708 DOI: 10.1186/s13195-023-01344-0] [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: 05/09/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Health-related quality of life (HR-QoL) is an important outcome for patients and crucial for demonstrating the value of new treatments. Health utility estimates in subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are limited, especially in biomarker-confirmed populations. Besides, little is known about the longitudinal HR-QoL trajectory. This study aims to provide health utility estimates for SCD and MCI and investigate the QoL trajectory along the disease continuum. METHODS Longitudinal data from 919 SCD and 1336 MCI patients from the MEMENTO cohort were included. SCD was defined as clinical dementia rating (CDR) = 0, and MCI as CDR = 0.5. HR-QoL was measured using the EQ-5D-3L patient-reported instrument. Linear mixed-effect models (LMM) were used to assess the longitudinal change in HR-QoL and identify predictors of these changes. RESULTS Baseline health utilities were 0.84 ± 0.16 and 0.81 ± 0.18, and visual analogue scale (VAS) were 75.8 ± 14.82 and 70.26 ± 15.77 in SCD and MCI. In amyloid-confirmed cases, health utilities were 0.85 ± 0.14 and 0.86 ± 0.12 in amyloid-negative and amyloid-positive SCD, and 0.83 ± 0.17 and 0.84 ± 0.16 in amyloid-negative and amyloid-positive MCI. LMM revealed an annual decline in health utility of - 0.015 (SE = 0.006) and - 0.09 (SE = 0.04) in moderate and severe dementia (P < 0.05). There was a negative association between clinical stage and VAS where individuals with MCI, mild, moderate, and severe dementia were on average 1.695 (SE = 0.274), 4.401 (SE = 0.676), 4.999 (SE = 0.8), and 15.386 (SE = 3.142) VAS points lower than individuals with SCD (P < 0.001). Older age, female sex, higher body mass index, diabetes, cardiovascular history, depression, and functional impairment were associated with poor HR-QoL. Amyloid positivity was associated with an annual decline of - 0.011 (SE = 0.004, P < 0.05) health utility over time. CONCLUSIONS Health utility estimates from this study can be used in economic evaluations of interventions targeting SCD and MCI. Health utility declines over time in moderate and severe dementia, and VAS declines with advancing clinical stages. Amyloid-positive patients show a faster decline in health utility indicating the importance of considering biomarker status in HR-QoL assessments. Future research is needed to confirm the longitudinal relationship between amyloid status and HR-QoL and to examine the level at which depression and IADL contribute to HR-QoL decline in AD.
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Affiliation(s)
- Sandar Aye
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden.
| | - Vincent Bouteloup
- Centre Inserm U1219, Institut de Santé Publiqued'Epidémiologie Et de Développement (ISPED), Bordeaux School of Public Health, Université de Bordeaux, 146 Rue Léo Saignat, Bordeaux, Cedex, 33076, France
- CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, 33000, France
| | - Ashley Tate
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
| | - Ron Handels
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
- Deperatment of Psychiatry and Neuropsychology, Maastricht University, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht, the Netherlands
| | - Delphine Jean
- Centre Inserm U1219, Institut de Santé Publiqued'Epidémiologie Et de Développement (ISPED), Bordeaux School of Public Health, Université de Bordeaux, 146 Rue Léo Saignat, Bordeaux, Cedex, 33076, France
- CHU de Bordeaux, Pôle de Santé Publique, Bordeaux, 33000, France
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, BioClinicum J9:20, Akademiska Stråket, Solna, 171 64, Sweden
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Ma Y, Zhu Y, Hong D, Zhao H, Li L. Association between tea drinking and disability levels in older Chinese adults: a longitudinal analysis. Front Nutr 2023; 10:1233664. [PMID: 38024372 PMCID: PMC10644393 DOI: 10.3389/fnut.2023.1233664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objective As the global population ages, disability among the elderly presents unprecedented challenges for healthcare systems. However, limited research has examined whether dietary interventions like tea consumption may alleviate and prevent disability in older adults. As an important dietary therapy, the health benefits of tea drinking have gained recognition across research disciplines. Therefore, this study aimed to investigate the association between tea drinking habits and disability levels in the elderly Chinese population. Methods Leveraging data from the 2008 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey, we disaggregated tea drinking frequency and activities of daily living (ADL) measures and deployed fixed-effect ordered logit models to examine the tea-disability association for the first time. We statistically adjusted for potential confounders and conducted stratified analyses to assess heterogeneity across subpopulations. Results Multivariable fixed-effect ordered logistic regression suggested tea drinking has protective effects against ADL disability. However, only daily tea drinking was associated with lower risks of basic activities of daily living (BADL) disability [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.41-0.92] and lower levels of instrumental activities of daily living (IADL) disability (OR = 0.78; 95% CI, 0.64-0.95). Stratified analyses indicated heterogeneous effects across age and income groups. Daily tea drinking protected against BADL (OR = 0.26 and OR = 0.28) and IADL disability (OR = 0.48 and OR = 0.45) for adults over 83 years old and high-income households, respectively. Conclusion We found that drinking tea almost daily was protective against disability in elderly people, warranting further research into optimal dosages. Future studies should utilize more rigorous causal inference methods and control for confounders.
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Affiliation(s)
- Yinghui Ma
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
- School of Economics and Management, Beijing Forestry University, Beijing, China
| | - Yuying Zhu
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Dandan Hong
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Haiyue Zhao
- School of Economics and Management, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Lei Li
- College of Economics and Management, Zhejiang A & F University, Hangzhou, China
- Research Academy for Rural Revitalization of Zhejiang, Zhejiang A & F University, Hangzhou, China
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Puthusseryppady V, Bregola A, Camino J, Backhouse T, Mioshi E. Is Carer Management Style Associated with Longitudinal Functional Decline in Dementia? J Alzheimers Dis 2023; 96:1139-1149. [PMID: 37955085 DOI: 10.3233/jad-230075] [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: 11/14/2023]
Abstract
BACKGROUND Various intrinsic (related to dementia) and extrinsic (not related to dementia) factors have been suggested to contribute separately to disability in people living with dementia (PLwD). OBJECTIVE To investigate if the combination of specific intrinsic and extrinsic factors at baseline is associated with longitudinal declines in activities of daily living (ADL) performance of PLwD at 12-month follow-up. METHODS 141 community-dwelling PLwD-carer dyads were assessed on their global cognition (ACE-III), apathy (CBI-R), carer management styles (DMSS), medical comorbidities (CCI), and ADL performance (DAD) at baseline, and for a subset of participants (n = 53), at 12-month follow-up. Multiple linear regression models were run to assess: 1) the relationships between PLwD's DAD scores and the remaining variables at baseline and 2) whether these variables' scores at baseline were associated with longitudinal change in the PLwD's DAD scores. RESULTS At baseline, having lower ACE-III (β= 0.354, p < 0.001), higher CBI-R (β= -0.284, p < 0.001), higher DMSS criticism (β= -0.367, p = 0.013), lower DMSS encouragement (β= 0.370, p = 0.014), and higher CCI scores (β= -2.475, p = 0.023) were significantly associated with having lower DAD scores. The PLwD's DAD scores significantly declined from baseline to follow-up (p < 0.001, d = 1.15), however this decline was not associated with the baseline scores of any of the independent variables. Instead, it was associated with declines in the PLwD's ACE-III scores from baseline to follow-up (β= 1.021, p = 0.001). CONCLUSIONS In our limited sample, cognitive changes seem to be the main factor underlying longitudinal decline in ADL performance for PLwD. Carer management styles appear associated with current ADL performance but not with longitudinal ADL decline.
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Affiliation(s)
- Vaisakh Puthusseryppady
- School of Health Sciences, University of East Anglia, Norwich, UK
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, USA
| | - Allan Bregola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Julieta Camino
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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5
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Martin P, Poon LW, Lee G, Obhi HK, Kallianpur KJ, Willcox B, Masaki K. A 13-Year Time-Lagged Description of General Cognitive and Functional Abilities in Older Men: A Cross-Lagged Panel Model. J Aging Health 2022; 35:335-344. [PMID: 36194185 DOI: 10.1177/08982643221130381] [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
Objectives: The purpose of this study was to evaluate a cross-lagged panel model of general cognition and functional abilities over 13 years. The goal was to determine whether general cognitive abilities predict or precede functional decline versus functional abilities predicting cognitive decline. Methods: The sample included 3508 men (71-93 years of age at baseline) of the Kuakini Honolulu-Asia Aging Study who were tested repeatedly using a global cognitive test and an assessment of functional capacity. Education and age served as covariates. Cross-lagged models were tested, assessing stationarity of stability and cross-lags. Results: The overall model fit the data well. Cognitive scores had better stability than functional abilities and predicted functional abilities more strongly than functional abilities predicted cognitive scores over time. The strength of all cross-lags increased over time. Discussion: These longitudinal data show that cognitive scores predicted functional decline in a population-based study of older men.
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Affiliation(s)
| | | | - Gina Lee
- 1177Iowa State University, Ames, USA
| | | | - Kalpana J Kallianpur
- 3950Kuakini Medical Center, Honolulu, HI, USA.,University of Hawaii, Honolulu, USA
| | - Bradley Willcox
- 3950Kuakini Medical Center, Honolulu, HI, USA.,University of Hawaii, Honolulu, USA
| | - Kamal Masaki
- 3950Kuakini Medical Center, Honolulu, HI, USA.,University of Hawaii, Honolulu, USA
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Sun Q, Jiang N, Lu N, Lou VWQ. Bidirectional relationship between cognitive function and loss hierarchy of activities of daily living among older adults with disabilities in urban China: a cross-lagged analysis. BMJ Open 2022; 12:e057211. [PMID: 36691162 PMCID: PMC9442490 DOI: 10.1136/bmjopen-2021-057211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/11/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The present study aimed to determine the bidirectional relationship between cognitive function and the loss hierarchy of activities of daily living (ADL) among older adults in China. DESIGN Data were derived from the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai (2010-2013). SETTING Community-dwelling older adults and their primary caregivers were invited to participate in this research. PARTICIPANTS The inclusion criteria for the older adults were as follows: (a) have a Shanghai urban household registration status, (b) be 75 years old or older, (c) have no fewer than two limitations in ADLs or equivalent, and (d) have one primary caregiver aged 18 years or older. 469 older adults cared by their spouses or children were included in the final analytical sample of this research. PRIMARY AND SECONDARY OUTCOME MEASURES Cognitive function was assessed using the Chinese version of the Short Portable Mental Status Questionnaire and ADLs were measured by self-reports of having difficulty or needing help with basic daily activities. RESULTS Cognitive function in 2010 was a significant predictor of intermediate loss of ADLs in 2013 (β=-0.13, p<0.05) and late loss of ADLs in 2013 (β=-0.17, p<0.01). The loss hierarchy of ADLs among older adults was not shown to be significant as a risk factor of cognitive function in 2013. CONCLUSIONS Practitioners are encouraged to adopt the ADL loss hierarchy as a supplementary needs assessment tool to make the social service delivery process more effective, economical and tailored. Cognitive function change monitoring programmes and services providing education on nutrition and encouraging social participation of older individuals were also helpful in promoting the quality of life of the older adults.
