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Ke C, Shan S, Tan Y, Cao Y, Xie Z, Shi S, Pan J, Zhang W. Signaling pathways in the treatment of Alzheimer's disease with acupuncture: a narrative review. Acupunct Med 2024; 42:216-230. [PMID: 38859546 DOI: 10.1177/09645284241256669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND To date, there is no effective treatment for Alzheimer's disease (AD), a progressive neurodegenerative disorder that is increasing in prevalence worldwide. The objective of this review was to summarize the core targets and signaling pathways involved in acupuncture treatment for AD. METHODS We reviewed numerous signaling pathways, including mammalian target of rapamycin (mTOR), phosphatidylinositol 3-kinase-protein kinase B (PI3 K/Akt), adenosine monophosphate-activated protein kinase (AMPK), mitogen-activated protein kinase (MAPK), nuclear factor (NF)-kB, p53, Wnt, nitric oxide (NO), Janus kinase / signal transducer and activator of transcription (JAK/ STAT), RhoA/ROCK (Rho-associated protein kinase) and Ca2+/ calmodulin-dependent protein kinase II (CaMKII) / cyclic adenosine monophosphate-response element-binding protein (CREB). The relevant data were obtained from PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang databases. RESULTS In summary, the effects of acupuncture are mediated by multiple targets and pathways. Furthermore, acupuncture can improve pathological changes associated with AD (such as abnormal deposition of amyloid (A)β, tau hyperphosphorylation, synaptic dysfunction and neuronal apoptosis) through multiple signaling pathways. CONCLUSION Overall, our findings provide a basis for future research into the effects of acupuncture on AD.
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Affiliation(s)
- Chao Ke
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Shengtao Shan
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yan Tan
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yang Cao
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Zhengrong Xie
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Senjie Shi
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jiang Pan
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Wei Zhang
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
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Paolillo EW, Casaletto KB, Clark AL, Taylor JC, Heuer HW, Wise AB, Dhanam S, Sanderson-Cimino M, Saloner R, Kramer JH, Kornak J, Kremers W, Forsberg L, Appleby B, Bayram E, Bozoki A, Brushaber D, Darby RR, Day GS, Dickerson BC, Domoto-Reilly K, Elahi F, Fields JA, Ghoshal N, Graff-Radford N, G H Hall M, Honig LS, Huey ED, Lapid MI, Litvan I, Mackenzie IR, Masdeu JC, Mendez MF, Mester C, Miyagawa T, Naasan G, Pascual B, Pressman P, Ramos EM, Rankin KP, Rexach J, Rojas JC, VandeVrede L, Wong B, Wszolek ZK, Boeve BF, Rosen HJ, Boxer AL, Staffaroni AM. Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study. JMIR Aging 2024; 7:e52831. [PMID: 38922667 PMCID: PMC11237775 DOI: 10.2196/52831] [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: 09/16/2023] [Revised: 02/09/2024] [Accepted: 03/07/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown. OBJECTIVE This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD. METHODS Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer's Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants' smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age. RESULTS The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases). CONCLUSIONS These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change.
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Affiliation(s)
- Emily W Paolillo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kaitlin B Casaletto
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Annie L Clark
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jack C Taylor
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Hilary W Heuer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Amy B Wise
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Sreya Dhanam
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mark Sanderson-Cimino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Rowan Saloner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Walter Kremers
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - Leah Forsberg
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Brian Appleby
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Ece Bayram
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Andrea Bozoki
- Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | - Danielle Brushaber
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - R Ryan Darby
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Fanny Elahi
- Department of Neurology, The Deane Center for Wellness and Cognitive Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters Veterans Affairs Medical Center, New York, NY, United States
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Nupur Ghoshal
- Department of Neurology, Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO, United States
| | | | - Matthew G H Hall
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lawrence S Honig
- Department of Neurology, Columbia University, New York, NY, United States
| | - Edward D Huey
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Ian R Mackenzie
- Department of Pathology, University of British Columbia, Vancouver, BC, Canada
| | - Joseph C Masdeu
- Stanley H. Appel Department of Neurology, Nantz National Alzheimer Center, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Carly Mester
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - Toji Miyagawa
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Belen Pascual
- Stanley H. Appel Department of Neurology, Nantz National Alzheimer Center, Houston Methodist Research Institute, Weill Cornell Medicine, Houston, TX, United States
| | - Peter Pressman
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Eliana Marisa Ramos
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica Rexach
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julio C Rojas
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lawren VandeVrede
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bonnie Wong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Adam M Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Zheng X, Wang S, Huang J, Li C, Shang H. Predictors for survival in patients with Alzheimer's disease: a large comprehensive meta-analysis. Transl Psychiatry 2024; 14:184. [PMID: 38600070 PMCID: PMC11006915 DOI: 10.1038/s41398-024-02897-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
The prevalence of Alzheimer's disease (AD) is increasing as the population ages, and patients with AD have a poor prognosis. However, knowledge on factors for predicting the survival of AD remains sparse. Here, we aimed to systematically explore predictors of AD survival. We searched the PubMed, Embase and Cochrane databases for relevant literature from inception to December 2022. Cohort and case-control studies were selected, and multivariable adjusted relative risks (RRs) were pooled by random-effects models. A total of 40,784 reports were identified, among which 64 studies involving 297,279 AD patients were included in the meta-analysis after filtering based on predetermined criteria. Four aspects, including demographic features (n = 7), clinical features or comorbidities (n = 13), rating scales (n = 3) and biomarkers (n = 3), were explored and 26 probable prognostic factors were finally investigated for AD survival. We observed that AD patients who had hyperlipidaemia (RR: 0.69) were at a lower risk of death. In contrast, male sex (RR: 1.53), movement disorders (including extrapyramidal signs) (RR: 1.60) and cancer (RR: 2.07) were detrimental to AD patient survival. However, our results did not support the involvement of education, hypertension, APOE genotype, Aβ42 and t-tau in AD survival. Our study comprehensively summarized risk factors affecting survival in patients with AD, provided a better understanding on the role of different factors in the survival of AD from four dimensions, and paved the way for further research.
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Affiliation(s)
- Xiaoting Zheng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shichan Wang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jingxuan Huang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chunyu Li
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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4
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Cho EB, Jung SY, Jung JH, Yeo Y, Kim HJ, Han K, Shin DW, Min JH. The risk of dementia in multiple sclerosis and neuromyelitis optica spectrum disorder. Front Neurosci 2023; 17:1214652. [PMID: 37397465 PMCID: PMC10309000 DOI: 10.3389/fnins.2023.1214652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Cognitive impairment is a common feature of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, there is a lack of population-based study of dementia risk in these disorders. In the present study, the risk of dementia in MS and NMOSD patients in Republic of Korea was estimated. Methods Data analyzed in this study were obtained from the Korean National Health Insurance Service (KNHIS) database between January 2010 and December 2017. The study included 1,347 MS patients and 1,460 NMOSD patients ≥40 years of age who had not been diagnosed with dementia within 1 year prior to the index date. Matched controls were selected based on age, sex, and the presence of hypertension, diabetes mellitus, or dyslipidemia. Results In MS and NMOSD patients, the risk of developing any dementia [adjusted hazard ratio (aHR) = 2.34; 95% confidence interval (CI) = 1.84-2.96 and aHR = 2.19; 95% CI = 1.61-3.00, respectively], Alzheimer's disease [AD; aHR = 2.23; 95% confidence interval (CI) = 1.70-2.91 and aHR = 1.99; 95% CI = 1.38-2.88, respectively], and vascular dementia (aHR = 3.75; 95% CI = 1.91-7.35 and aHR = 3.21; 95% CI = 1.47-7.02, respectively) was higher compared with the matched controls. NMOSD patients had a lower risk of any dementia and AD compared with MS patients after adjusting for age, sex, income, hypertension, diabetes, and dyslipidemia (aHR = 0.67 and 0.62). Conclusion The risk of dementia increased in MS and NMOSD patients and dementia risk was higher in MS than in NMOSD.
