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Dobson R, Patterson K, Malik R, Mandal U, Asif H, Humphreys R, Payne M, O-Charoenrat E, Huzzey L, Clare A, Green K, Morton M, Sohrabi C, Singh N, Pasupathy A, Patel M, Whiteman S, Maxmin K, Bass N, Gupta B, Cooper C, Marshall C, Weil RS, Mummery CJ. Eligibility for antiamyloid treatment: preparing for disease-modifying therapies for Alzheimer's disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333468. [PMID: 38862265 DOI: 10.1136/jnnp-2024-333468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/27/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) for Alzheimer's disease (AD) have early evidence of efficacy. Widespread delivery of DMTs will require major service reconfiguration. Treatment pathways will need to include triaging for eligibility, regular infusions and baseline and follow-up MRI scanning. A critical step in planning is provision of real-world estimates of patients likely to be eligible for triaging, but these are challenging to obtain. METHODS We performed a retrospective service evaluation of patients attending five memory services across North and East London and a national specialist cognitive disorders service. We examined the likely proportion of patients who would (1) be referred for triaging for DMTs and (2) potentially be suitable for treatments. RESULTS Data from a total of 1017 patients were included, 517 of whom were seen in community memory services and 500 in a specialist clinic. In the memory services, 367/517 (71%) were diagnosed with possible AD. After exclusions of those in whom cognitive and frailty scores, MRI contraindications or anticoagulant use indicated they would be unlikely to be suitable, an estimated 32% would be eligible for triaging. In the specialist cognitive clinic, where additional investigations are available, 14% of those seen (70/500) would be potentially eligible for treatment. CONCLUSIONS While a sizeable proportion of patients attending memory clinics may be referred for triaging for DMTs for AD, only a minority are likely to be suitable for these, as demonstrated in patients seen in specialist cognitive services. This will need to be considered when designing pathways for DMT delivery.
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Affiliation(s)
- Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Academic Health Science Centre, UCL Partners, London, UK
| | | | - Reshad Malik
- Haringey Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
- Enfield Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Uttara Mandal
- Haringey Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Hina Asif
- Haringey Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Ros Humphreys
- Haringey Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Michael Payne
- Haringey Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Eng O-Charoenrat
- Haringey Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Lauren Huzzey
- Enfield Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Adam Clare
- Enfield Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Kate Green
- Enfield Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Maija Morton
- Barnet Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Catrin Sohrabi
- Barnet Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Navreen Singh
- Barnet Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Amirtha Pasupathy
- Barnet Memory Service, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Milan Patel
- Camden Memory Service, Camden and Islington Mental Health and Social Care Trust, London, UK
| | - Sam Whiteman
- Camden Memory Service, Camden and Islington Mental Health and Social Care Trust, London, UK
| | - Kate Maxmin
- Camden Memory Service, Camden and Islington Mental Health and Social Care Trust, London, UK
| | - Nicholas Bass
- Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | - Bhavya Gupta
- Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | - Claudia Cooper
- East London NHS Foundation Trust, London, UK
- Centre for Psychiatry, Queen Mary University of London, London, UK
| | - Charles Marshall
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | - Rimona Sharon Weil
- Academic Health Science Centre, UCL Partners, London, UK
- Dementia Research Centre, University College London, London, UK
| | - Catherine J Mummery
- Dementia Research Centre, University College London, London, UK
- Department of Neurodegenerative Disease, National Hospital for Neurology and Neurosurgery, London, UK
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Camic PM, Sullivan MP, Harding E, Gould M, Wilson L, Rossi-Harries S, Grillo A, McKee-Jackson R, Cox SM, Stott J, Brotherhood EV, Windle G, Crutch SJ. 'Misdiagnosed and Misunderstood': Insights into Rarer Forms of Dementia through a Stepwise Approach to Co-Constructed Research Poetry. Healthcare (Basel) 2024; 12:485. [PMID: 38391860 PMCID: PMC10887667 DOI: 10.3390/healthcare12040485] [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: 11/18/2023] [Revised: 01/13/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
This study investigated co-constructed research poetry as a way to understand the lived experiences of people affected by rarer dementia and as a means to use poetry to convey those experiences to healthcare professionals. Using mixed methods, 71 people living with rarer dementia and care-partners (stakeholders) contributed to co-constructing 27 poems with professional poets; stakeholders' verbatim words were analysed with descriptive qualitative analysis. Stakeholders were also surveyed and interviewed about their participation. Healthcare professionals (n = 93) were surveyed to elicit their responses to learning through poetry and its acceptability as a learning tool. Poems conveyed a shared narrative of different aspects of lived experience, often owing to atypical symptoms, misunderstandings by professionals, lack of support pathways, and a continuous struggle to adapt. Stakeholder surveys indicated it was a valuable experience to both co-create and respond to the poems, whilst group interviews revealed people's experiences of the research poetry were characterised by reflection on lived experience, curiosity and exploration. Healthcare professionals' responses reinforced poetry's capacity to stimulate cognitive and affective learning specific to rare dementia support and prompt both empathy and critical thinking in practice. As the largest poetry-based study that we are aware of, this novel accessible approach of creating group poems yielded substantial information about the experiences and needs of those affected by rarer dementia and how poetry can contribute to healthcare education and training.