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Affiliation(s)
- Qian Sun
- Department of Social Security, Hebei University of Economics and Business, Shijiazhuang, People's Republic of China
- Hebei Collaborative Innovation Center On Urban-rural Integration, Shijiazhuang, People's Republic of China
- Sau Po Centre on Ageing, the University of Hong Kong, Hong Kong, People's Republic of China
| | - Nan Jiang
- Institute of Hospital Management, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Nan Lu
- Department of Social Work, Renmin University of China, Beijing, China
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, the University of Hong Kong, Hong Kong, People's Republic of China
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, People's Republic of China
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7
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Hlávka JP, Tysinger B, Yu JC, Lakdawalla DN. Access to Disease-Modifying Alzheimer's Therapies: Addressing Possible Challenges Using Innovative Payment Models. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:S1098-3015(22)02039-3. [PMID: 35803845 PMCID: PMC9813270 DOI: 10.1016/j.jval.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Aduhelm is the first approved disease-modifying therapies (DMT) for Alzheimer disease (AD). Nevertheless, under current payment models, AD DMTs-especially because they treat broader populations-will pose challenges to patient access since costs may accrue sooner than benefits do. New payment approaches may be needed to address this difference in timing. METHODS We use the Future Elderly Model that draws on nationally representative data sets such as the Health and Retirement Study to estimate the potential benefits because of hypothetical AD DMTs in 4 stylized treatment scenarios for patients with mild cognitive impairment or mild AD, and develop a payment model to estimate the accrual of net costs and benefits to private and public payers. RESULTS The modeled AD DMTs result in clinical benefit of 0.30 to 0.55 quality-adjusted life-years gained per patient in the baseline treatment scenario and 0.13 to 0.24 quality-adjusted life-years gained per patient in the least optimistic scenario. Private payers may observe a net loss in patients at the age of 61 to 65 years under the status quo (payment upon treatment). Constant and deferred installment payment models resolve this issue. CONCLUSIONS Innovative payment solutions, such as installment payments, may be required to address misaligned incentives that AD DMTs may create among patients younger than the age of 65 years and may help address concerns about the timing and magnitude of costs and benefits accrued to private payers.
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Affiliation(s)
- Jakub P Hlávka
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA; USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA.
| | - Bryan Tysinger
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA; USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
| | - Jeffrey C Yu
- USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA; School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Darius N Lakdawalla
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA; USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA; School of Pharmacy, University of Southern California, Los Angeles, CA, USA
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8
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Sato A, Tagai N, Ogino Y, Uozumi H, Kawakami S, Yamamoto T, Tanuma S, Maruki‐Uchida H, Mori S, Morita M. Passion fruit seed extract protects beta-amyloid-induced neuronal cell death in a differentiated human neuroblastoma SH-SY5Y cell model. Food Sci Nutr 2022; 10:1461-1468. [PMID: 35592293 PMCID: PMC9094456 DOI: 10.1002/fsn3.2757] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease with accompanying perceptive disorder. We previously reported that decreasing levels of brain-derived neurotrophic factor (BDNF) promoted beta-amyloid (Aβ)-induced neuronal cell death in neuron-like differentiated SH-SY5Y (ndSH-SY5Y) human neuroblastoma cells in an AD mimic cell model. We investigated the neuroprotective effects of passion fruit seed extract (PFSE) and one of the main stilbene compounds, piceatannol, in an AD cell model using ndSH-SY5Y cells. Both PFSE and piceatannol were found to protect Aβ-induced neurite fragmentation in the cell model (protection efficacy; 34% in PFSE and 36% in piceatannol). In addition, both PFSE and piceatannol suppress Aβ-induced neuronal cell death in the cell model (inhibitory effect; 27% in PFSE and 32% in piceatannol). Our study is the first to report that piceatannol-rich PFSE can repress Aβ-induced neuronal cell death by protecting against neurite fragmentation in the AD human cell model. These findings suggest that piceatannol-rich PFSE can be considered a potentially neuroprotective functional food for both prevention and treatment of AD.
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Affiliation(s)
- Akira Sato
- Department of Biochemistry and Molecular BiologyFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
- Department of BiochemistryFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
| | - Nozomi Tagai
- Department of Biochemistry and Molecular BiologyFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
- Department of BiochemistryFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
| | - Yoko Ogino
- Department of Biochemistry and Molecular BiologyFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
- Department of BiochemistryFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
- Present address:
Department of Gene RegulationFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
| | - Haruka Uozumi
- Department of Biochemistry and Molecular BiologyFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
| | - Shinpei Kawakami
- Research and Development InstituteHealth Science Research Center, Morinaga & Co., Ltd.YokohamaJapan
| | - Takayuki Yamamoto
- Research and Development InstituteHealth Science Research Center, Morinaga & Co., Ltd.YokohamaJapan
| | - Sei‐ichi Tanuma
- Department of BiochemistryFaculty of Pharmaceutical SciencesTokyo University of ScienceNoda, ChibaJapan
- Department of Genomic Medicinal ScienceResearch Institute for Science and TechnologyOrganization for Research AdvancementTokyo University of ScienceNoda, ChibaJapan
| | - Hiroko Maruki‐Uchida
- Research and Development InstituteHealth Science Research Center, Morinaga & Co., Ltd.YokohamaJapan
| | - Sadao Mori
- Research and Development InstituteHealth Science Research Center, Morinaga & Co., Ltd.YokohamaJapan
| | - Minoru Morita
- Research and Development InstituteHealth Science Research Center, Morinaga & Co., Ltd.YokohamaJapan
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Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
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Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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10
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Atkins AS, Kraus MS, Welch M, Yuan Z, Stevens H, Welsh-Bohmer KA, Keefe RSE. Remote self-administration of digital cognitive tests using the Brief Assessment of Cognition: Feasibility, reliability, and sensitivity to subjective cognitive decline. Front Psychiatry 2022; 13:910896. [PMID: 36090378 PMCID: PMC9448897 DOI: 10.3389/fpsyt.2022.910896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is a common and pervasive feature of etiologically diverse disorders of the central nervous system, and a target indication for a growing number of symptomatic and disease modifying drugs. Remotely acquired digital endpoints have been recognized for their potential in providing frequent, real-time monitoring of cognition, but their ultimate value will be determined by the reliability and sensitivity of measurement in the populations of interest. To this end, we describe initial validation of remote self-administration of cognitive tests within a regulatorily compliant tablet-based platform. Participants were 61 older adults (age 55+), including 20 individuals with subjective cognitive decline (SCD). To allow comparison between remote (in-home) and site-based testing, participants completed 2 testing sessions 1 week apart. Results for three of four cognitive domains assessed demonstrated equivalence between remote and site-based tests, with high cross-modality ICCs (absolute agreement) for Symbol Coding (ICC = 0.75), Visuospatial Working Memory (ICC = 0.70) and Verbal Fluency (ICC > 0.73). Group differences in these domains were significant and reflected sensitivity to objective cognitive impairment in the SCD group for both remote and site-based testing (p < 0.05). In contrast, performance on tests of verbal episodic memory suggested inflated performance during unmonitored testing and indicate reliable use of remote cognitive assessments may depend on the construct, as well as the population being tested.
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Affiliation(s)
| | | | | | | | | | - Kathleen A Welsh-Bohmer
- WCG-VeraSci, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Richard S E Keefe
- WCG-VeraSci, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
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Xu C, Wu J, Wu Y, Ren Z, Yao Y, Chen G, Fang EF, Noh JH, Liu YU, Wei L, Chen X, Sima J. TNF-α-dependent neuronal necroptosis regulated in Alzheimer's disease by coordination of RIPK1-p62 complex with autophagic UVRAG. Theranostics 2021; 11:9452-9469. [PMID: 34646380 PMCID: PMC8490500 DOI: 10.7150/thno.62376] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Neuronal death is a major hallmark of Alzheimer's disease (AD). Necroptosis, as a programmed necrotic process, is activated in AD. However, what signals and factors initiate necroptosis in AD is largely unknown. Methods: We examined the expression levels of critical molecules in necroptotic signaling pathway by immunohistochemistry (IHC) staining and immunoblotting using brain tissues from AD patients and AD mouse models of APP/PS1 and 5×FAD. We performed brain stereotaxic injection with recombinant TNF-α, anti-TNFR1 neutralizing antibody or AAV-mediated gene expression and knockdown in APP/PS1 mice. For in vitro studies, we used TNF-α combined with zVAD-fmk and Smac mimetic to establish neuronal necroptosis models and utilized pharmacological or molecular biological approaches to study the signaling pathways. Results: We find that activated neuronal necroptosis is dependent on upstream TNF-α/TNFR1 signaling in both neuronal cell cultures and AD mouse models. Upon TNF-α stimulation, accumulated p62 recruits RIPK1 and induces its self-oligomerization, and activates downstream RIPK1/RIPK3/MLKL cascade, leading to neuronal necroptosis. Ectopic accumulation of p62 is caused by impaired autophagy flux, which is mediated by UVRAG downregulation during the TNF-α-promoted necroptosis. Notably, UVRAG overexpression inhibits neuronal necroptosis in cell and mouse models of AD. Conclusions: We identify a finely controlled regulation of neuronal necroptosis in AD by coordinated TNF-α signaling, RIPK1/3 activity and autophagy machinery. Strategies that could fine-tune necroptosis and autophagy may bring in promising therapeutics for AD.
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Affiliation(s)
- Chong Xu
- Laboratory of Aging Neuroscience and Neuropharmacology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Jialin Wu
- Laboratory of Aging Neuroscience and Neuropharmacology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Yiqun Wu
- Laboratory of Aging Neuroscience and Neuropharmacology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Zhichu Ren
- Laboratory of Aging Neuroscience and Neuropharmacology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Yuyuan Yao
- Laboratory of Aging Neuroscience and Neuropharmacology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Guobing Chen
- Institute of Geriatric Immunology, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Evandro F. Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
| | - Ji Heon Noh
- Department of Biochemistry, Chungnam National University, Daehak-ro 99, Yuseong-gu, Daejeon
| | - Yong U. Liu
- Laboratory for Neuroscience in Health and Disease, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, 510180, China
| | - Libin Wei
- Jiangsu Key Laboratory of Carcinogenesis and Intervention, China Pharmaceutical University, Nanjing, 210009, China
| | - Xijing Chen
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China
| | - Jian Sima
- Laboratory of Aging Neuroscience and Neuropharmacology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
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12
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Carles S, Taddé BO, Berr C, Helmer C, Jacqmin-Gadda H, Carrière I, Proust-Lima C. Dynamic reciprocal relationships between cognitive and functional declines along the Alzheimer's disease continuum in the prospective COGICARE study. Alzheimers Res Ther 2021; 13:148. [PMID: 34479648 PMCID: PMC8418020 DOI: 10.1186/s13195-021-00887-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Thoroughly understanding the temporal associations between cognitive and functional dimensions along the dementia process is fundamental to define preventive measures likely to delay the disease's onset. This work aimed to finely describe the trajectories of cognitive and functional declines, and assess their dynamic bidirectional relationships among subjects at different stages of the dementia process. METHODS We leveraged extensive repeated data of cognition and functional dependency from the French prospective COGICARE study, designed to better characterize the natural history of cognitive and functional declines around dementia diagnosis. Cognition was measured by the Mini-Mental State Examination, the Isaacs Set Test for verbal fluency, the Benton Visual Retention Test for visuo-spatial memory, and Trail Making Test Part B for executive functioning. Functional dependency was measured by basic and instrumental activities of daily living. The study included 102 cognitively normal, 123 mildly cognitively impaired, and 72 dementia cases with a median of 5 repeated visits over up to 57 months. We used a dynamic causal model which addresses the two essential issues in temporal associations assessment: focusing on intra-individual change and accounting for time. RESULTS Better cognitive abilities were associated with lower subsequent decline of the functional level among the three clinical stages with an intensification over time but no reciprocity of the association whatever the clinical status. CONCLUSION This work confirms that the progressive functional dependency could be induced by cognitive impairment. Subjects identified as early as possible with clinically significant cognitive impairments could benefit from preventive measures before the deterioration of activities of daily living and the appearance of dementia clinical signs.