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Affiliation(s)
- Eun Bin Cho
- Department of Neurology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Se Young Jung
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Digital Healthcare, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin-Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Yohwan Yeo
- Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
- Center for Wireless and Population Health Systems, University of California San Diego, La Jolla, CA, United States
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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Nisar M, Gondal HY, Cheema ZM, Yousaf S, Nadeem H. New azole-derived hemiaminal ethers as promising acetylcholinesterase inhibitors: synthesis, X-ray structures, in vitro and in silico studies. J Biomol Struct Dyn 2023; 41:15535-15548. [PMID: 37021341 DOI: 10.1080/07391102.2023.2190805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
A new class of azole-derived hemiaminal ethers is designed as acetylcholinesterase (AChE) inhibitors. The synthesized compounds exhibited remarkable inhibitory activity against acetylcholine. Chiral hemiaminals (3d and 3i) based on (R)-menthoxymethyl group exhibit excellent inhibition with IC50 values of 0.983 ± 1.41 and 1.154 ± 0.89 µM. Similarly, butoxymethyl derivatives 3a, 3f and 3h, also showed promising inhibition comparable to the standard drug, Donepezil. In silico studies were performed to understand the mode of interactions with the target proteins, where menthoxymethyl azoles 3d and 3i demonstrated the highest docking scores. Molecular dynamics simulations displayed the stable ligand-protein complex of 3i with effective binding interactions. The bioavailability and pharmacokinetic parameterssupported the suitability of these small molecule inhibitors to develop cost-effective drug leads for Alzheimer's disease (AD). MTT assay substantiated the non-cytotoxic nature of the compounds. The synthesized compounds are extensively characterized by 1H NMR, 13C NMR and mass spectral data and SC-XRD.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Muhammad Nisar
- Institute of Chemistry, University of Sargodha, Sargodha, Pakistan
| | | | | | - Sammer Yousaf
- HEJ Research Institute of Chemistry, ICCBS, University of Karachi, Pakistan
| | - Humaira Nadeem
- Department of Pharmaceutical Chemistry, Riphah International University, Islamabad, Pakistan
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Maclagan LC, Abdalla M, Harris DA, Stukel TA, Chen B, Candido E, Swartz RH, Iaboni A, Jaakkimainen RL, Bronskill SE. Can Patients with Dementia Be Identified in Primary Care Electronic Medical Records Using Natural Language Processing? JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:42-58. [PMID: 36910911 PMCID: PMC9995630 DOI: 10.1007/s41666-023-00125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/23/2022] [Accepted: 01/07/2023] [Indexed: 01/24/2023]
Abstract
Dementia and mild cognitive impairment can be underrecognized in primary care practice and research. Free-text fields in electronic medical records (EMRs) are a rich source of information which might support increased detection and enable a better understanding of populations at risk of dementia. We used natural language processing (NLP) to identify dementia-related features in EMRs and compared the performance of supervised machine learning models to classify patients with dementia. We assembled a cohort of primary care patients aged 66 + years in Ontario, Canada, from EMR notes collected until December 2016: 526 with dementia and 44,148 without dementia. We identified dementia-related features by applying published lists, clinician input, and NLP with word embeddings to free-text progress and consult notes and organized features into thematic groups. Using machine learning models, we compared the performance of features to detect dementia, overall and during time periods relative to dementia case ascertainment in health administrative databases. Over 900 dementia-related features were identified and grouped into eight themes (including symptoms, social, function, cognition). Using notes from all time periods, LASSO had the best performance (F1 score: 77.2%, sensitivity: 71.5%, specificity: 99.8%). Model performance was poor when notes written before case ascertainment were included (F1 score: 14.4%, sensitivity: 8.3%, specificity 99.9%) but improved as later notes were added. While similar models may eventually improve recognition of cognitive issues and dementia in primary care EMRs, our findings suggest that further research is needed to identify which additional EMR components might be useful to promote early detection of dementia. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00125-6.
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Affiliation(s)
| | - Mohamed Abdalla
- Department of Computer Science, University of Toronto, Toronto, Canada
| | - Daniel A. Harris
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Therese A. Stukel
- ICES, G1-06, 2075 Bayview Avenue, Toronto, M4N 3M5 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Branson Chen
- ICES, G1-06, 2075 Bayview Avenue, Toronto, M4N 3M5 Canada
| | - Elisa Candido
- ICES, G1-06, 2075 Bayview Avenue, Toronto, M4N 3M5 Canada
| | - Richard H. Swartz
- ICES, G1-06, 2075 Bayview Avenue, Toronto, M4N 3M5 Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - R. Liisa Jaakkimainen
- ICES, G1-06, 2075 Bayview Avenue, Toronto, M4N 3M5 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Susan E. Bronskill
- ICES, G1-06, 2075 Bayview Avenue, Toronto, M4N 3M5 Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
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7
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Perales-Puchalt J, Strube K, Townley R, Niedens M, Arreaza H, Zaudke J, Burns JM. Primary Care Provider Preferences on Dementia Training: A Qualitative Study. J Alzheimers Dis 2023; 92:1067-1075. [PMID: 36847003 PMCID: PMC10119892 DOI: 10.3233/jad-221014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Dementia has no cure, but interventions can stabilize the progression of cognitive, functional, and behavioral symptoms. Primary care providers (PCPs) are vital for the early detection, and long-term management of these diseases, given their gatekeeping role in the healthcare system. However, PCPs rarely implement evidence-based dementia care due to time limitations and knowledge about diagnosis and treatment. Training PCPs may help address these barriers. OBJECTIVE We explored the preferences of PCPs for dementia care training programs. METHODS We conducted qualitative interviews with 23 PCPs recruited nationally via snowball sampling. We conducted remote interviews and organized the transcripts for qualitative review to identify codes and themes, using thematic analysis methods. RESULTS PCP preferences varied regarding many aspects of ADRD training. Preferences varied regarding how to best increase PCP participation in training, and what content and materials were needed to help them and the families they serve. We also found differences regarding the duration and timing of training, and the modality of training sessions (remote versus in-person). CONCLUSION The recommendations arising from these interviews have the potential to inform the development and refinement of dementia training programs to optimize their implementation and success.