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Affiliation(s)
- Paul M Camic
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Martha Gould
- Independent Researcher, North Bay, ON P1B 8L7, Canada
| | - Lawrence Wilson
- Independent Researcher, Sonic Studios, Rye, East Sussex TN31 7NY, UK
| | - Sam Rossi-Harries
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Roberta McKee-Jackson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Susan M Cox
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Gill Windle
- Ageing and Dementia @ Bangor, Dementia Services Development Centre, School of Health Sciences, Bangor University, Bangor LL57 2EE, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
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O'Hara L, Neville C, Marr C, McAlinden M, Kee F, Weir D, McGuinness B. Investigating the prevalence of cognitive impairment and dementia in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA): the Harmonised Cognitive Assessment Protocol (HCAP) cross-sectional substudy. BMJ Open 2024; 14:e075672. [PMID: 38296305 PMCID: PMC10831431 DOI: 10.1136/bmjopen-2023-075672] [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: 05/15/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) study is the largest study of ageing in Northern Ireland (NI). The Harmonised Cognitive Assessment Protocol (HCAP) is a substudy of NICOLA designed to assess cognitive impairment and dementia in individuals aged 65 and over. The NICOLA-HCAP substudy is funded by the National Institute on Aging as part of a network for enhancing cross-national research within a worldwide group of population-based, longitudinal studies of ageing, all of which are centred around the US-based Health and Retirement Study. METHODS AND ANALYSIS The NICOLA-HCAP study will draw on the main NICOLA cohort (of 8283 participants) and randomly sample 1000 participants aged 65 and over to take part in the substudy. Participants will complete a series of cognitive tests (n=19) via a computer-assisted personal interview administered in their home (or alternatively within the research centre) and will be asked to nominate a family member or friend to complete an additional interview of validated instruments to provide information on respondent's prior and current cognitive and physical functioning and whether the individual requires help with daily activities. The objectives of the study are: to investigate the prevalence of dementia and cognitive impairment in NICOLA; harmonise scoring of the NICOLA-HCAP data to the HCAP studies conducted in Ireland, the USA and England; to explore the validity of dementia estimates; and investigate the risk factors for dementia and cognitive impairment. ETHICS AND DISSEMINATION The study received ethical approval from the Faculty of Medicine, Health and Life Sciences Research Ethics Committee, Queen's University Belfast. We will provide data from the Northern Irish HCAP to the research community via data repositories such as the Dementias Platform UK and Gateway to Global Aging to complement existing public data resources and support epidemiological research by others. Findings will also be disseminated through peer-reviewed publications and at international conferences.
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Affiliation(s)
- Leeanne O'Hara
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Calum Marr
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - David Weir
- University of Michigan, Ann Arbor, Michigan, USA
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Henney AE, Gillespie CS, Alam U, Hydes TJ, Mackay CE, Cuthbertson DJ. High intake of ultra-processed food is associated with dementia in adults: a systematic review and meta-analysis of observational studies. J Neurol 2024; 271:198-210. [PMID: 37831127 PMCID: PMC10770002 DOI: 10.1007/s00415-023-12033-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND AIMS Poor cardiometabolic health is associated with dementia. Considering previous meta-analyses have confirmed associations between ultra-processed foods (UPFs) and cardiometabolic disease, we were interested in the contribution of UPF consumption to the risk of developing dementia. METHODS We performed a systematic review and meta-analysis of all records registered on Ovid Medline and Web of Science from inception until December 2022 [PROSPERO (CRD42023388363)]. Studies that assessed UPF consumption in adults, determined according to NOVA, and that reported dementia (Alzheimer's disease, vascular dementia and mild cognitive impairment) determined by clearly stated diagnostic criteria (including formal assessment of dementia or use of diagnostic codes) were included. The association between UPF consumption and dementia was assessed using random-effects meta-analysis, controlling for confounding variables. Study quality was assessed using the Newcastle Ottawa Scale and evidence credibility evaluated using the NutriGrade system. RESULTS Seven thousand ten records were screened, and 122 records underwent full text review. From these, 10 observational (8 longitudinal) studies, analysing 867,316 individuals, were included. Included studies adjusted for age, socioeconomic status and co-morbidity, alongside other confounders. High (vs. low) intake of UPF was associated with increased risk of dementia (pooled relative risk 1.44 (95% confidence interval 1.09-1.90) (p = 0.02)) (I2 = 97.0%), although moderate (vs. low) intake of UPF was not (1.12 (0.96-1.31) (0.13)) (85.0%). Funnel plots demonstrate low risk of publication bias. CONCLUSION High UPF consumption is associated with dementia. Public health measures to reduce overconsumption of UPFs are imperative to reduce the burden of dementia.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK.