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Affiliation(s)
- Sophie Carles
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091, Montpellier, France
| | | | - Claudine Berr
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091, Montpellier, France
| | | | | | - Isabelle Carrière
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091, Montpellier, France
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13
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Giebel CM, Knopman D, Mioshi E, Khondoker M. Distinguishing Frontotemporal Dementia From Alzheimer Disease Through Everyday Function Profiles: Trajectories of Change. J Geriatr Psychiatry Neurol 2021; 34:66-75. [PMID: 32054376 PMCID: PMC7423644 DOI: 10.1177/0891988720901791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Different dementia syndromes display different patterns of everyday functioning. This article explored different patterns of functioning at baseline and trajectories of change in behavioral variant frontotemporal dementia (bvFTD) and Alzheimer disease (AD). METHODS Data from the Uniform Data Set of the National Alzheimer's Coordinating Centre were employed. The Functional Assessment Questionnaire assessed functioning at up to 7 follow-up visits. Independent t tests assessed variations in functioning between syndromes at baseline. Linear mixed-effect modeling explored longitudinal functional trajectories between syndromes. RESULTS Data from 3351 patients (306 bvFTD and 3,045AD) were analyzed. At baseline, patients with bvFTD performed all daily activities poorer than AD dementia. Linear mixed models showed a significant effect of syndrome and time on functioning, and evidence of interaction between syndrome and time, with bvFTD showing a steeper decline for using the stove and travel. CONCLUSIONS Findings can help in the effective care planning of everyday functioning for bvFTD and AD dementia.
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Affiliation(s)
- Clarissa M. Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom,NIHR ARC NWC, Liverpool, United Kingdom
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom,Mizanur Khondoker, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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14
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Tagai N, Tanaka A, Sato A, Uchiumi F, Tanuma SI. Low Levels of Brain-Derived Neurotrophic Factor Trigger Self-aggregated Amyloid β-Induced Neuronal Cell Death in an Alzheimer's Cell Model. Biol Pharm Bull 2020; 43:1073-1080. [PMID: 32612070 DOI: 10.1248/bpb.b20-00082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Alzheimer's disease (AD) is pathologically characterized by accumulation of amyloid β (Aβ) and hyperphosphorylated tau, and thereby induction of neuronal cell death. The Aβ-induced neuronal cell death has been shown to occur by several modes, such as apoptosis, necrosis, and necroptosis. Interestingly, in AD patients, the brain and serum levels of brain-derived neurotrophic factor (BDNF) have been reported to be significantly decreased. However, the relationship between Aβ and BDNF in the onset of AD remains to be fully understood. Here, we used neuron-like differentiated human neuroblastoma SH-SY5Y (ndSH-SY5Y) cells to study the neurotoxicity of self-aggregated Aβ1-42 peptide under different concentrations of BDNF in the culture medium. Importantly, decreasing levels of BDNF caused a considerable suppression in the extension of neurite length. Furthermore, only under low levels of BDNF, the aggregated Aβ was revealed to induce neurite fragmentation and neuronal cell death in ndSH-SY5Y cells. Notably, the aggregated Aβ and low levels of BDNF-induced neuronal cell death was characterized at least as caspase-6 dependent cell death and necroptosis. These results indicate that our ndSH-SY5Y cell system, cultured under decreasing levels of BDNF and aggregated Aβ, has the potential to be applied in the analysis of the molecular mechanisms of the progressive neurodegenerative processes of AD and the discovery of neuroprotective drug candidates.
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Affiliation(s)
- Nozomi Tagai
- Department of Biochemistry, Faculty of Pharmaceutical Sciences, Tokyo University of Science.,Department of Gene Regulation, Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Ayako Tanaka
- Department of Biochemistry, Faculty of Pharmaceutical Sciences, Tokyo University of Science.,Department of Gene Regulation, Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Akira Sato
- Department of Biochemistry, Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Fumiaki Uchiumi
- Department of Gene Regulation, Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Sei-Ichi Tanuma
- Department of Genomic Medicinal Science, Research Institute for Science and Technology, Organization for Research Advancement, Tokyo University of Science
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15
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da Silva ACS, Ansai JH, Cezar NODC, Carvalho Vale FA, dos Santos JG, de Andrade LP. Outcomes and interventions in the elderly with and without cognitive impairment: a longitudinal study. Dement Neuropsychol 2020; 14:394-402. [PMID: 33354293 PMCID: PMC7735049 DOI: 10.1590/1980-57642020dn14-040010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/25/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Clinical follow-up studies are necessary for a better understanding of the evolution of cognitive impairment as well as the development of better assessment and intervention tools. OBJECTIVE To investigate whether older people with preserved cognition (PC), mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) show differences in clinical outcomes and interventions after a 32-month period. METHODS One hundred twenty-four community-dwelling older people were included and classified in one of three groups (PC, MCI and mild AD). Information on clinical outcomes (deaths, new diagnoses, falls, need for assistance or changes in routine and hospitalizations) and interventions (increased use of medication, physiotherapeutic intervention, practice of physical exercise, etc.) in the 32-month period were collected by telephone or during a home visit on a single day. RESULTS Ninety-five participants (35 with PC, 33 with MCI and 27 with AD) were reevaluated after 32 months. The need for assistance/changes in routine was significantly higher in the AD group, especially with regard to basic activities of daily living. Unlike the other groups, the PC group did not show "other diagnoses" (urinary incontinence, prolapse, change in vision or autoimmune disease). No significant differences were found regarding other variables. CONCLUSIONS Older people with and without cognitive impairment exhibited differences in some clinical outcomes after 32 months, such as need for assistance or changes in their routine and new diagnoses of specific diseases. Therefore, the multidimensionality of geriatric patients should be considered when planning assessments and interventions.
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Affiliation(s)
| | - Juliana Hotta Ansai
- Gerontology Department, Universidade Federal de São Carlos – São Carlos, SP, Brazil
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16
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Factors associated with functional loss among community-dwelling Mexican older adults. ACTA ACUST UNITED AC 2020; 40:546-556. [PMID: 33030833 PMCID: PMC7666859 DOI: 10.7705/biomedica.5380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Indexed: 11/29/2022]
Abstract
Introduction: Functional status decline is related to many negative outcomes. Objective: To explore the relationship of sociodemographic, medical, and psychological factors with the incidence of functional status decline in Mexican older adults. Materials and methods: Data from the 2012 and 2015 waves of the Mexican Health and Aging Study (MHAS) survey were analyzed. Participants with previous functional status decline at baseline were excluded. We assessed functional status decline individually with activities of daily living (ADL) and instrumental ADL (IADLs) in an individual way. Results: Age was associated with functional limitations in ADL. Being male had an association with limitations for IADL. A poor financial situation and lower education related to higher limitations for ADL. Furthermore, pain, comorbidities, and depression were found to be independently associated with limitations in ADL. IADL limitation was associated with age, poor education, comorbidities, and depression, as well as cognitive impairment. Conclusions: We found that factors such as age, financial status, educational level, pain, and the number of comorbidities were associated with the incidence of functional status decline. Pain had a greater association in the 3-year functional ADL decline incidence when compared with cognitive impairment. Studying functional decline by domains allowed us to find more detailed information to identify factors susceptible to intervention with the aim to reduce the incidence of functional status decline and dependence.
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17
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Clemson L, Laver K, Rahja M, Culph J, Scanlan JN, Day S, Comans T, Jeon YH, Low LF, Crotty M, Kurrle S, Cations M, Piersol CV, Gitlin LN. Implementing a Reablement Intervention, “Care of People With Dementia in Their Environments (COPE)”: A Hybrid Implementation-Effectiveness Study. THE GERONTOLOGIST 2020; 61:965-976. [DOI: 10.1093/geront/gnaa105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background and Objectives
The translation of reablement programs into practice is lagging despite strong evidence for interventions that maintain function for the person living with dementia as well as improve carer well-being. The aim was to evaluate the implementation of an evidence-based program, Care of People with Dementia in Their Environments (COPE), into health services.
Research Design and Methods
An implementation-effectiveness hybrid design was used to evaluate implementation outcomes while simultaneously involving a pragmatic pre–post evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention, outcomes for people living with dementia and carers, and beliefs and behaviors of interventionists contributing to successful implementation.
Results
Seventeen organizations in Australia across 3 health contexts, 38 occupational therapists, and 17 nurses participated in training and implementation. While there were challenges and delays in implementation, most organizations were able to offer the program and utilized different models of funding. Overall, we found there was moderate fidelity to components of the program. Pre–post outcomes for carer well-being and coping (Perceived Change Index, p < .001) and activity engagement of the person living with dementia (p = .002) were significantly increased, replicating previous trial results. What contributed most to therapists implementing the program (Determinants of Implementation Behaviour Questionnaire) was a stronger intent to deliver (p < .001), higher confidence (p < .001), a sense of control in delivery (p = .004), and a belief the program was very useful to their clients (p = .002).
Discussion and Implications
This study demonstrated that implementation is possible in multiple health systems and beneficial to individuals and their families.
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Affiliation(s)
- Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
- Centre of Excellence in Population Ageing Research, The University of Sydney, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Miia Rahja
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Culph
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Justin N Scanlan
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Sally Day
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sue Kurrle
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cathy V Piersol
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
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18
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Does Telehealth Delivery of a Dyadic Dementia Care Program Provide a Noninferior Alternative to Face-To-Face Delivery of the Same Program? A Randomized, Controlled Trial. Am J Geriatr Psychiatry 2020; 28:673-682. [PMID: 32234275 DOI: 10.1016/j.jagp.2020.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to determine whether delivery of a dyadic intervention using telehealth was noninferior to delivery of the same program using traditional face-to-face delivery through home visits. DESIGN We conducted a noninferiority randomized controlled trial. PARTICIPANTS Participants had a diagnosis of dementia, were living in the community, and had an informal caregiver who reported difficulties in managing activities of daily living or behavioral symptoms. INTERVENTION Participants were randomized to receive either telehealth or home visit delivery of the same intervention program. MEASUREMENTS The primary outcome was the Caregiving Mastery Index, secondary outcomes included caregiver's perceptions of change, activities of daily living function, and type and frequency of behavioral symptoms of persons living with dementia. Therapists delivering the intervention recorded the time spent delivering the intervention as well as travel time. RESULTS Sixty-three dyads were recruited and randomized. Both groups reported improvements for the primary outcome, however, these were not statistically significant. There were no significant differences between groups for the primary outcome (mean difference 0.09 (95% confidence interval -1.26 to 1.45) or the secondary outcomes at 4 months. Both groups reported significant improvements in caregiver's perceptions of change. The amount of time spent delivering the content of the program was similar between groups, however offering the intervention via telehealth significantly reduced travel time (mean 255.9 minutes versus mean 77.2 minutes, p <0.0001). CONCLUSION It is feasible to offer dyadic interventions via telehealth and doing so reduces travel time and results in similar benefits for families.
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19
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Tanaka H, Nagata Y, Ishimaru D, Ogawa Y, Fukuhara K, Nishikawa T. Clinical factors associated with activities of daily living and their decline in patients with severe dementia. Psychogeriatrics 2020; 20:327-336. [PMID: 31883310 DOI: 10.1111/psyg.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/11/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To identify the clinical factors affecting activities of daily living (ADL) at baseline and after 6 months. METHODS We conducted a single-centre observational study at two time points across 6 months (baseline and after 6 months) from April 2015 to March 2017. in a 270-bed rural recuperation hospital at Hyogo prefecture in Japan. The total number of participants was 131 (male 33, female 98; mean age: 87.0 ± 7.0; mild and moderate dementia, 38; severe dementia, 93). Measurement scales used were Personal Self-Maintenance Scale (PSMS) for assessing ADL, Mini-Mental State Examination and Cognitive Test in Severe Dementia (CTSD) for cognitive function, Neuropsychiatric Inventory-Nursing Home version and Cornell Scale for Depression in Dementia (CSDD) for behavioural/psychological symptoms of dementia, Mini Nutritional Assessment Short form (MNA-SF) for nutritional status, Pain Assessment in Advanced Dementia for pain, and Charlson comorbidity index (CCI) and the number of illness categories based on Cumulative Illness Rating Scale Geriatrics for comorbidities. Multiple regression analyses identified the association between PSMS score as the dependent variable and other variables as independent variables. RESULTS In participants with severe dementia, the PSMS scores at baseline were significantly associated with CTSD, CCI, MNA-SF, and CSDD scores. In the longitudinal analysis, only CTSD score was significantly associated with PSMS score after 6 months. It is noteworthy that for participants with severe dementia, the only factor associated with ADL after 6 months was cognitive function, as assessed by CTSD score. CONCLUSIONS The most important factor predicting functional decline is cognitive function, even at the severe and profound stage.