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Affiliation(s)
- Jaime Perales-Puchalt
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelsey Strube
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ryan Townley
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Health System, Kansas City, KS, USA
| | - Michelle Niedens
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Health System, Kansas City, KS, USA
| | - Hector Arreaza
- Clínica Sierra Vista, Bakersfield, CA, USA
- Rio Bravo Family Medicine Residency Program, Bakersfield, CA, USA
| | | | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Health System, Kansas City, KS, USA
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Li J, Weiss J, Rajadhyaksha A, Acosta D, Harrati A, Jiménez Velázquez IZ, Liu MM, Llibre Guerra JJ, de Jesús Llibre Rodriguez J, Dow WH. Dementia Attributable Healthcare Utilizations in the Caribbean versus United States. J Alzheimers Dis 2023; 96:801-811. [PMID: 37840491 PMCID: PMC10754385 DOI: 10.3233/jad-230505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Despite the high burden of Alzheimer's disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region. OBJECTIVE This study examines healthcare utilization associated with Alzheimer's disease and other dementias among older adults in the Caribbean as compared to the US. METHODS We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias. RESULTS Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean. CONCLUSIONS The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.
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Affiliation(s)
- Jing Li
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | | | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña (UNPHU), Santo Domingo, Dominican Republic
| | | | | | - Mao-Mei Liu
- Department of Demography, University of California at Berkeley, Berkeley, CA, USA
| | | | | | - William H. Dow
- Department of Demography, University of California at Berkeley, Berkeley, CA, USA
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
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9
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Giaquinto F, Battista P, Angelelli P. Touchscreen Cognitive Tools for Mild Cognitive Impairment and Dementia Used in Primary Care Across Diverse Cultural and Literacy Populations: A Systematic Review. J Alzheimers Dis 2022; 90:1359-1380. [PMID: 36245376 DOI: 10.3233/jad-220547] [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: 12/14/2022]
Abstract
BACKGROUND Touchscreen cognitive tools opened new promising opportunities for the early detection of cognitive impairment; however, most research studies are conducted in English-speaking populations and high-income countries, with a gap in knowledge about their use in populations with cultural, linguistic, and educational diversity. OBJECTIVE To review the touchscreen tools used in primary care settings for the cognitive assessment of mild cognitive impairment (MCI) and dementia, with a focus on populations of different cultures, languages, and literacy. METHODS This systematic review was conducted following the PRISMA guidelines. Studies were identified by searching across MEDLINE, EMBASE, EBSCO, OVID, SCOPUS, SCIELO, LILACS, and by cross-referencing. All studies that provide a first-level cognitive assessment for MCI and dementia with any touchscreen tools suitable to be used in the context of primary care were included. RESULTS Forty-two studies reporting on 30 tools and batteries were identified. Substantial differences among the tools emerged, in terms of theoretical framework, clinical validity, and features related to the application in clinical practice. A small proportion of the tools are available in multiple languages. Only 7 out of the 30 tools have a multiple languages validation. Only two tools are validated in low-educated samples, e.g., IDEA and mSTS-MCI. CONCLUSION General practitioners can benefit from touchscreen cognitive tools. However, easy requirements of the device, low dependence on the examiner, fast administration, and adaptation to different cultures and languages are some of the main features that we need to take into consideration when implementing touchscreen cognitive tools in the culture and language of underrepresented populations.
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Affiliation(s)
- Francesco Giaquinto
- Department of History, Laboratory of Applied Psychology and Intervention, Society and Human Studies, University of Salento, Lecce, Italy
| | - Petronilla Battista
- Clinical and Scientific Institutes Maugeri Pavia, Scientific Institute of Bari, IRCCS, Italy
| | - Paola Angelelli
- Department of History, Laboratory of Applied Psychology and Intervention, Society and Human Studies, University of Salento, Lecce, Italy
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10
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Liu DM, Yan L, Wang L, Lin HH, Jiang XY. Dementia-related contact experience, attitudes, and the level of knowledge in medical vocational college students. World J Clin Cases 2022; 10:10097-10108. [PMID: 36246808 PMCID: PMC9561600 DOI: 10.12998/wjcc.v10.i28.10097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/27/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dementia is a severe neurological and psychological disease that occurs in older adults worldwide. The knowledge and attitude of medical-vocational college students play an important role in supporting primary healthcare systems.
AIM To investigate the level of knowledge, contact experience, and attitudes toward dementia among medical-vocational college students in China.
METHODS A cross-sectional survey was conducted, and 3-year medical and medical-related students from eight vocational colleges in Anhui province were recruited. The contact experience, attitudes, and knowledge level of students toward dementia were assessed using a questionnaire designed according to the Chinese version of the Alzheimer’s Disease Knowledge Scale (ADKS).
RESULTS A total of 2444 medical and medical-related students completed the survey, of whom 86.7% of respondents had interests and concerns regarding Alzheimer’s disease (AD), and 29.2% of respondents had experiences of contact with dementia patients. Overall attitudes toward dementia were negative. Only 35.4% of students were interested in participating in the caregiving of dementia patients. The mean score of students’ knowledge about AD as assessed by the ADKS was 21.16 (standard deviation, 3.43) out of 30.
CONCLUSION Dementia-related knowledge of medical-vocational college students was at a medium level, and their overall attitudes toward dementia were negative.
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Affiliation(s)
- Dong-Mei Liu
- School of Nursing, Anhui Medical College, Hefei 230062, Anhui Province, China
| | - Ling Yan
- School of Nursing, Anhui Medical College, Hefei 230062, Anhui Province, China
| | - Li Wang
- School of Nursing, Anhui Medical College, Hefei 230062, Anhui Province, China
| | - Hui-Hui Lin
- School of Nursing, Anhui Medical College, Hefei 230062, Anhui Province, China
| | - Xia-Yan Jiang
- School of Nursing, Anhui Medical College, Hefei 230062, Anhui Province, China
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11
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A Review on Characteristics of Experimental Research on Acupuncture Treatment for Alzheimer's Disease: Study Design. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8243704. [PMID: 35855822 PMCID: PMC9288276 DOI: 10.1155/2022/8243704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022]
Abstract
Background This review aims to systematically summarize and analyze recent high-quality animal research results about the use of acupuncture in Alzheimer's disease (AD) patients. This information will be useful in providing a reference for future experimental research and an experimental basis for the clinical use of acupuncture in the treatment of AD. Methods We utilized and referenced various electronic libraries from their inception to November 2021. Relevant information was reviewed and information such as the journal names, publication records, animal model selections and preparations, intervention measures, acupoint selections, detection methods, and detection indicators was extracted. Results. A total of 75 eligible studies were selected for additional review. Male SAMP8 mice, APP/PS1 double transgenic mice, Sprague-Dawley (SD) rats, and Wistar rats were the four commonly used animal strains in the experiments. The animals were categorized as transgenic and surgical mouse models. Experimental interventions included manual acupuncture (MA), Electro-acupuncture (EA), Moxibustion, and EA combined with Moxibustion. A retention time of 20 min was the optimal timing for experimental studies, with 14 sessions chosen as the most common treatment time. EA was the most prescribed acupuncture treatment type with continuous wave, 2 Hz frequency, and 1 mA electric current selected as frequently used parameters. A total of 78 acupoint prescriptions were analyzed involving 21 acupoints. The top 3 combinations of common acupoints were GV20 ⟶ EX-HN3, GV20 ⟶ BL23, and GV20 ⟶ GV26. A total of 39 articles had positive drug control groups, sham acupuncture, and/or nonacupoint control groups. Furthermore, 10 types of behavioral tests, 29 detection methods, 178 evaluation indicators, and 18 tissue samples were included in the analysis. Conclusions By collating these high-quality research studies systematically and comprehensively, acupuncture was found to be a viable and effective treatment in AD animal models. In addition, when designing experiments, researchers could refer to the detailed data provided here to make better schemes and maybe conduct more investigations in unresearched areas.