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK.
- Aintree University Hospital, Liverpool, UK.
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Theresa J Hydes
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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Dinneweth J, Gadeyne S. Socioeconomic Disparities in Neurodegenerative Disease Mortality: A Population-Based Study among Belgian Men and Women Aged 65 or Older. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237113. [PMID: 38488199 PMCID: PMC10943715 DOI: 10.1177/00469580241237113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
This study investigates the association between socioeconomic position (SEP) - in terms of income and education - and mortality from neurodegenerative diseases, that is, dementia, parkinsonism, and motor neuron diseases (MNDs). We calculated age-standardized mortality rates and mortality rate ratios using log linear Poisson regression for different SEP groups, stratified by gender, age-group, and care home residency, utilizing the 2011 Belgian census linked to register data on cause-specific mortality for 2011 to 2016. Mortality was significantly higher in the lowest educational- and income groups. The largest disparities were found in dementia mortality. Income had a strong negative effect on parkinsonism mortality, education a positive effect. We found no significant association between SEP and MND. Our study provides evidence supporting the presence of socioeconomic disparities in mortality due to neurodegeneration. We found a strong negative association between SEP and NDD mortality, which varies between NDD, gender and care home residency.
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Affiliation(s)
- Janna Dinneweth
- Brussels Institute for Social and Population Studies/Vrije Universiteit Brussel, Brussels, Belgium
| | - Sylvie Gadeyne
- Brussels Institute for Social and Population Studies/Vrije Universiteit Brussel, Brussels, Belgium
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Dobson R, Rehill N, Weil RS. Democratising access to dementia research. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2023; 22:12-15. [PMID: 38445268 PMCID: PMC7615713 DOI: 10.47795/sqwe8437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
As the UK population ages, dementia affects an increasing proportion of the population. There is a drive to accelerate dementia research, however access to research is not equitably distributed. We examine access to dementia research and discuss some enabling factors and barriers. High recruitment is frequently driven by a person (or people) dedicated to improving research participation. Barriers are commonly structural, rather than lack of willingness or knowledge. A recurring issue was lack of time and/or resources. Leveraging existing infrastructure, such as streamlined and efficient governance frameworks, is a clear part of the solution. Research teams need to ensure inclusion/exclusion criteria serve the target population, and that any intervention is accessible to a range of patients. An injection of resources is crucial to support the recruitment process on the ground.
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Leahy TP, Simpson A, Sammon C, Ballard C, Gsteiger S. Estimating the prevalence of diagnosed Alzheimer disease in England across deprivation groups using electronic health records: a clinical practice research datalink study. BMJ Open 2023; 13:e075800. [PMID: 37879685 PMCID: PMC10603427 DOI: 10.1136/bmjopen-2023-075800] [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: 05/19/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Estimate the prevalence of diagnosed Alzheimer's disease (AD) and early Alzheimer's disease (eAD) overall and stratified by age, sex and deprivation and combinations thereof in England on 1 January 2020. DESIGN Cross-sectional. SETTING Primary care electronic health record data, the Clinical Practice Research database linked with secondary care data, Hospital Episode Statistics (HES) and patient-level deprivation data, Index of Multiple Deprivation (IMD). OUTCOME MEASURES The prevalence per 100 000 of the population and corresponding 95% CIs for both diagnosed AD and eAD overall and stratified by covariates. Sensitivity analyses were conducted to assess the sensitivity of the population definition and look-back period. RESULTS There were 448 797 patients identified in the Clinical Practice Research Datalink that satisfied the study inclusion criteria and were eligible for HES and IMD linkage. For the main analysis of AD and eAD, 379 763 patients are eligible for inclusion in the denominator. This resulted in an estimated prevalence of diagnosed AD of 378.39 (95% CI, 359.36 to 398.44) per 100 000 and eAD of 292.81 (95% CI, 276.12 to 310.52) per 100 000. Prevalence estimates across main and sensitivity analyses for the entire AD study population were found to vary widely with estimates ranging from 137.48 (95% CI, 127.05 to 148.76) to 796.55 (95% CI, 768.77 to 825.33). There was significant variation in prevalence of diagnosed eAD when assessing the sensitivity with the look-back periods, as low as 120.54 (95% CI, 110.80 to 131.14) per 100 000, and as high as 519.01 (95% CI, 496.64 to 542.37) per 100 000. CONCLUSIONS The study found relatively consistent patterns of prevalence across both AD and eAD populations. Generally, the prevalence of diagnosed AD increased with age and increased with deprivation for each age category. Women had a higher prevalence than men. More granular levels of stratification reduced patient numbers and increased the uncertainty of point prevalence estimates. Despite this, the study found a relationship between deprivation and prevalence of AD.