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Affiliation(s)
- Hiroyuki Tanaka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Yuma Nagata
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Daiki Ishimaru
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasuhiro Ogawa
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Keita Fukuhara
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Takashi Nishikawa
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
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20
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Wada-Isoe K, Kikuchi T, Umeda-Kameyama Y, Mori T, Akishita M, Nakamura Y. ABC Dementia Scale Classifies Alzheimer's Disease Patients into Subgroups Characterized by Activities of Daily Living, Behavioral and Psychological Symptoms of Dementia, and Cognitive Function. J Alzheimers Dis 2020; 73:383-392. [PMID: 31771061 PMCID: PMC7029317 DOI: 10.3233/jad-190767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/27/2022]
Abstract
The course of Alzheimer's disease (AD) varies between individuals, and the relationship between cognitive and functional decline and the deterioration of behavioral and psychological symptoms of dementia (BPSD) is still poorly understood. Until recently, it was challenging to monitor subsequent changes in these symptoms because there was no single composite scale available that could simultaneously evaluate activities of daily living (ADL), BPSD, and cognitive function (CF) states. The present authors developed a new, brief assessment scale, the "ABC Dementia Scale" (ABC-DS), which is based on item response theory and facilitates concurrent measurement of ADL, BPSD, and CF states. We previously presented the reliability, construct validity, concurrent validity, and responsiveness of the ABC-DS. We obtained the evidence through three clinical trials featuring 1,400 subjects in total. In the present study, we performed a secondary analysis of the data obtained in the previous study. We conducted hierarchical cluster analyses that allowed us to classify 197 AD patients in terms of similarities regarding ADL, BPSD, and CF domain scores, as measured by the ABC-DS. Consequently, the scale identified subgroups of patients with global clinical dementia ratings of 1, 2, and 3. Considering our results in conjunction with the clinical experiences of the AD expert among the present authors regarding longitudinal changes in ADL, BPSD, and CF, we were able to propose potential progression pathways of AD in the form of a hypothetical roadmap.
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Affiliation(s)
- Kenji Wada-Isoe
- Department of Dementia Research, Kawasaki Medical School, Kita-ku, Okayama, Japan
| | - Takashi Kikuchi
- Translational Research Informatics Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Chuo-ku Kobe, Hyogo, Japan
| | - Yumi Umeda-Kameyama
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Mori
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Nakamura
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - on behalf of the ABC Dementia Scale Research Group
- Department of Dementia Research, Kawasaki Medical School, Kita-ku, Okayama, Japan
- Translational Research Informatics Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Chuo-ku Kobe, Hyogo, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
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21
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Wang J, Zhu WH, Li YF, Zhu WW. Temporal precedence of cognitive function and functional abilities: A latent difference score model of the Chinese community-dwelling elders. Int J Geriatr Psychiatry 2019; 34:1892-1899. [PMID: 31469190 DOI: 10.1002/gps.5206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Little research has explored how cognitive function and activities of daily living (ADL) affect each other over time. In addition, no current finding provides a clear hint to the temporal precedence between them. The present study tries to address these limitations of prior studies by utilizing a longitudinal data and advanced statistical modeling. METHODS This study analyzed the data from the China Health and Retirement Longitudinal Study (CHARLS), a prospective observational study performed every 2 years for a total of three waves between 2011 and 2015 using a multistage probability sampling. Cognitive function was measured on the basis of three aspects of cognitive performance. Functional abilities were assessed using six types of activities of ADL and five types of instrumental ADL (IADL). Latent difference score modeling was employed to investigate the temporal precedence between cognitive function and ADL. RESULTS The best fitting model indicates poor cognitive function precede worsening in ADL function, whereas the current findings did not support that poor ADL predate the cognition decline or reciprocal influence hypotheses. CONCLUSIONS The elderly with poor cognitive function may be more vulnerable to deterioration in ADL. Findings underscore the importance of early screening for cognitive function among the elderly as the key strategy to prevent further ADL impairment and keep independence.
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Affiliation(s)
- Juan Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, China.,Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Heng Zhu
- College of information science and technology, Jinan University, Guangzhou, China
| | - You-Fu Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Wen Zhu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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22
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Aluminum-induced "mixed" cell death in mice cerebral tissue and potential intervention. Neurotox Res 2019; 37:835-846. [PMID: 31721047 DOI: 10.1007/s12640-019-00123-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/10/2019] [Accepted: 10/04/2019] [Indexed: 01/14/2023]
Abstract
The brain is one of organs vulnerable to aluminum insult. Aluminum toxicity is involved in neurobehavioral deficit, neuronal cell dysfunction, and death. The aim of this study are as follows: (1) to evaluate the repairing efficiency of Necrostatin-1 (Nec-1), a cell death inhibitor, and Z-VAD-FMK, a pan-caspase inhibitor, on Al-induced neurobehavioral deficit and neuronal cell death, in order to evidence the cell death inducing ability of aluminum, and (2) to primarily explore the possibility of treating neuronal cell loss-related disease, such as Alzheimer's disease, with Nec-1 and Z-VAD in Al-induced dementia animal model. We found Nec-1 and Z-VAD-FMK alone or in combination could reduce aluminum-induced learning and memory impairment in mice. Pathohistological results indicated that Nec-1 and Z-VAD-FMK can decrease Al-induced neuronal death cell. In addition, some cell death-associated proteins in cell death signal pathway were inhibited by Nec-1 and Z-VAD-FMK in Al-exposed mice. In conclusions, Nec-1 and Z-VAD-FMK can repair the injury of learning and memory induced by aluminum in mice. Furthermore, Nec-1 was more obvious to repair the injury of learning and memory function compared with Z-VAD-FMK. Nec-1 and Z-VAD-FMK can repair the Al-induced morphological injury of cell and reduce the amounts of dead cell, and repairing effects were more significant at higher doses. The effect of Nec-1 was stronger than Z-VAD-FMK, though their mechanism was different. The combination of them had the strongest effect. Our study evidenced Al-induced neuronal necroptosis and apoptosis existing in animal model and suggested potential therapeutic effects of Nec-1 and Z-VAD-FMK on neuronal cell death in neurodegenerative diseases.
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23
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de Heus RA, Olde Rikkert MG, Tully PJ, Lawlor BA, Claassen JA. Blood Pressure Variability and Progression of Clinical Alzheimer Disease. Hypertension 2019; 74:1172-1180. [DOI: 10.1161/hypertensionaha.119.13664] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Blood pressure variability (BPV) has been shown to have predictive value over blood pressure (BP) levels alone in stroke patients. We assessed whether BPV predicts cognitive and functional decline in Alzheimer disease, using data from a randomized trial (NILVAD [A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer’s Disease]). Patients with mild-to-moderate Alzheimer disease were included if they had ≥3 office BP measurements available to determine visit-to-visit BPV. Day-to-day BPV was assessed using home BP measurements in a subsample. The variation independent of mean was used to calculate BPV. Outcomes were change in Alzheimer’s Disease Assessment Scale–cognitive subscale-12 and Disability Assessment for Dementia after 1 and 1.5 years. A total of 460 patients aged 72.1 (SD=8.1) years, with mean BP of 134.0/75.1 (10.9/6.3) mm Hg were included. After 1 year, patients in the highest quartile of BPV had deteriorated more on Alzheimer’s Disease Assessment Scale–cognitive subscale compared with patients in the lowest quartile (systolic: β, 2.24 [95% CI, 0.11–4.38],
P
=0.040; diastolic: β, 2.54 [95% CI, 0.33–4.75]
P
=0.024). This association was still present after 1.5 years (systolic: β, 2.86 [95% CI, 0.35–5.36],
P
=0.026; diastolic: β, 3.30 [95% CI, 0.67–5.93],
P
=0.014). There was no effect of visit-to-visit BPV on Disability Assessment for Dementia. Day-to-day BPV was available for 46 patients. Significant associations were observed between day-to-day BPV and deterioration on Alzheimer’s Disease Assessment Scale–cognitive subscale (systolic:
P
=0.036) and Disability Assessment for Dementia (systolic:
P
=0.020; diastolic:
P
=0.007) after 1 year, but not after 1.5 years. All associations were adjusted for potential confounders, including intervention group. In conclusion, this post hoc analysis indicates that higher visit-to-visit and day-to-day BPV might be associated with progression of Alzheimer disease. Targeting BPV may be a future target to slow decline in patients with Alzheimer disease.
Clinical Trial Registration
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02017340.
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Affiliation(s)
- Rianne A.A. de Heus
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Marcel G.M. Olde Rikkert
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Phillip J. Tully
- School of Medicine, The University of Adelaide, Australia (P.J.T.)
| | - Brian A. Lawlor
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland (B.A.L.)
- Department of Medical Gerontology, Trinity College Institute of Neuroscience, Dublin, Ireland (B.A.L.)
| | - Jurgen A.H.R. Claassen
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
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Saari T, Hallikainen I, Hänninen T, Räty H, Koivisto A. Relationships between Cognition and Activities of Daily Living in Alzheimer's Disease During a 5-Year Follow-Up: ALSOVA Study. J Alzheimers Dis 2019; 64:269-279. [PMID: 29889073 DOI: 10.3233/jad-171059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impaired cognition and activities of daily living (ADL) are core symptoms of Alzheimer's disease (AD), but their relationship is unclear. OBJECTIVES To explore relationships between cognitive domains and functional ability during 5-year follow-up in persons with AD. METHODS We analyzed ALSOVA study data from 236 individuals with very mild or mild AD at baseline. The CERAD Neuropsychological Battery (CERAD-NB) was used as a cognitive measure and Alzheimer's Disease Cooperative Study ADL (ADCS-ADL) as a functional measure, analyzing the IADL and BADL sub-scores separately. Annual regression models and linear mixed-effect models (LMMs) covering a 5-year follow-up period were used. RESULTS Annually, the CERAD-NB total and especially Verbal Fluency, Clock Drawing, and Constructional Praxis were associated with the total ADCS-ADL and IADL scores increasingly yet modestly, and to a lesser extent the BADL score. In the LMMs, the same measures and MMSE were associated with ADL. CONCLUSION Measures of executive function and visuoconstructive skills appear to be associated with caregiver-interview based ADL measure during the progression of AD.