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12
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Möllers T, Stocker H, Perna L, Rujescu D, Holleczek B, Schöttker B, Brenner H. Subjective short-term memory difficulties at ages 50-75 predict dementia risk in a community-based cohort followed over 17 years. Age Ageing 2022; 51:6607610. [PMID: 35697354 DOI: 10.1093/ageing/afac113] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Subjective cognitive decline (SCD) is an established precursor of dementia. However, the relationship between SCD and dementia has been mostly studied among people aged 65+. We aimed to assess the association between subjective memory difficulties at ages 50-75 with all-cause dementia and dementia-subtypes in a community-based cohort with long-term follow-up. METHODS 6,190 individuals (51% female) aged 50-75 years (median age, 62) attending a general health examination (by a total of 684 general practitioners) in Saarland, Germany, in 2000-2002 were recruited for a community-based cohort study. Subjective difficulties regarding short-term and long-term memory were assessed at baseline with two simple yes/no questions. Associations with dementia (-subtypes) diagnoses during 17 years of follow-up were estimated by Cox proportional hazards models. RESULTS 492 participants were diagnosed with dementia during 17 years of follow-up. Participants with short-term memory difficulties were at higher risk to receive incident all-cause dementia and vascular dementia diagnoses both within 0-9 years (age and sex adjusted hazard ratios (aHR), 1.80 and 2.00, respectively) and within 0-17 years (aHR 1.55 and 1.78, respectively) from recruitment (P < 0.05 in all cases). For clinical Alzheimer's disease, a significant association was only seen within the initial 6 years. There were no associations of long-term memory difficulties with any type of dementia. CONCLUSIONS Subjective difficulties in short-term memory predict both intermediate and long-term risk of vascular and all-cause dementia even among late middle-age adults. These results underline the importance of cardiovascular disease prevention efforts well before old age for maintaining cognitive health.
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Affiliation(s)
- Tobias Möllers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Hannah Stocker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Department of Translational Research in Psychiatry - Max Planck Institute of Psychiatry, München, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Division of General Psychiatry, Medical University Vienna, Vienna, Austria
| | | | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
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13
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Tahami Monfared AA, Byrnes MJ, White LA, Zhang Q. The Humanistic and Economic Burden of Alzheimer's Disease. Neurol Ther 2022; 11:525-551. [PMID: 35192176 PMCID: PMC9095804 DOI: 10.1007/s40120-022-00335-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease (AD) is the leading cause of cognitive impairment and dementia in older individuals (aged ≥ 65 years) throughout the world. As a result of these progressive deficits in cognitive, emotional, and physical function, AD dementia can cause functional disability and loss of independence. To gain a deeper understanding of the recent literature on the burden of AD, including that of mild cognitive impairment (MCI) due to AD, we conducted a comprehensive targeted review of the PubMed-indexed literature (2014 to 2021) to examine the humanistic and economic burden of AD (including MCI) in North America, Europe, and Asia. Our literature review identified a range of factors associated with quality of life (QoL): some factors were positively associated with QoL, including caregiver relationship, religiosity, social engagement, and ability to engage in activities of daily living (ADL), whereas other factors such as neuropsychiatric symptoms were associated with poorer QoL. While patient- and proxy-rated QoL are highly correlated in patients with early AD dementia, proxy-rated QoL declines more substantially as severity worsens. The maintenance of self-reported QoL in patients with more severe AD dementia may be due to lack of awareness or to adaptation to circumstances. Compared to persons with normal cognition, MCI is associated with a greater cost burden, and individuals with MCI exhibit worse QoL. Key drivers of the societal economic burden of AD include disease severity, dependence level, institutionalization, and comorbidity burden. Evaluation of the impact of a hypothetical disease-modifying treatment delaying the progression from MCI to AD has suggested that such a treatment may result in cost savings.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai, 200 Metro Blvd, Nutley, NJ, 07110, USA. .,McGill University, Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada.
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14
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Mahmoudi E, Sadaghiyani S, Lin P, Kamdar N, Norcott A, Peterson MD, Meade MA. Diagnosis of Alzheimer's disease and related dementia among people with multiple sclerosis: Large cohort study, USA. Mult Scler Relat Disord 2022; 57:103351. [PMID: 35158460 DOI: 10.1016/j.msard.2021.103351] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/23/2021] [Accepted: 10/24/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alzheimer's disease and related dementia (ADRD) and multiple sclerosis (MS) are two neurodegenerative diseases with some shared pathophysiological characteristics. While the salient attribute of ADRD is a progressive decline in cognitive function, MS is mainly known for causing physical weakness, vision loss, and muscle stiffness. Progressive cognitive decline, however, is not uncommon among MS patients, and many case reports of MS were indicative of ADRD coexistence. Due to a lack of large epidemiological studies on this topic, we aimed to examine time to diagnosis of and adjusted hazard for ADRD using administrative claims data, comparing adults with and without MS. METHODS Using 2007-2017 private claims data from Optum Clinformatics Data Mart in the U.S., we identified adults (45+) with a MS diagnosis (n = 6151) as well as adults without MS for comparison (n = 916,143). We propensity score matched people with MS with those without (n = 6025) using age, sex, race/ethnicity, chronic conditions including cardiometabolic, psychologic, and musculoskeletal, U.S. Census Division, and socioeconomic variables. In addition to incidence estimates of ADRD diagnosis compared at 4-years, survival models were utilized to quantify unadjusted, fully adjusted, and adjusted propensity-matched hazard ratios. RESULTS Unmatched data revealed that incidence of early-onset ADRD diagnosis was 7 times higher among adults 45-64 years old with MS (1.4%) compared to those without (0.2%); among older adults (65+) with MS, incident ADRD was 4.0% compared to 3.3% among those without MS. Adjusted survival models indicated that adults with MS had a substantially high risk for early-onset ADRD diagnosis (among 45-64 years old: unmatched hazard ratio (HR): 4.25 (95% CI: 3.40 -5.32), matched HR: 4.49 (95% CI:2.62-7.69); among 65+ years old: unmatched HR: 1.39 (95% CI: 1.22, 1.58), matched HR: 1.26 (1.04, 1.54)). CONCLUSIONS Individuals with MS had a greater incidence of and risk for early- and late-onset ADRD diagnosis compared to those without MS. It is not clear whether this greater risk is due to an accelerated dementia risk or at least partially due to clinical misdiagnosis. Advancements in the development of clinical and imaging biomarkers should be more commonly used in clinical settings to facilitate future research on this topic.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, USA; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Shima Sadaghiyani
- Department of Psychiatry-Neuropsychology, Michigan Medicine, University of Michigan, USA
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, USA; Department of Emergency Medicine, Michigan Medicine, University of Michigan, USA; Department of Surgery, Michigan Medicine, University of Michigan, USA
| | - Alexandra Norcott
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, Michigan Medicine, University of Michigan, USA; Department of Internal Medicine, GRECC, Ann Arbor Veterans Affairs Healthcare System, USA
| | - Mark D Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michelle A Meade
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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15
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Perales-Puchalt J, Townley R, Niedens M, Vidoni ED, Greiner KA, Zufer T, Schwasinger-Schmidt T, McGee JL, Arreaza H, Burns JM. Acceptability and Preliminary Effectiveness of a Remote Dementia Educational Training Among Primary Care Providers and Health Navigators. J Alzheimers Dis 2022; 89:1375-1384. [PMID: 36031891 PMCID: PMC9703617 DOI: 10.3233/jad-220235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal care can improve lives of families with dementia but remains under-implemented. Most healthcare professional training is in person, time-intensive, and does not focus on key aspects such as early detection, and cultural competency. OBJECTIVE We explored the acceptability and preliminary effectiveness of a training, The Dementia Update Course, which addressed these issues. We hypothesized that the training would lead to increased levels of perceived dementia care competency among key healthcare workers, namely primary care providers (PCPs) and health navigators (HNs). METHODS We conducted pre-post training assessments among 22 PCPs and 32 HNs. The 6.5-h training was remote, and included didactic lectures, case discussion techniques, and materials on dementia detection and care. Outcomes included two 5-point Likert scales on acceptability, eleven on perceived dementia care competency, and the three subscales of the General Practitioners Confidence and Attitude Scale for Dementia. We used paired samples t-tests to assess the mean differences in all preliminary effectiveness outcomes. RESULTS The training included 28.6% of PCPs and 15.6% of HNs that self-identified as non-White or Latino and 45.5% of PCPs and 21.9% of HNs who served in rural areas. PCPs (84.2%) and HNs (91.7%) reported a high likelihood to recommend the training and high satisfaction. Most preliminary effectiveness outcomes analyzed among PCPs (11/14) and all among HNs (8/8) experienced an improvement from pre- to post-training (p < 0.05). CONCLUSION A relatively brief, remote, and inclusive dementia training was associated with high levels of acceptability and improvements in perceived dementia care competency among PCPs and HNs.
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Affiliation(s)
- Jaime Perales-Puchalt
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ryan Townley
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | - Michelle Niedens
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | - Eric D Vidoni
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - K Allen Greiner
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | - Tahira Zufer
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
| | | | | | - Hector Arreaza
- Clínica Sierra Vista, Bakersfield, CA, USA
- Rio Bravo Family Medicine Residency Program, Bakersfield, CA, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Universityof Kansas Health System, Kansas City, KS, USA
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16
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Patel MR, Jagsi R, Resnicow K, Smith SN, Hamel LM, Su C, Griggs JJ, Buchanan D, Isaacson N, Torby M. A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship. Popul Health Manag 2021; 24:710-721. [PMID: 33989065 PMCID: PMC8713277 DOI: 10.1089/pop.2021.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little information has been compiled across studies about existing interventions to mitigate issues of medical financial hardship, despite growing interest in health care delivery. The purpose of this qualitative systematic scoping review was to examine content and outcomes of interventions to address medical financial hardship. PRISMA guidelines were applied to present results using PubMed, Scopus, and CINAHL, published between January 1980 and August 2020. Additional studies were identified through reference lists of selected papers. Included studies focused on mitigating medical financial hardship from out-of-pocket (OOP) health care expenses as an intervention strategy with at least 1 evaluation component. Screening 2412 articles identified 339 articles for full-text review, 12 of which met inclusion criteria. Variation was found regarding targets and outcome measurement of intervention. Primary outcomes were in the following categories: financial outcomes (eg, OOP expenses), behavioral outcomes, psychosocial, health care utilization, and health status. No included studies reported significant reduction in OOP expenses, perceptions of financial burden/toxicity, or health status. However, changes were observed for behavioral outcomes (adherence to treatment, patient needs addressed), some psychosocial outcomes (mental health symptoms, perceived support, patient satisfaction), and care utilization such as routine health care. No patterns were observed in the achievement of outcomes across studies based on intensity of intervention. Few rigorous studies exist in this emerging field, and studies have not shown consistent positive effects. Future research should focus on conceptual clarity of the intervention, align outcome measurement and achieve consensus around outcomes, and employ rigorous study designs, measurement, and outcome follow-up.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shawna N. Smith
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lauren M. Hamel
- Wayne State University School of Medicine/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Christopher Su
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Internal Medicine-Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jennifer J. Griggs
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Department of Internal Medicine-Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Oncology Quality Consortium, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Diamond Buchanan
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nicole Isaacson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Michelle Torby
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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17
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Co M, Couch E, Gao Q, Martinez A, Das-Munshi J, Prina M. Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1640-1663. [PMID: 34324226 DOI: 10.1002/gps.5590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well-studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. METHODS We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random-effects meta-analysis to synthesise findings. The Newcastle-Ottawa Scale was used to assess quality and risk of bias in individual studies. RESULTS We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta-analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82-0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50-0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. CONCLUSION Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elyse Couch
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Qian Gao
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea Martinez
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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18
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Wiese LK, Williams CL, Hain D, Newman D, Houston CP, Kaack C, Galvin JE. Detecting dementia among older, ethnically diverse residents of rural subsidized housing. Geriatr Nurs 2021; 42:524-532. [PMID: 33039199 PMCID: PMC8024416 DOI: 10.1016/j.gerinurse.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christine L Williams
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, United States.
| | - Debra Hain
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - David Newman
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christina P Houston
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Carolina Kaack
- Louis and Anne Green Memory & Wellness Center, 777 Glades Road, Bldg AZ-79, Boca Raton, FL 33431, United States
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, 5250 University Drive, Coral Gables, FL, United States.