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Affiliation(s)
- Toni Saari
- Department of Education and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Hänninen
- NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Räty
- Department of Education and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Anne Koivisto
- Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.,NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
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25
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Clinical Pharmacokinetics and Safety of ALZ-801, a Novel Prodrug of Tramiprosate in Development for the Treatment of Alzheimer's Disease. Clin Pharmacokinet 2019; 57:315-333. [PMID: 29063518 PMCID: PMC5814546 DOI: 10.1007/s40262-017-0608-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background ALZ-801 is an orally available, valine-conjugated prodrug of tramiprosate. Tramiprosate, the active agent, is a small-molecule β-amyloid (Aβ) anti-oligomer and aggregation inhibitor that was evaluated extensively in preclinical and clinical investigations for the treatment of Alzheimer’s disease (AD). Tramiprosate has been found to inhibit β-amyloid oligomer formation by a multi-ligand enveloping mechanism of action that stabilizes Aβ42 monomers, resulting in the inhibition of formation of oligomers and subsequent aggregation. Although promising as an AD treatment, tramiprosate exhibited two limiting deficiencies: high intersubject pharmacokinetic (PK) variability likely due to extensive gastrointestinal metabolism, and mild-to-moderate incidence of nausea and vomiting. To address these, we developed an optimized prodrug, ALZ-801, which retains the favorable efficacy attributes of tramiprosate while improving oral PK variability and gastrointestinal tolerability. In this study, we summarize the phase I bridging program to evaluate the safety, tolerability and PK for ALZ-801 after single and multiple rising dose administration in healthy volunteers. Methods Randomized, placebo-controlled, phase I studies in 127 healthy male and female adult and elderly volunteers included [1] a single ascending dose (SAD) study; [2] a 14-day multiple ascending dose (MAD) study; and [3] a single-dose tablet food-effect study. This program was conducted with both a loose-filled capsule and an immediate-release tablet formulation, under both fasted and fed conditions. Safety and tolerability were assessed, and plasma and urine were collected for liquid chromatography-mass spectrometry (LC-MS) determination and non-compartmental PK analysis. In addition, we defined the target dose of ALZ-801 that delivers a steady-state plasma area under the curve (AUC) exposure of tramiprosate equivalent to that studied in the tramiprosate phase III study. Results ALZ-801 was well tolerated and there were no severe or serious adverse events (AEs) or laboratory findings. The most common AEs were transient mild nausea and some instances of vomiting, which were not dose-related and showed development of tolerance after continued use. ALZ-801 produced dose-dependent maximum plasma concentration (Cmax) and AUC exposures of tramiprosate, which were equivalent to that after oral tramiprosate, but with a substantially reduced intersubject variability and a longer elimination half-life. Administration of ALZ-801 with food markedly reduced the incidence of gastrointestinal symptoms compared with the fasted state, without affecting plasma tramiprosate exposure. An immediate-release tablet formulation of ALZ-801 displayed plasma exposure and low variability similar to the loose-filled capsule. ALZ-801 also showed excellent dose-proportionality without accumulation or decrease in plasma exposure of tramiprosate over 14 days. Based on these data, 265 mg of ALZ-801 twice daily was found to achieve a steady-state AUC exposure of tramiprosate equivalent to 150 mg twice daily of oral tramiprosate in the previous phase III trials. Conclusions ALZ-801, when administered in capsule and tablet forms, showed excellent oral safety and tolerability in healthy adults and elderly volunteers, with significantly improved PK characteristics over oral tramiprosate. A clinical dose of ALZ-801 (265 mg twice daily) was established that achieves the AUC exposure of 150 mg of tramiprosate twice daily, which showed positive cognitive and functional improvements in apolipoprotein E4/4 homozygous AD patients. These bridging data support the phase III development of ALZ-801in patients with AD. Electronic supplementary material The online version of this article (doi:10.1007/s40262-017-0608-3) contains supplementary material, which is available to authorized users.
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26
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Kahle-Wrobleski K, Andrews JS, Belger M, Ye W, Gauthier S, Rentz DM, Galasko D. Dependence Levels as Interim Clinical Milestones Along the Continuum of Alzheimer's Disease: 18-Month Results from the GERAS Observational Study. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2018; 4:72-80. [PMID: 29186278 DOI: 10.14283/jpad.2017.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND While functional loss forms part of the current diagnostic criteria used to identify dementia due to Alzheimer's disease, the gradual and progressive nature of the disease makes it difficult to recognize clinically relevant signposts that could be helpful in making treatment and management decisions. Having previously observed a significant relationship between stages of functional dependence (the level of assistance patients require consequent to Alzheimer's disease deficits, derived from the Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale) and cognitive severity, we investigated whether measures of functional dependence could be utilized to identify clinical milestones of Alzheimer's disease progression. OBJECTIVES To describe the patterns of change in dependence over the course of 18 months in groups stratified according to cognitive Alzheimer's disease dementia severity (determined using the Mini-Mental State Examination score) and to identify characteristics associated with patients showing worsening dependence (progressors) versus those showing no change or improvement (non-progressors). DESIGN Analysis of longitudinal data from the GERAS study. SETTING GERAS is an 18-month prospective, multicenter, naturalistic, observational cohort study reflecting the routine care of patients with Alzheimer's disease in France, Germany, and the United Kingdom. PARTICIPANTS 1495 community-living patients, aged ≥55 years, diagnosed with probable Alzheimer's disease dementia, and their caregivers. MEASUREMENTS Dependence levels, cognitive function, behavioral symptoms, caregiver burden, and cost were assessed at baseline and at 18 months. RESULTS Of 971 patients having both baseline and 18-month data, 42% (408) were progressors and 563 (58%) were non-progressors. This general pattern held for all three levels of baseline Alzheimer's disease dementia severity - mild (Mini-Mental State Examination score 21-26), moderate (15-20) or moderately severe/severe (<15) - with 40-45% of each group identified as progressors and 55-60% as non-progressors. No baseline differences were seen between progressors and non-progressors in cognitive scores or behavioral symptoms, although progressors had significantly shorter times since diagnosis and showed milder functional impairment. Baseline factors predictive of increasing dependence over 18 months included more severe cognitive impairment, living with others, and having multiple caregivers. A higher level of initial dependence was associated with less risk of dependence progression. Total societal costs of care also increased with greater dependence. CONCLUSIONS In this large cohort, 42% of Alzheimer's disease dementia patients at all levels of cognitive severity became more dependent within 18 months of observation while 58% did not progress. Dependence levels may be considered as meaningful interim clinical milestones that reflect Alzheimer's disease-related functional deficits, although a time frame that extends beyond 18 months may be necessary to observe changes if used in clinical trials or other longitudinal studies. Recognition of predictors of greater dependence offers opportunities for intervention.
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Affiliation(s)
- K Kahle-Wrobleski
- Kristin Kahle-Wrobleski, PhD, Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis IN 46285, USA, Phone: 317-651-9881, Fax: 317-276-5791,
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27
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Bauer M, Fetherstonhaugh D, Haesler E, Beattie E, Hill KD, Poulos CJ. The impact of nurse and care staff education on the functional ability and quality of life of people living with dementia in aged care: A systematic review. NURSE EDUCATION TODAY 2018; 67:27-45. [PMID: 29729501 DOI: 10.1016/j.nedt.2018.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/27/2018] [Accepted: 04/13/2018] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Educational initiatives can improve care delivery and the experience of living in residential aged care for people with dementia. This review aimed to determine the impact of nurse and care staff education on measures of functional ability and quality of life for older people with dementia living in care homes. DESIGN Systematic review. DATA SOURCES Search of on-line databases in English between January 2000 and January 2017. REVIEW METHODS Three reviewers used data extraction and critical appraisal tools of the Joanna Briggs Institute to determine methodological quality of research. RESULTS AND CONCLUSION Thirty-two studies met the initial inclusion criteria and 13 were retrieved for full appraisal. There was limited impact of nurse and care staff education on residents' agitation, anxiety, mood and quality of life. The most consistent improvement in functional ability due to education may be in the execution of activities of daily living. More successful programs included multi-faceted components (e.g. hands on support, clinical auditing) in conjunction with didactic teaching. There is a need for more rigorous and well-designed studies to test interventions.
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Affiliation(s)
- Michael Bauer
- Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Deirdre Fetherstonhaugh
- Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Emily Haesler
- Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Elizabeth Beattie
- School of Nursing and Midwifery, Faculty of Health, Queensland University of Technology, Queensland, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Western Australia, Australia.
| | - Christopher J Poulos
- Research and Aged Care Clinical Services, Centre for Positive Ageing, Hammond Care, New South Wales, Australia.
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28
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Yu F, Chen Y, Mathiason MA, Wan Q, Lin FV. Cognitive and physical factors affecting daily function in Alzheimer's disease: A cross-sectional analysis. Nurs Health Sci 2018; 21:14-20. [PMID: 29736953 DOI: 10.1111/nhs.12426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 02/24/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022]
Abstract
Understanding the factors affecting activities of daily living (ADL) is important in Alzheimer's disease (AD), because decline in ADL contributes to many poor health outcomes. Existing studies often investigate the factors in isolation without a theoretical framework. The purpose of the present study was to provide preliminary results on how cognition, physical performance, and behavioral and psychological symptoms of dementia mediate the relationship of aerobic fitness and ADL in AD. A cross-sectional analysis was used (n = 28: average age 78 [8] years, education 16 (3) years, Mini-Mental State Examination scores 20 [4]). The results showed that aerobic fitness is not linked to ADL directly, and its association with ADL was mediated by physical performance and global cognition. Our findings provide preliminary support for aerobic fitness as a potential therapeutic target, as enhanced aerobic fitness could simultaneously modify other factors affecting ADL. Nurses are in a unique position for coordinating exercise safety assessment and prescription and educating older adults with AD about exercise participation.
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Affiliation(s)
- Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yan Chen
- Taihe Hospital, Shiyan, Hubei Province, China
| | | | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
| | - Feng V Lin
- School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
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29
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Abstract
Alzheimer's disease (AD) is a debilitating disease influencing a multitude of outcomes, including memory function. Recent work suggests that memory may be influenced by exercise ('memorcise'), even among those with AD. The present narrative review details (1) the underlying mechanisms of AD; (2) whether exercise has a protective effect in preventing AD; (3) the mechanisms through which exercise may help to prevent AD; (4) the mechanisms through which exercise may help attenuate the progression of AD severity among those with existing AD; (5) the effects and mechanisms through which exercise is associated with memory among those with existing AD; and (6) exercise recommendations for those with existing AD. Such an understanding will aid clinicians in their ability to use exercise as a potential behavioral strategy to help prevent and treat AD.
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Affiliation(s)
- Paul D Loprinzi
- a Physical Activity Epidemiology Laboratory, Exercise Psychology Laboratory, Department of Health, Exercise Science and Recreation Management , The University of Mississippi , University , MS , USA
| | - Emily Frith
- a Physical Activity Epidemiology Laboratory, Exercise Psychology Laboratory, Department of Health, Exercise Science and Recreation Management , The University of Mississippi , University , MS , USA
| | - Pamela Ponce
- a Physical Activity Epidemiology Laboratory, Exercise Psychology Laboratory, Department of Health, Exercise Science and Recreation Management , The University of Mississippi , University , MS , USA
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30
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Correlation Between Caregiver Reports of Physical Function and Performance-based Measures in a Cohort of Older Adults With Alzheimer Disease. Alzheimer Dis Assoc Disord 2017; 30:169-74. [PMID: 26191966 DOI: 10.1097/wad.0000000000000101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The objectives of this report are to determine the association between performance-based measures of physical function with caregiver reports of physical function in older adults with Alzheimer disease (AD) and to examine whether those associations vary by the level of patients' cognitive functioning. Subjects included 180 patient-caregiver dyads who are enrolled in a clinical trial testing the impact of an occupational therapy intervention plus guideline-level care to delay functional decline among older adults with AD. The primary caregiver-reported measure is the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Inventory (ADCS-ADL). Performance-based measures include the Short Physical Performance Battery and the Short Portable Sarcopenia Measure. Analysis of covariance (ANCOVA) models were used to determine the associations of each physical performance measure with ADCS-ADL, adjusting for cognition function and other covariates. We found significant correlations between caregiver reports and observed performance-based measures across all levels of cognitive function, with patients in the lowest cognitive group showing the highest correlation. These findings support the use of proxy reports to assess physical function among older adults with AD.