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19
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Pisu M, Martin RC, Shan L, Pilonieta G, Kennedy RE, Oates G, Kim YI, Geldmacher DS. Dementia Care in Diverse Older Adults in the U.S. Deep South and the Rest of the United States. J Alzheimers Dis 2021; 83:1753-1765. [PMID: 34459392 PMCID: PMC8843111 DOI: 10.3233/jad-210240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Use of specialists and recommended drugs has beneficial effects for older adults living with Alzheimer's disease and related dementia (ADRD). Gaps in care may exist for minorities, e.g., Blacks, and especially in the United States (U.S.) Deep South (DS), a poor U.S. region with rising ADRD cases and minority overrepresentation. Currently, we have little understanding of ADRD care utilization in diverse populations in this region and elsewhere in the U.S. (non-DS), and the factors that adversely impact it. OBJECTIVE To examine utilization of specialists and ADRD drugs (outcomes) in racial/ethnic groups of older adults with ADRD and the personal or context-level factors affecting these outcomes in DS and non-DS. METHODS We obtained outcomes and personal-level covariates from claims for 127,512 Medicare beneficiaries with ADRD in 2013-2015, and combined county-level data in exploratory factor analysis to define context-level covariates. Adjusted analyses tested significant association of outcomes with Black/White race and other factors in DS and non-DS. RESULTS Across racial/ethnic groups, 33%-43% in DS and 43%-50% in non-DS used specialists; 47%-55% in DS and 41%-48% in non-DS used ADRD drugs. In adjusted analyses, differences between Blacks and Whites were not significant. Vascular dementia, comorbidities, poverty, and context-level factor "Availability of Medical Resources" were associated with specialist use; Alzheimer's disease and senile dementia, comorbidities, and specialist use were associated with drug use. In non-DS only, other individual, context-level covariates were associated with the outcomes. CONCLUSION We did not observe significant gaps in ADRD care in DS and non-DS; however, research should further examine determinants of low specialist and drug use in these regions.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-4410, USA
- Alzheimer’s Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy C. Martin
- Alzheimer’s Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham, Sparks Center, Suite 350, 1720 7th Avenue South, Birmingham, AL 35233, USA
| | - Liang Shan
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-4410, USA
| | - Giovanna Pilonieta
- Department of Neurology, University of Alabama at Birmingham, Sparks Center, Suite 350, 1720 7th Avenue South, Birmingham, AL 35233, USA
- Department of Health Services Administration, University of Alabama at Birmingham, USA
| | - Richard E. Kennedy
- Alzheimer’s Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Gerontology, Geriatrics and Palliative Care, 933 19th Street South, CH19 201, Birmingham, AL 35294
| | - Gabriela Oates
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, Birmingham, AL
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-4410, USA
| | - David S. Geldmacher
- Alzheimer’s Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham, Sparks Center, Suite 350, 1720 7th Avenue South, Birmingham, AL 35233, USA
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20
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Li Q, Wang Q, Guan H, Zhou Y, Liu L. Schisandrin Inhibits NLRP1 Inflammasome-Mediated Neuronal Pyroptosis in Mouse Models of Alzheimer's Disease. Neuropsychiatr Dis Treat 2021; 17:261-268. [PMID: 33542629 PMCID: PMC7853410 DOI: 10.2147/ndt.s279147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In recent years, schisandrin (SCH) was proved to improve Alzheimer's Disease (AD). The aim of our study is to explore the effect of SCH on neuronal pyroptosis in the disease. METHODS A Morris water maze test was performed to evaluate the spatial learning and memory retention of AD mouse. ELISA was fulfilled to examine the concentration of Aβ, IL-1β, and IL-18. Western blot was performed to detect the expression of apoptosis- and pyroptosis-related proteins. Besides, the neuronal apoptosis rate was examined using TUNEL assay. Immunohistochemistry was utilized to detect the activation of NLRP1 inflammasome. RESULTS Here, AD mice have serious cognitive impairment. Meantime, Aβ was highly expressed in the brains of AD mice. SCH could effectively rescue the cognitive impairment in AD mice and impede the production of Aβ. Subsequently, we further demonstrated that SCH repressed neuronal apoptosis, pyroptosis-related proteins expression, and the activation of NLRP1 inflammasome in the hippocampus of AD mice. We also proved that Aβ induced neuronal apoptosis and pyroptosis in vitro. However, the effects of Aβ on neuronal apoptosis and pyroptosis were partly reversed by SCH treatment. CONCLUSION Overall, our data indicated that SCH improved cognitive impairment in AD mice through inhibition of NLRP1 inflammasome-mediated neuronal pyroptosis and neuronal apoptosis. Our works provided new evidence to support SCH acting as a potential treatment method in AD.
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Affiliation(s)
- Quan Li
- Department of Organs, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang, People's Republic of China
| | - Qi Wang
- Teaching and Research Department of Basic Theory of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang, People's Republic of China
| | - Huibo Guan
- Teaching and Research Department of Diagnostics of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang, People's Republic of China
| | - Yanyan Zhou
- Teaching and Research Department of Basic Theory of Traditional Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang, People's Republic of China
| | - Li Liu
- Department of Cardiovascular Diseases, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang, People's Republic of China
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21
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Black CM, Lipton RB, Thiel E, Brouillette M, Khandker R. Relationship Between Treatment Initiation and Healthcare Costs in Alzheimer's Disease. J Alzheimers Dis 2020; 68:1575-1585. [PMID: 30909221 DOI: 10.3233/jad-180983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The relationship between Alzheimer's disease (AD) treatment patterns and healthcare costs is unknown. Administrative claims data from the MarketScan Commercial and Medicare databases covering 2010 through 2016 were used to identify the comorbidities, treatment patterns, and healthcare costs in the three years prior to and one year post medical diagnosis of AD in 21,448 patients with no treatment and 57,970 patients with treatment. Pre-index mean annual costs ranged from $14,228 to $26,876, and post-index mean annual costs ranged from $21,052 to $45,685 depending on age and treatment timing. After adjusting for baseline characteristics, patients 50-100 years old who initiated treatment with an FDA approved drug prior to or concurrent with diagnosis had healthcare costs 9%-19% lower in the year following diagnosis than those who did not receive treatment. Early or concurrent treatment is associated with lower overall healthcare costs in the year following AD diagnosis.
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22
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Alzheimer's disease; a review of the pathophysiological basis and therapeutic interventions. Life Sci 2020; 256:117996. [PMID: 32585249 DOI: 10.1016/j.lfs.2020.117996] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder and is identified as the most common cause for dementia. Despite huge global economic burden and the impact on the close family of the patients, there is no definitive cure and thus, improved treatment methods are of need. While memory and cognition are severely affected in AD, exact etiology is yet unknown. The β-Amyloid plaque formation and aggregation hypothesis is among the well-known hypotheses used to explain disease pathogenesis. Currently there are five Food and Drug Administration (FDA) approved drugs as treatment options. All these drugs are used for symptomatic treatment of AD. Thus, disease modifying therapies which can directly address the pathological changes in AD, are needed. Such therapies could be designed based on inhibiting key steps of pathogenesis. Currently there are novel AD drug candidates with various therapeutic mechanisms, undergoing different stages of drug development. Extensive research is being done globally to broaden understanding of the exact mechanisms involved in AD and to develop therapeutic agents that can successfully hinder the occurrence and progression of the disease. In this review, a comprehensive approach to understanding AD and suggestions to be considered in the development of therapeutics for it are presented.