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31
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Tariq S, Barber PA. Dementia risk and prevention by targeting modifiable vascular risk factors. J Neurochem 2017; 144:565-581. [PMID: 28734089 DOI: 10.1111/jnc.14132] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/23/2017] [Accepted: 07/15/2017] [Indexed: 01/04/2023]
Abstract
The incidence of dementia is expected to double in the next 20 years and will contribute to heavy social and economic burden. Dementia is caused by neuronal loss that leads to brain atrophy years before symptoms manifest. Currently, no cure exists and extensive efforts are being made to mitigate cognitive impairment in late life in order to reduce the burden on patients, caregivers, and society. The most common type of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) often co-exists in the brain and shares common, modifiable risk factors, which are targeted in numerous secondary prevention trials. There is a growing need for non-pharmacological interventions and infrastructural support from governments to encourage psychosocial and behavioral interventions. Secondary prevention trials need to be redesigned based on the risk profile of individual subjects, which require the use of validated and standardized clinical, biological, and neuroimaging biomarkers. Multi-domain approaches have been proposed in high-risk populations that target optimal treatment; clinical trials need to recruit individuals at the highest risk of dementia before symptoms develop, thereby identifying an enriched disease group to test preventative and disease modifying strategies. The underlying aim should be to reduce microscopic brain tissue loss by modifying vascular and lifestyle risk factors over a relatively short period of time, thus optimizing the opportunity for preventing dementia in the future. Collaboration between international research groups is of key importance to the optimal use and allocation of existing resources, and the development of new techniques in preventing dementia. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Sana Tariq
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
| | - Philip A Barber
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada.,Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
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32
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Giebel CM, Burns A, Challis D. Taking a positive spin: preserved initiative and performance of everyday activities across mild Alzheimer's, vascular and mixed dementia. Int J Geriatr Psychiatry 2017; 32:959-967. [PMID: 27445133 DOI: 10.1002/gps.4553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The literature commonly evaluates those daily activities which are impaired in dementia. However, in the mild stages, people with dementia (PwD) are still able to initiate and perform many of those tasks. With a lack of research exploring variations between different dementia diagnoses, this study sought to investigate those daily activities with modest impairments in the mild stages and how these compare between Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia. METHODS Staff from memory assessment services from nine National Health Service trusts across England identified and approached informal carers of people with mild dementia. Carers completed the newly revised Interview for Deteriorations in Daily Living Activities in Dementia 2 assessing the PwD's initiative and performance of instrumental activities of daily living (IADLs). Data were analysed using analysis of variance and Chi-square tests to compare the maintenance of IADL functioning across AD, VaD, and mixed dementia. RESULTS A total of 160 carers returned the Interview for Deteriorations in Daily Living Activities in Dementia 2, of which 109, 21, and 30 cared for someone with AD, VaD, and mixed dementia, respectively. There were significant variations across subtypes, with AD showing better preserved initiative and performance than VaD for several IADLs. Overall, PwD showed greater preservation of performance than initiative, with tasks such as preparing a hot drink and dressing being best maintained. CONCLUSION Findings can help classify dementia better into subtypes in order to receive bespoke support. It suggests that interventions should primarily address initiative to improve overall functioning. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Clarissa M Giebel
- School of Psychological Sciences, University of Manchester, Manchester, UK.,Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
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33
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Necroptosis activation in Alzheimer's disease. Nat Neurosci 2017; 20:1236-1246. [PMID: 28758999 DOI: 10.1038/nn.4608] [Citation(s) in RCA: 287] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 06/21/2017] [Indexed: 12/16/2022]
Abstract
Alzheimer's disease (AD) is characterized by severe neuronal loss; however, the mechanisms by which neurons die remain elusive. Necroptosis, a programmed form of necrosis, is executed by the mixed lineage kinase domain-like (MLKL) protein, which is triggered by receptor-interactive protein kinases (RIPK) 1 and 3. We found that necroptosis was activated in postmortem human AD brains, positively correlated with Braak stage, and inversely correlated with brain weight and cognitive scores. In addition, we found that the set of genes regulated by RIPK1 overlapped significantly with multiple independent AD transcriptomic signatures, indicating that RIPK1 activity could explain a substantial portion of transcriptomic changes in AD. Furthermore, we observed that lowering necroptosis activation reduced cell loss in a mouse model of AD. We anticipate that our findings will spur a new area of research in the AD field focused on developing new therapeutic strategies aimed at blocking its activation.
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34
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Ingber AP, Hassenstab J, Fagan AM, Benzinger TLS, Grant EA, Holtzman DM, Morris JC, Roe CM. Cerebrospinal Fluid Biomarkers and Reserve Variables as Predictors of Future "Non-Cognitive" Outcomes of Alzheimer's Disease. J Alzheimers Dis 2017; 52:1055-64. [PMID: 27104893 DOI: 10.3233/jad-150478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The influence of reserve variables and Alzheimer's disease (AD) biomarkers on cognitive test performance has been fairly well-characterized. However, less is known about the influence of these factors on "non-cognitive" outcomes, including functional abilities and mood. OBJECTIVE We examined whether cognitive and brain reserve variables mediate how AD biomarker levels in cognitively normal persons predict future changes in function, mood, and neuropsychiatric behavior. METHODS Non-cognitive outcomes were examined in 328 individuals 50 years and older enrolled in ongoing studies of aging and dementia at the Knight Alzheimer Disease Research Center (ADRC). All participants were cognitively normal at baseline (Clinical Dementia Rating [CDR] 0), completed cerebrospinal fluid (CSF) and structural neuroimaging studies within one year of baseline, and were followed for an average of 4.6 annual visits. Linear mixed effects models explored how cognitive reserve and brain reserve variables mediate the relationships between AD biomarker levels and changes in function, mood, and neuropsychiatric behavior in cognitively normal participants. RESULTS Education levels did not have a significant effect on predicting non-cognitive decline. However, participants with smaller brain volumes exhibited the worst outcomes on measures of mood, functional abilities, and behavioral disturbance. This effect was most pronounced in individuals who also had abnormal CSF biomarkers. CONCLUSIONS The findings suggest that brain reserve plays a stronger, or earlier, role than cognitive reserve in protecting against non-cognitive impairment in AD.
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Affiliation(s)
- Adam P Ingber
- Department of Biological Statistics and Computational Biology, Cornell University, Ithaca, NY, USA
| | - Jason Hassenstab
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne M Fagan
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tammie L S Benzinger
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Elizabeth A Grant
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - David M Holtzman
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Molecular Biology and Pharmacology, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine M Roe
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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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.
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Affiliation(s)
| | - Catherine Reed
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
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Haaksma ML, Vilela LR, Marengoni A, Calderón-Larrañaga A, Leoutsakos JMS, Olde Rikkert MGM, Melis RJF. Comorbidity and progression of late onset Alzheimer's disease: A systematic review. PLoS One 2017; 12:e0177044. [PMID: 28472200 PMCID: PMC5417646 DOI: 10.1371/journal.pone.0177044] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/23/2017] [Indexed: 01/18/2023] Open
Abstract
Background Alzheimer’s disease is a neurodegenerative syndrome characterized by multiple dimensions including cognitive decline, decreased daily functioning and psychiatric symptoms. This systematic review aims to investigate the relation between somatic comorbidity burden and progression in late-onset Alzheimer’s disease (LOAD). Methods We searched four databases for observational studies that examined cross-sectional or longitudinal associations of cognitive or functional or neuropsychiatric outcomes with comorbidity in individuals with LOAD. From the 7966 articles identified originally, 11 studies were included in this review. The Newcastle-Ottawa quality assessment was used. The large variation in progression measures, comorbidity indexes and study designs hampered the ability to perform a meta-analysis. This review was registered with PROSPERO under DIO: 10.15124/CRD42015027046. Results Nine studies indicated that comorbidity burden was associated with deterioration in at least one of the three dimensions of LOAD examined. Seven out of ten studies investigating cognition found comorbidities to be related to decreased cognitive performance. Five out of the seven studies investigating daily functioning showed an association between comorbidity burden and decreased daily functioning. Neuropsychiatric symptoms (NPS) increased with increasing comorbidity burden in two out of three studies investigating NPS. Associations were predominantly found in studies analyzing the association cross-sectionally, in a time-varying manner or across short follow-up (≤2 years). Rarely baseline comorbidity burden appeared to be associated with outcomes in studies analyzing progression over longer follow-up periods (>2 years). Conclusion This review provides evidence of an association between somatic comorbidities and multifaceted LOAD progression. Given that time-varying comorbidity burden, but much less so baseline comorbidity burden, was associated with the three dimensions prospectively, this relationship cannot be reduced to a simple cause-effect relation and is more likely to be dynamic. Therefore, both future studies and clinical practice may benefit from regarding comorbidity as a modifiable factor with a possibly fluctuating influence on LOAD.
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Affiliation(s)
- Miriam L. Haaksma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Lara R. Vilela
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute, IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Carlos III Health Institute, Madrid, Spain
| | - Jeannie-Marie S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Marcel G. M. Olde Rikkert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - René J. F. Melis
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- * E-mail:
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Weiner MW, Veitch DP, Aisen PS, Beckett LA, Cairns NJ, Green RC, Harvey D, Jack CR, Jagust W, Morris JC, Petersen RC, Salazar J, Saykin AJ, Shaw LM, Toga AW, Trojanowski JQ. The Alzheimer's Disease Neuroimaging Initiative 3: Continued innovation for clinical trial improvement. Alzheimers Dement 2017; 13:561-571. [PMID: 27931796 PMCID: PMC5536850 DOI: 10.1016/j.jalz.2016.10.006] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The overall goal of the Alzheimer's Disease Neuroimaging Initiative (ADNI) is to validate biomarkers for Alzheimer's disease (AD) clinical trials. ADNI-3, which began on August 1, 2016, is a 5-year renewal of the current ADNI-2 study. METHODS ADNI-3 will follow current and additional subjects with normal cognition, mild cognitive impairment, and AD using innovative technologies such as tau imaging, magnetic resonance imaging sequences for connectivity analyses, and a highly automated immunoassay platform and mass spectroscopy approach for cerebrospinal fluid biomarker analysis. A Systems Biology/pathway approach will be used to identify genetic factors for subject selection/enrichment. Amyloid positron emission tomography scanning will be standardized using the Centiloid method. The Brain Health Registry will help recruit subjects and monitor subject cognition. RESULTS Multimodal analyses will provide insight into AD pathophysiology and disease progression. DISCUSSION ADNI-3 will aim to inform AD treatment trials and facilitate development of AD disease-modifying treatments.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - John C Morris
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | | | - Jennifer Salazar
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie M Shaw
- Tailored Therapeutics, Eli Lilly and Company, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Liu-Seifert H, Andersen S, Case M, Sparks J, Holdridge KC, Wessels AM, Hendrix S, Aisen P, Siemers E. Statistical properties of continuous composite scales and implications for drug development. J Biopharm Stat 2017; 27:1104-1114. [PMID: 28402165 DOI: 10.1080/10543406.2017.1315819] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little research has been conducted on the statistical properties of composite measures comprising linear combinations of continuous component scales. We assessed the quantitative relationship between the composites and their individual components regarding their abilities to detect treatment effects. In particular, we developed the mathematical derivation of the treatment effect size of a continuous composite in relation to the treatment effect sizes of its components and proved multiple properties of the composite. We demonstrated that the treatment effect size of a composite is greater than the minimum treatment effect size of its components and that above certain thresholds of correlations of components and ratios of component effect sizes, the composite may outperform its components. Examples from Alzheimer's disease (AD) clinical studies of solanezumab and donepezil using the composite Integrated AD Rating Scale (iADRS) and its components, the AD Assessment Scale-Cognitive subscale (ADAS-Cog) and AD Cooperative Study-Activities of Daily Living inventory, instrumental items (ADCS-iADL) were consistent with the theoretical statistical properties. The understanding of the quantitative relationships between continuous composites and their components will be useful in clinical trial design and the development of new scales and composites across therapeutic areas.
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Affiliation(s)
- Hong Liu-Seifert
- a Lilly Research Laboratories , Lilly Corporate Center, Indianapolis , Indiana , USA
| | - Scott Andersen
- a Lilly Research Laboratories , Lilly Corporate Center, Indianapolis , Indiana , USA
| | - Michael Case
- a Lilly Research Laboratories , Lilly Corporate Center, Indianapolis , Indiana , USA
| | - JonDavid Sparks
- a Lilly Research Laboratories , Lilly Corporate Center, Indianapolis , Indiana , USA
| | - Karen C Holdridge
- a Lilly Research Laboratories , Lilly Corporate Center, Indianapolis , Indiana , USA
| | - Alette M Wessels
- a Lilly Research Laboratories , Lilly Corporate Center, Indianapolis , Indiana , USA
| | | | - Paul Aisen
- c Department of Neurology, University of Southern California , San Diego , California , USA
| | - Eric Siemers
- a Lilly Research Laboratories , Lilly Corporate Center, Indianapolis , Indiana , USA
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The newly revised interview for deteriorations in daily living activities in dementia (R-IDDD2): distinguishing initiative from performance at assessment. Int Psychogeriatr 2017; 29:497-507. [PMID: 27890028 DOI: 10.1017/s1041610216002003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Minimal evidence exists on the detailed deficits in complex instrumental activities of daily living (IADLs) in mild dementia. The aim of this study was twofold, to validate a revised questionnaire focusing measuring the initiative and performance of IADLs in mild dementia and to explore the relationship between individual IADLs and patient and carer well-being. METHODS A total of 183 carers of people with mild dementia completed a further modified Revised Interview for Deterioration in Daily Living Activities 2 (R-IDDD2), which comprised new activities such as computer use, as well as sub-activities on the performance scale. Carers also completed questionnaires assessing patient quality of life (QoL-AD), carer quality of life (AC-QoL), and burden (GHQ-12). RESULTS Persons with dementia were significantly poorer initiating than performing cleaning, doing repair work, and preparing a hot or cold meal, whereas being poorer at performing dressing and following current affairs. Using the computer, preparing a hot meal, finance, and medication management were most impaired, whereas more basic activities of dressing, washing oneself, brushing hair or teeth, and preparing a hot drink were most preserved. Poor initiative and performance on nearly all activities were significantly related to reduced carer and patient well-being. CONCLUSIONS The R-IDDD2 offers a platform to comprehensively assess everyday functioning. Deteriorations in initiative and performance need to be targeted separately in interventions, as the former requires effective triggering and the latter structured training and support. Most activities were significantly associated with well-being, particularly patient quality of life so that improving any activity should improve well-being.
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Ropacki MT, Hannesdottir K, Hendrix S, Gordon MF, Stephenson D, Coons SJ, Stern RA. Clinically Meaningful Outcomes in Early Alzheimer Disease: A Consortia-Driven Approach to Identifying What Matters to Patients. Ther Innov Regul Sci 2017; 51:380-390. [PMID: 30231712 DOI: 10.1177/2168479016689712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Numerous statistically derived composite measures have recently been proposed as clinical outcome assessments (COAs) for clinical trials in the early stages of Alzheimer disease. Critical Path Institute's Coalition Against Major Diseases (CAMD) advanced a proposed statistically derived composite measure to regulatory agencies with the goal of qualifying it as a COA for pre-dementia trials. In response to FDA's requirement to demonstrate that proposed COAs are meaningful to patients, this project aimed to identify the most important cognition-related concerns patients and informants report early in the disease and determine how this information maps to what is assessed by several statistically derived composite measures. METHODS Leveraging qualitative research completed by Critical Path Institute's Patient-Reported Outcome Consortium, CAMD utilized a summary report that included frequency grids of reported concerns of amnestic mild cognitive impairment patients and their informants, as well as the narrative transcripts from focus groups. Transcripts were reviewed and analyzed to identify which cognitive domains the patient- and informant-reported concerns mapped onto. The results were then compared to see how well these cognitive domains were represented in various statistically derived composite measures. RESULTS The patient- and informant-reported concerns primarily mapped to the cognitive domains of episodic memory and, secondarily, orientation and language. Depending on the specified composite, there were varying levels of alignment between their subcomponents and these cognitive domains. CONCLUSION Through secondary analyses of existing qualitative data, this study examined several statistically derived composite measures and found that they generally capture cognitive domains that reflect aspects of day-to-day functioning that patients and informants consider meaningful.
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Affiliation(s)
- Michael T Ropacki
- 1 Janssen Research & Development, LLC, San Francisco, CA, USA.,2 Neurology Department, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kristin Hannesdottir
- 3 AstraZeneca Neuroscience iMed, Cambridge, MA, USA (until September 2014), Consultant, Rockville, MD, USA (until October 2016)
| | | | | | - Diane Stephenson
- 6 Coalition Against Major Diseases, Critical Path Institute, Tucson, AZ, USA
| | - Stephen Joel Coons
- 7 Patient-Reported Outcome Consortium, Critical Path Institute, Tucson, AZ, USA
| | - Robert A Stern
- 8 Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, USA
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Tuokko H, Griffith LE, Simard M, Taler V. Cognitive measures in the Canadian Longitudinal Study on Aging. Clin Neuropsychol 2016; 31:233-250. [DOI: 10.1080/13854046.2016.1254279] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Holly Tuokko
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
| | - Lauren E. Griffith
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Martine Simard
- School of Psychology, Laval University and Centre de recherche de l’Institut universitaire en santé mentale de Québec, Quebec City, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa & Bruyère Research Institute, Ottawa, Canada
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Cummings J, Aisen PS, DuBois B, Frölich L, Jack CR, Jones RW, Morris JC, Raskin J, Dowsett SA, Scheltens P. Drug development in Alzheimer's disease: the path to 2025. Alzheimers Res Ther 2016; 8:39. [PMID: 27646601 PMCID: PMC5028936 DOI: 10.1186/s13195-016-0207-9] [Citation(s) in RCA: 286] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The global impact of Alzheimer's disease (AD) continues to increase, and focused efforts are needed to address this immense public health challenge. National leaders have set a goal to prevent or effectively treat AD by 2025. In this paper, we discuss the path to 2025, and what is feasible in this time frame given the realities and challenges of AD drug development, with a focus on disease-modifying therapies (DMTs). Under the current conditions, only drugs currently in late Phase 1 or later will have a chance of being approved by 2025. If pipeline attrition rates remain high, only a few compounds at best will meet this time frame. There is an opportunity to reduce the time and risk of AD drug development through an improvement in trial design; better trial infrastructure; disease registries of well-characterized participant cohorts to help with more rapid enrollment of appropriate study populations; validated biomarkers to better detect disease, determine risk and monitor disease progression as well as predict disease response; more sensitive clinical assessment tools; and faster regulatory review. To implement change requires efforts to build awareness, educate and foster engagement; increase funding for both basic and clinical research; reduce fragmented environments and systems; increase learning from successes and failures; promote data standardization and increase wider data sharing; understand AD at the basic biology level; and rapidly translate new knowledge into clinical development. Improved mechanistic understanding of disease onset and progression is central to more efficient AD drug development and will lead to improved therapeutic approaches and targets. The opportunity for more than a few new therapies by 2025 is small. Accelerating research and clinical development efforts and bringing DMTs to market sooner would have a significant impact on the future societal burden of AD. As these steps are put in place and plans come to fruition, e.g., approval of a DMT, it can be predicted that momentum will build, the process will be self-sustaining, and the path to 2025, and beyond, becomes clearer.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV USA
| | - Paul S. Aisen
- University of Southern California, San Diego, CA USA
| | - Bruno DuBois
- Institute for Memory and Alzheimer’s Disease (IM2A) and ICM, Salpêtrière University Hospital, Paris University, Paris, France
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Roy W. Jones
- The Research Institute for the Care of Older People (RICE), Royal United Hospital, Bath, UK
| | - John C. Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO USA
| | | | | | - Philip Scheltens
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
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Risk Factors of Caregiver Burden Evolution, for Patients With Subjective Cognitive Decline or Neurocognitive Disorders: A Longitudinal Analysis. J Am Med Dir Assoc 2016; 17:1037-1043. [PMID: 27575984 DOI: 10.1016/j.jamda.2016.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND/OBJECTIVES The identification of factors used to predict caregiver burden may help preventive care. This study aimed to assess the relationship between evolution of patients with subjective cognitive decline (SCD) or progressive neurocognitive disorder (NCD) and evolution of caregiver burden. DESIGN Observational, longitudinal study. SETTING The study was conducted in the Clinical and Research Memory Center of the University Hospital of Lyon (France), between the November 1, 2011 and the June 30, 2014, with a maximum follow-up of 30 months. PARTICIPANTS The study population included outpatients with SCD or NCD at all stages, and their informal caregiver. MEASUREMENTS The caregiver burden was assessed during 2 visits of the patients and their caregiver, with the short version of the Zarit Burden Inventory (ZBI). Functional, cognitive performance, and behavioral and psychological symptoms were measured twice, concomitantly with the ZBI, using the Instrumental Activities of Daily Living (IADL) scale, the Mini-Mental State Examination (MMSE), and the Neuropsychiatric Inventory (NPI), respectively. Etiology and stage of the cognitive impairment were collected. RESULTS The population study included 222 patients (mean age at inclusion: 80 years old, 62.9% females), with an average follow-up 12.6 ± 6 months. Proportion of patients with major NCD at the second visit (62.2%) increased compared with inclusion (50.0%). MMSE and IADL decreased between the 2 visits (P < .001), whereas ZBI increased (mean ZBI: 3.2 ± 2 at baseline, mean ZBI: 3.8 ± 2 at follow-up, P < .001). In unadjusted analyses, ZBI tended to be higher for patients whose MMSE decreased of at least 3 points between the visits. ZBI increased over time when IADL decreased (P value for within-patient effect <.001), while it remained stable when the IADL increased. ZBI increased when NPI increased. After mutual adjustment for change of MMSE, IADL, NPI, and etiologies, increase of ZBI over time remained significant when MMSE decreased at least 3 points between baseline and follow-up, when IADL decreased, and when NPI increased of at least 4 points. CONCLUSIONS In a study population of patients with SCD or NCD at all stages, concomitant decrease of cognitive performance, increase of functional impairment, and increase neuropsychiatric symptoms over time were independently associated with increased caregiver burden. The identification of risk factors associated with an increased caregiver burden over time may allow a better evaluation of the impact of specific interventions on cognitive, behavioral, and functional dimensions of NCD on caregivers. TRIAL REGISTRATION ClinicalTrials.govNCT02825732.
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Loh KP, Janelsins MC, Mohile SG, Holmes HM, Hsu T, Inouye SK, Karuturi MS, Kimmick GG, Lichtman SM, Magnuson A, Whitehead MI, Wong ML, Ahles TA. Chemotherapy-related cognitive impairment in older patients with cancer. J Geriatr Oncol 2016; 7:270-80. [PMID: 27197918 PMCID: PMC4969145 DOI: 10.1016/j.jgo.2016.04.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/07/2016] [Accepted: 04/18/2016] [Indexed: 12/22/2022]
Abstract
Chemotherapy-related cognitive impairment (CRCI) can occur during or after chemotherapy and represents a concern for many patients with cancer. Among older patients with cancer, in whom there is little clinical trial evidence examining side effects like CRCI, many unanswered questions remain regarding risk for and resulting adverse outcomes from CRCI. Given the rising incidence of cancer with age, CRCI is of particular concern for older patients with cancer who receive treatment. Therefore, research related to CRCI in older patients with cancers is a high priority. In this manuscript, we discuss current gaps in research highlighting the lack of clinical studies of CRCI in older adults, the complex mechanisms of CRCI, and the challenges in measuring cognitive impairment in older patients with cancer. Although we focus on CRCI, we also discuss cognitive impairment related to cancer itself and other treatment modalities. We highlight several research priorities to improve the study of CRCI in older patients with cancer.
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Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester, United States.
| | | | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester, United States
| | - Holly M Holmes
- University of Texas Health Science Center at Houston, United States
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, Canada
| | - Sharon K Inouye
- Harvard Medical School, Beth Israel Deaconess Medical Center, United States; Hebrew Senior Life, United States
| | | | | | | | - Allison Magnuson
- James P Wilmot Cancer Institute, University of Rochester, United States
| | | | - Melisa L Wong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, United States
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Liu-Seifert H, Siemers E, Price K, Han B, Selzler KJ, Henley D, Sundell K, Aisen P, Cummings J, Raskin J, Mohs R. Cognitive Impairment Precedes and Predicts Functional Impairment in Mild Alzheimer's Disease. J Alzheimers Dis 2016; 47:205-14. [PMID: 26402769 PMCID: PMC4923754 DOI: 10.3233/jad-142508] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: The temporal relationship of cognitive deficit and functional impairment in Alzheimer’s disease (AD) is not well characterized. Recent analyses suggest cognitive decline predicts subsequent functional decline throughout AD progression. Objective: To better understand the relationship between cognitive and functional decline in mild AD using autoregressive cross-lagged (ARCL) panel analyses in several clinical trials. Methods: Data included placebo patients with mild AD pooled from two multicenter, double-blind, Phase 3 solanezumab (EXPEDITION/2) or semagacestat (IDENTITY/2) studies, and from AD patients participating in the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Cognitive and functional outcomes were assessed using AD Assessment Scale-Cognitive subscale (ADAS-Cog), AD Cooperative Study-Activities of Daily Living instrumental subscale (ADCS-iADL), or Functional Activities Questionnaire (FAQ), respectively. ARCL panel analyses evaluated relationships between cognitive and functional impairment over time. Results: In EXPEDITION, ARCL panel analyses demonstrated cognitive scores significantly predicted future functional impairment at 5 of 6 time points, while functional scores predicted subsequent cognitive scores in only 1 of 6 time points. Data from IDENTITY and ADNI programs yielded consistent results whereby cognition predicted subsequent function, but not vice-versa. Conclusions: Analyses from three databases indicated cognitive decline precedes and predicts subsequent functional decline in mild AD dementia, consistent with previously proposed hypotheses, and corroborate recent publications using similar methodologies. Cognitive impairment may be used as a predictor of future functional impairment in mild AD dementia and can be considered a critical target for prevention strategies to limit future functional decline in the dementia process.