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23
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Möllers T, Perna L, Stocker H, Ihle P, Schubert I, Schöttker B, Frölich L, Brenner H. New use of psychotropic medication after hospitalization among people with dementia. Int J Geriatr Psychiatry 2020; 35:640-649. [PMID: 32100308 DOI: 10.1002/gps.5282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/13/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Psychotropic medication is commonly used among people with dementia (PWD), but it shows modest efficacy and it has been associated with severe adverse events. Hospitalizations are an opportunity for medication management as well as treatment recommendations for outpatient physicians. The aim of this study was to asses factors associated with new use of psychotropic medication after hospitalization among PWD. METHODS We conducted a retrospective dynamic cohort study from 2004 to 2015 using claims data from a German health insurance company. PWD were identified by an algorithm that included ICD-10 diagnosis and diagnostic measures. The medication classes included were antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication. The assessment period was up to 30 days after discharge from the hospital across four hospitalizations. RESULTS The main predictors for new use of psychotropic medication were similar across medication classes. Neuropsychiatric symptoms (NPS) and the need of care were associated with higher odds of new use of antidepressants, antipsychotics, and anxiolytics or hypnotics/sedatives. A hospital stay due to dementia was an independent predictor for new use across medication classes as well. Delirium increased the odds for new use of antipsychotics and anxiolytics or hypnotics/sedatives. CONCLUSIONS Factors associated with new use of psychotropic medication included delirium, NPS, and the need of care in PWD. The findings highlight the need for preventive interventions and non-medical treatment options in regards to delirium and NPS as well as for a more intensive use of screening tools for inappropriate medication use among PWD. Key points The percentage of new users was 1.8%, 7.1%, 2.1%, and 2.5% across hospitalizations for antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication, respectively. 83.0%, 61.9%, 56.9%, and 88.1% of new users received antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication for more than 6 weeks. Delirium and neuropsychiatric symptoms were associated with significantly increased odds of new psychotropic medication use. Hospital stays due to dementia and the need of care were predictors for new use of psychotropic medication.
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Affiliation(s)
- Tobias Möllers
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Department of Translational Research in Psychiatry, Max Planck Institute for Psychiatry, Munich, Germany
| | - Hannah Stocker
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Peter Ihle
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ben Schöttker
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Lutz Frölich
- Department of Gerontopsychiatry, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Hermann Brenner
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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24
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Rasmussen J, Langerman H. Alzheimer's Disease - Why We Need Early Diagnosis. Degener Neurol Neuromuscul Dis 2019; 9:123-130. [PMID: 31920420 PMCID: PMC6935598 DOI: 10.2147/dnnd.s228939] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/16/2019] [Indexed: 12/27/2022] Open
Abstract
Alzheimer's disease is the leading cause of dementia. However, neither Alzheimer's disease nor Alzheimer's dementia are an inevitable consequence of aging. This review provides an overview of the issues involved in a diagnosis of Alzheimer's disease before an individual meets the criteria for Alzheimer's dementia. It examines how Alzheimer's disease diagnosis rates can be improved, the implications of an early diagnosis for the individual, carer and society, and the importance of risk reduction to prevent or delay progression. Although no disease-modifying agents capable of reversing the initial pathological changes are currently available, it may be possible to prevent or delay the development of dementia in a proportion of the population by modifying exposure to common risk factors. In other individuals, diagnosing the disease or risk of disease early is still valuable so that the individual and their carers have time to make choices and plan for the future, and to allow access to treatments that can help manage symptoms. Primary healthcare professionals play a pivotal role in recognising individuals at risk, recommending lifestyle changes in mid-adult life that can prevent or slow down the disease, and in timely diagnosis. Early intervention is the optimal strategy, because the patient's level of function is preserved for longer.
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25
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Abstract
AIMS The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia. METHODS A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses. RESULTS A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance. CONCLUSIONS Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.
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26
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Schaefer KR, Noonan C, Mosley M, Smith J, Galbreath D, Fenn D, Robinson RF, Manson SM. Differences in service utilization at an urban tribal health organization before and after Alzheimer's disease or related dementia diagnosis: A cohort study. Alzheimers Dement 2019; 15:1412-1419. [PMID: 31563535 PMCID: PMC6874738 DOI: 10.1016/j.jalz.2019.06.4945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The prevalence, mortality, and healthcare impact of Alaska Native and American Indian (ANAI) people with Alzheimer's disease and related dementias (ADRD) are unknown. METHODS We conducted a cohort study of electronic health record data that compared healthcare service utilization in patients with and without an ADRD diagnosis. Zero-inflated negative binomial regression with robust standard errors was used to estimate utilization rates. RESULTS Compared with patients without ADRD, utilization rates were similar before but higher after ADRD diagnosis. For those with diagnosed ADRD, utilization increased gradually over time with sharp upward change during the year of diagnosis. DISCUSSION This is the only study quantifying changes in healthcare service utilization before and after ADRD diagnosis among ANAI people, which is crucial for tailoring geriatric care for ANAI populations.
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Affiliation(s)
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Michael Mosley
- Data Service Department, Southcentral Foundation, Anchorage, AK, USA
| | - Julia Smith
- Data Service Department, Southcentral Foundation, Anchorage, AK, USA
| | - Donna Galbreath
- Medical Service Administration, Southcentral Foundation, Anchorage, AK, USA
| | - David Fenn
- Organizational Development and Innovation, Southcentral Foundation, Anchorage, AK, USA
| | | | - Spero M Manson
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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27
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Wei S, Mai Y, Peng W, Ma J, Sun C, Li G, Liu Z. The effect of nonpharmacologic therapy on global cognitive functions in patients with Alzheimer's disease: an updated meta-analysis of randomized controlled trials. Int J Neurosci 2019; 130:28-44. [PMID: 31251099 DOI: 10.1080/00207454.2019.1638377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: The effectiveness of non-pharmacologic therapy (NPT) in treating the global cognition dysfunction associated with Alzheimer's disease (AD) has not been clearly demonstrated. Therefore, we performed a meta-analysis to address this issue.Methods: The Cochrane Central Register of Controlled Trials, PUBMED, EMBASE and other databases were searched, and outcomes measured by the Mini-Mental State Examination (MMSE) or the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) were analysed.Results: Seven types of NPT were included, 25 randomized controlled trials (RCTs) were selected and 3238 participants were included in the meta-analysis. There were significant differences between the NPT and control groups in the MMSE and ADAS-cog scores.Conclusions: Although more extensive trials need to be performed, NPT has been observed to be beneficial in AD patients.
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Affiliation(s)
- Shouchao Wei
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yingren Mai
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wanjuan Peng
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jing Ma
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chaowen Sun
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Guangning Li
- Department of Neurology, Huadu District People's Hospital, Southern Medical University, Guangzhou, China
| | - Zhou Liu
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Linna M, Vuoti S, Silander K, Hörhammer I, Halminen O, Mikkola T, Koivuranta-Vaara P, Virta LJ, Koivusalo M, Ylisaukko-oja T. Impact of Anti-Dementia Medication on the Risk of Death and Causes of Death in Alzheimer’s Disease. J Alzheimers Dis 2019; 71:1297-1308. [DOI: 10.3233/jad-190288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Miika Linna
- Aalto University/Health Care, Engineering, Management and Architecture (HEMA), Aalto, Finland
| | | | - Katariina Silander
- Aalto University/Health Care, Engineering, Management and Architecture (HEMA), Aalto, Finland
| | - Iiris Hörhammer
- Aalto University/Health Care, Engineering, Management and Architecture (HEMA), Aalto, Finland
| | - Olli Halminen
- Aalto University/Health Care, Engineering, Management and Architecture (HEMA), Aalto, Finland
| | - Teija Mikkola
- Finnish Local and Regional Authorities, Helsinki, Finland
| | | | - Lauri J. Virta
- Research Department, Social Insurance Institution of Finland, Turku, Finland
| | | | - Tero Ylisaukko-oja
- MedEngine, Helsinki, Finland
- University of Oulu, Center for Life Course Health Research, Oulu, Finland
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29
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Thunell J, Ferido P, Zissimopoulos J. Measuring Alzheimer's Disease and Other Dementias in Diverse Populations Using Medicare Claims Data. J Alzheimers Dis 2019; 72:29-33. [PMID: 31524159 DOI: 10.3233/jad-190310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined how methods used for identifying dementia in administrative claims affected dementia incidence across racial/ethnic populations using a 100% sample of Medicare beneficiaries (n = 23,793,452). We found levels differed by method from 3.1% annual incidence to 3.6% in 2014. Dementia incidence declined from 2007 to 2014, but choice of method differentially impacted levels and trends by race/ethnicity. Methods using codes for dementia diagnosis and drugs to treat symptoms identified proportionally more Hispanics and Asians with dementia than other race/ethnicities, while codes for dementia diagnosis, drugs, and symptoms identified proportionally more whites and American Indians/Alaska Natives with dementia than other race/ethnicities.
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Affiliation(s)
- Johanna Thunell
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Patricia Ferido
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Julie Zissimopoulos
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA.,USC Price School of Public Policy, Los Angeles, CA, USA
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30
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Fishman P, Coe NB, White L, Crane PK, Park S, Ingraham B, Larson EB. Cost of dementia in Medicare managed care: a systematic literature review. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:e247-e253. [PMID: 31419102 PMCID: PMC7441813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We conducted a systematic review of studies reporting the direct healthcare costs of treating older adults with diagnosed Alzheimer disease and related dementias (ADRD) within private Medicare managed care plans. STUDY DESIGN A systematic review of all studies published in English reporting original empirical analyses of direct costs for older adults with ADRD in Medicare managed care. METHODS All papers indexed in PubMed or Web of Science reporting ADRD costs within Medicare managed care plans from 1983 through 2018 were identified and reviewed. RESULTS Despite the growth in Medicare managed care enrollment, only 9 papers report the costs of care for individuals with ADRD within these plans, and only 1 study reports data less than 10 years old. This limited literature reports wide ranges for ADRD-attributable costs, with estimates varying from $3738 to $8726 in annual prevalent costs and $8938 to $38,794 in 1-year immediate postdiagnosis incident costs. Reviewed studies also used varied study populations, case and cost ascertainment methods, and analytic methods, making cross-study comparisons difficult. CONCLUSIONS The expected continued growth in Medicare managed care enrollment, coupled with the large and growing impact of ADRD on America's healthcare delivery and finance systems, requires more research on the cost of ADRD within managed care. This research should use more consistent approaches to identify ADRD prevalence and provide more detail regarding which components of care are included in analyses and how the costs of care are captured and measured.
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Affiliation(s)
- Paul Fishman
- Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98185.
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31
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Amado DK, Brucki SMD. Knowledge about Alzheimer's disease in the Brazilian population. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:775-782. [PMID: 30570022 DOI: 10.1590/0004-282x20180106] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/21/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Dementia is a very common disease, but the general population's knowledge about its main etiology, Alzheimer's disease (AD), is still poor, leading to delayed seeking of healthcare services, less prevention of disease by lifestyle changes and more difficulty in managing the care of the demented. To measure knowledge about AD in a Brazilian sample, taking into account some demographic variables. METHODS A link to a self-administered online questionnaire was sent by email and via other social media to anyone older than 18 years old. Our questionnaire contained sociodemographic questions and the Alzheimer's Disease Knowledge Scale (ADKS), a well-established scale comprising 30 "true or false" questions about AD. RESULTS 1,414 people (1,076 females), with a mean age of 42.3 years (SD ± 14.1), and 87.4% having more than 11 years of schooling, answered the online questionnaire. The mean total score for the ADKS was 21.6 out of 30 points (SD ± 3.73); however when we excluded health professionals (36.4% of the sample), it dropped to 20.5/30 (SD ± 3.51). The scores were positively influenced by educational level, professional skills (better for health professionals, mainly physicians) and by age (younger than 65 years). Being a caregiver or family member did not influence the knowledge about disease. DISCUSSION Despite the high prevalence of AD, few studies have been conducted in Brazil regarding the population's knowledge about the disease. Our study revealed a lack of information about AD in our country, even in relatives and caregivers of demented patients.
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Affiliation(s)
- Daniel Krempel Amado
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil.,Hospital Santa Marcelina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil.,Hospital Santa Marcelina, Departamento de Neurologia, São Paulo SP, Brasil
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Dominguez LJ, Barbagallo M. Dietary Strategies and Supplements for the Prevention of Cognitive Decline and Alzheimer’s Disease. OMEGA FATTY ACIDS IN BRAIN AND NEUROLOGICAL HEALTH 2019:231-247. [DOI: 10.1016/b978-0-12-815238-6.00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
Population-based clinic-pathological studies have established that the most common pathological substrate of dementia in community-dwelling elderly people is mixed, especially Alzheimer's disease (AD) and cerebrovascular ischemic disease (CVID), rather than pure AD. While these could be just two frequent unrelated comorbidities in the elderly, epidemiological research has reinforced the idea that mid-life (age <65 years) vascular risk factors increase the risk of late-onset (age ≥ 65 years) dementia, and specifically AD. By contrast, healthy lifestyle choices such as leisure activities, physical exercise, and Mediterranean diet are considered protective against AD. Remarkably, several large population-based longitudinal epidemiological studies have recently indicated that the incidence and prevalence of dementia might be decreasing in Western countries. Although it remains unclear whether these positive trends are attributable to neuropathologically definite AD versus CVID, based on these epidemiological data it has been estimated that a sizable proportion of AD cases could be preventable. In this review, we discuss the current evidence about modifiable risk factors for AD derived from epidemiological, preclinical, and interventional studies, and analyze the opportunities for therapeutic and preventative interventions.
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Affiliation(s)
- Alberto Serrano-Pozo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John H. Growdon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Fantoni ER, Chalkidou A, O’ Brien JT, Farrar G, Hammers A. A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease. J Alzheimers Dis 2018; 63:783-796. [PMID: 29689725 PMCID: PMC5929301 DOI: 10.3233/jad-171093] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. OBJECTIVE To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. METHODS Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. RESULTS For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. CONCLUSIONS Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans.
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Affiliation(s)
| | - Anastasia Chalkidou
- King’s Technology Evaluation Centre (KiTEC), London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | | | | | - Alexander Hammers
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
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