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Affiliation(s)
- Hong Liu-Seifert
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Eric Siemers
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Karen Price
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Baoguang Han
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | | | - David Henley
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karen Sundell
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Paul Aisen
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | | | - Richard Mohs
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
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46
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Resnick B, Klinedinst NJ, Yerges-Armstrong L, Magaziner J, Orwig D, Hochberg MC, Gruber-Baldini AL, Hicks GE, Dorsey SG. Pain, Genes, and Function in the Post-Hip Fracture Period. Pain Manag Nurs 2016; 17:181-96. [PMID: 27283266 PMCID: PMC4902874 DOI: 10.1016/j.pmn.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
Post-hip fracture generalized pain can lead to a progressive decline in function and greater disability. The purpose of this study was to explore the factors that influence pain among older adults post-hip fracture, including genetic variability, and evaluate whether pain directly or indirectly influenced upper and lower extremity function. This was a secondary data analysis using data from the first 200 participants in a Baltimore Hip Study (BHS), BHS-7. Assessments were done at 2 months post-hip fracture and included age, sex, marital status, education, cognitive status, comorbidities, body mass index (BMI), upper and lower extremity function, single nucleotide polymorphisms (SNPs) from 10 candidate genes, and total areas of pain and pain intensity. Model testing was done using the AMOS statistical program. The full sample included 172 participants with an average age of 81. Fifty percent were female and the majority was Caucasian (93%). Model testing was done on 144 individuals who completed 2 month surveys. Across all models, age, cognition, and BMI were significantly associated with total areas of pain. Thirty SNPs from five genes (BDNF, FKBP5, NTRK2, NTRK3, and OXTR) were associated with areas of pain and/or pain intensity. Together, age, cognition, BMI, and the SNP from one of the five genes explained 25% of total areas of pain and 15% of pain intensity. Only age and cognition were significantly associated with lower extremity function, and only cognition was significantly associated with upper extremity function. The full model was partially supported in this study. Our genetic findings related to pain expand prior reports related to BDNF and NTRK2.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland.
| | | | | | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Denise Orwig
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Marc C Hochberg
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Susan G Dorsey
- University of Maryland School of Nursing, Baltimore, Maryland
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47
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Function and clinical meaningfulness of treatments for mild Alzheimer's disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 2:105-12. [PMID: 27239541 PMCID: PMC4879645 DOI: 10.1016/j.dadm.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Effectiveness of Alzheimer's disease (AD) treatments is commonly evaluated with coprimary outcomes; cognition with function to ensure clinical meaningfulness of a cognitive effect. Methods We reviewed the literature for functional outcomes in mild AD or mild cognitive impairment (MCI) patients (distinct from combined mild-moderate/severe AD) treated with approved AD drugs. Cognitive and functional treatment differences in mild AD patients in solanezumab EXPEDITION/EXPEDITION2 studies were compared across time. Results Seven publications provided MCI/mild AD functional outcomes, one of which reported a significant functional treatment effect. Secondary analyses of EXPEDITION studies suggested a smaller functional effect of solanezumab relative to cognition. An increasing effect of solanezumab over 18 months was shown for cognition and function. Discussion Function as the sole measure to demonstrate clinical meaningfulness of cognitive effects in mild AD may have limitations. For disease-modifying treatments, point differences on cognitive and functional scales should be qualified with duration of treatment.
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48
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Vellas B, Bateman R, Blennow K, Frisoni G, Johnson K, Katz R, Langbaum J, Marson D, Sperling R, Wessels A, Salloway S, Doody R, Aisen P. Endpoints for Pre-Dementia AD Trials: A Report from the EU/US/CTAD Task Force. J Prev Alzheimers Dis 2015; 2:128-135. [PMID: 26247004 PMCID: PMC4523051 DOI: 10.14283/jpad.2015.55] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
For Alzheimer's disease treatment trials that focus on the pre-dementia stage of disease, outcome measures are needed that will enable assessment of disease progression in patients who are clinically normal. The EU/US CTAD Task Force, an international collaboration of investigators from industry, academia, non-profit foundations, and regulatory agencies, met in Philadelphia, Pennsylvania, USA, on November 19, 2014 to discuss existing and novel outcome assessments that may be useful in pre-dementia trials. Composite measures that assess changes in episodic memory, executive function, global cognition, and global function have recently been developed by a number of groups and appear to be sensitive at this stage. Functional measures that involve real-life complex tasks also appear to capture early subtle changes in pre-dementia subjects and have the advantage of representing clinically meaningful change. Patient reported outcomes and novel CSF and imaging biomarkers have also shown promise. More studies are needed to validate all of these tests in the pre-dementia population. Many of them have been incorporated as exploratory measures in ongoing or planned trials.
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Affiliation(s)
- B Vellas
- UMR1027 Inserm, F-31073, Toulouse, France ; University of Toulouse III, F-31073, France ; Gerontopole Toulouse, Toulouse University Hospital, F-31000, Toulouse, France
| | - R Bateman
- Washington University School of Medicine, St. Louis, MO, USA
| | - K Blennow
- University of Gothenburg, MöIndal Hospital, Sahlgrenska University Hospital, 43180 MöIndal, Sweden
| | - G Frisoni
- University Hospitals and University of Geneva, Geneva, Switzerland ; IRCCS Fatebenefratelli, Brescia, Italy
| | - K Johnson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - R Katz
- Division of Neuropharmacological Drug Products, U.S. Food and Drug Administration, USA
| | - J Langbaum
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - D Marson
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - R Sperling
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Wessels
- Eli Lilly and Company, Indianapolis, IN, USA
| | - S Salloway
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - R Doody
- Baylor College of Medicine, Houston, TX, USA
| | - P Aisen
- Department of Neurosciences, University of California, San Diego, San Diego, CA USA
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49
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Ascher-Svanum H, Chen YF, Hake A, Kahle-Wrobleski K, Schuster D, Kendall D, Heine RJ. Cognitive and Functional Decline in Patients With Mild Alzheimer Dementia With or Without Comorbid Diabetes. Clin Ther 2015; 37:1195-205. [PMID: 25676448 DOI: 10.1016/j.clinthera.2015.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/06/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE Although diabetes is recognized as a risk factor for the development of cognitive impairment and for accelerated progression to Alzheimer disease (AD), it is unclear whether patients with diabetes who have already progressed to AD have a different rate of cognitive and functional decline compared with that in those without diabetes. This post hoc exploratory analysis compared cognitive and functional decline over an 18-month period in patients with mild AD dementia with and without comorbid diabetes. Decline in quality of life was assessed as a secondary objective. METHODS In a post hoc exploratory analysis, we analyzed data from the placebo groups of three 18-month, randomized, placebo-controlled trials of solanezumab and semagacestat in patients with AD. Data from patients with mild AD dementia (Mini-Mental State Examination [MMSE] score, 20-26) and comorbid diabetes at baseline were compared with data from patients with mild AD dementia without diabetes at baseline. Cognition was assessed using the 14-item AD Assessment Scale-Cognitive Subscale (ADAS-Cog14) and the MMSE. Functioning was assessed with the AD Cooperative Study-Activities of Daily Living Inventory (instrumental subset) (ADCS-iADL). Quality of life was assessed using the European Quality of Life-5 Dimensions scale, proxy version (proxy utility score and visual analog scale score), and the Quality of Life in AD scale, self-report and proxy (caregiver) versions. Group comparisons of changes from baseline to 18 months in cognitive, functional, and quality-of-life measures employed a repeated-measures model adjusted for propensity score, study, baseline cognition score (functional or quality of life), age, sex, level of education, genotype of the apolipoprotein E gene, and concurrent use of an acetylcholinesterase inhibitor or memantine. FINDINGS At baseline, patients with mild AD dementia with and without diabetes did not significantly differ on the cognitive measures, but those without diabetes were functioning at a significantly higher level. At 18 months, compared with patients without diabetes, those with diabetes showed a numerically but statistically nonsignificantly lesser cognitive decline (least squares mean between-group differences: ADAS-Cog14 score, 1.61 [P = 0.21]; MMSE score, -0.40 [P = 0.49]) and a statistically significantly lesser functional decline (least squares mean between-group difference in ADCS-iADL score, -3.07; P = 0.01). The 2 groups did not differ on declines in the quality-of-life measures. IMPLICATIONS The present findings suggest that diabetes may influence the rate of functional decline among patients with mild AD dementia. These results require replication in studies that address the limitations of the present post hoc exploratory analysis and that explore the potential causes of the observed differences.
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Affiliation(s)
| | | | - Ann Hake
- Eli Lilly and Company, Indianapolis, Indiana
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50
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Viola KL, Klein WL. Amyloid β oligomers in Alzheimer's disease pathogenesis, treatment, and diagnosis. Acta Neuropathol 2015; 129:183-206. [PMID: 25604547 DOI: 10.1007/s00401-015-1386-3] [Citation(s) in RCA: 440] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/11/2015] [Accepted: 01/11/2015] [Indexed: 12/22/2022]
Abstract
Protein aggregation is common to dozens of diseases including prionoses, diabetes, Parkinson's and Alzheimer's. Over the past 15 years, there has been a paradigm shift in understanding the structural basis for these proteinopathies. Precedent for this shift has come from investigation of soluble Aβ oligomers (AβOs), toxins now widely regarded as instigating neuron damage leading to Alzheimer's dementia. Toxic AβOs accumulate in AD brain and constitute long-lived alternatives to the disease-defining Aβ fibrils deposited in amyloid plaques. Key experiments using fibril-free AβO solutions demonstrated that while Aβ is essential for memory loss, the fibrillar Aβ in amyloid deposits is not the agent. The AD-like cellular pathologies induced by AβOs suggest their impact provides a unifying mechanism for AD pathogenesis, explaining why early stage disease is specific for memory and accounting for major facets of AD neuropathology. Alternative ideas for triggering mechanisms are being actively investigated. Some research favors insertion of AβOs into membrane, while other evidence supports ligand-like accumulation at particular synapses. Over a dozen candidate toxin receptors have been proposed. AβO binding triggers a redistribution of critical synaptic proteins and induces hyperactivity in metabotropic and ionotropic glutamate receptors. This leads to Ca(2+) overload and instigates major facets of AD neuropathology, including tau hyperphosphorylation, insulin resistance, oxidative stress, and synapse loss. Because different species of AβOs have been identified, a remaining question is which oligomer is the major pathogenic culprit. The possibility has been raised that more than one species plays a role. Despite some key unknowns, the clinical relevance of AβOs has been established, and new studies are beginning to point to co-morbidities such as diabetes and hypercholesterolemia as etiological factors. Because pathogenic AβOs appear early in the disease, they offer appealing targets for therapeutics and diagnostics. Promising therapeutic strategies include use of CNS insulin signaling enhancers to protect against the presence of toxins and elimination of the toxins through use of highly specific AβO antibodies. An AD-dependent accumulation of AβOs in CSF suggests their potential use as biomarkers and new AβO probes are opening the door to brain imaging. Overall, current evidence indicates that Aβ oligomers provide a substantive molecular basis for the cause, treatment and diagnosis of Alzheimer's disease.
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