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Affiliation(s)
| | - Alex Simpson
- Global Access, F Hoffmann-La Roche AG, Basel, Switzerland
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Watson J, Green MA, Giebel C, Darlington-Pollock F, Akpan A. Social and spatial inequalities in healthcare use among people living with dementia in England (2002-2016). Aging Ment Health 2023; 27:1476-1487. [PMID: 35959941 PMCID: PMC9612936 DOI: 10.1080/13607863.2022.2107176] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Healthcare services for people living with dementia (PLWD) are stretched, and government promises of increased funding remain undelivered. With the UK dementia population to surpass 1 million by 2024, and dementia care costs predicted to almost treble by 2040, it is essential we understand differences in healthcare use among PLWD. This study aimed to explore social and spatial variations in healthcare use among people diagnosed with dementia (2002-2016). METHODS Data were derived from Electronic Health Records of Clinical Practice Research Datalink GP patients in England (n = 142,302). To standardise healthcare contacts, rates of healthcare contacts per year were calculated for three primary (GP observations and medications) and three secondary healthcare types [Accident & Emergency (A&E) attendances and, emergency and elective hospital admissions]. Fully-adjusted generalised linear regression models were used to identify healthcare use variation by social and spatial groups. Twelve models were generated, one for each healthcare type in early- and late-onset populations separately. RESULTS This study highlights numerous social and spatial variations in healthcare use among PLWD. Among PLWD, several groups tended to have healthcare service use more closely associated with negative outcomes, including a greater likelihood of A&E attendances and emergency and elective hospital admissions. These groups include: men, people from White ethnicity groups and people from more deprived and rural areas. CONCLUSIONS Systemic and social measures are needed to reduce variations in healthcare use inequalities in PWLD. These include greater healthcare continuity, health checks and medicines reviews, culturally appropriate services, better and more accessible treatment and improved infrastructure.
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Affiliation(s)
- James Watson
- School of Environmental Sciences, The University of Liverpool, Liverpool, United Kingdom
| | - Mark A. Green
- School of Environmental Sciences, The University of Liverpool, Liverpool, United Kingdom
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
- NIHR ARC NWC, Liverpool, United Kingdom
| | | | - Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Liverpool University Hospitals NHS FT, Liverpool, United Kingdom
- Healthy Ageing Group, University of Cumbria, Cumbria, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- NIHR CRN NWC, Liverpool, United Kingdom
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Dai J, Xu Y, Wang T, Zeng P. Exploring the relationship between socioeconomic deprivation index and Alzheimer's disease using summary-level data: From genetic correlation to causality. Prog Neuropsychopharmacol Biol Psychiatry 2023; 123:110700. [PMID: 36566903 DOI: 10.1016/j.pnpbp.2022.110700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 11/04/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Patients with Alzheimer's disease (AD) are markedly increasing as population aging and no disease-modifying therapies are currently available for AD. Previous studies suggested a broad link between socioeconomic status and a variety of disorders, including mental illness and cognitive abilities. However, the association between socioeconomic deprivation and AD has been unknown. We here employed Townsend deprivation index (TDI) to explore such relation and found a positive genetic correlation (r̂g=0.211, P = 8.00 × 10-4) between the two traits with summary statistics data (N = 455,258 for TDI and N = 455,815 for AD). Then, we performed pleiotropy analysis at both variant and gene levels using a powerful method called PLACO and detected 87 distinct pleiotropic genes. Functional analysis demonstrated these genes were significantly enriched in pancreas, liver, heart, blood, brain, and muscle tissues. Using Mendelian randomization methods, we further found that one genetically predicted standard deviation elevation in TDI could lead to approximately 18.5% (95% confidence intervals 1.6- 38.2%, P = 0.031) increase of AD risk, and that the identified causal association was robust against used MR approaches, horizontal pleiotropy, and instrumental selection. Overall, this study provides deep insight into common genetic components underlying TDI and AD, and further reveals causal connection between them. It is also helpful to develop a more suitable plan for ameliorating inequities, hardship, and disadvantage, with the hope of improving health outcomes among economically disadvantaged people.
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Affiliation(s)
- Jing Dai
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Yue Xu
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Ting Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Ping Zeng
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China; Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China; Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China; Key Laboratory of Environment and Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China; Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
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Baranyi G, Conte F, Deary IJ, Shortt N, Thompson CW, Cox SR, Pearce J. Neighbourhood deprivation across eight decades and late-life cognitive function in the Lothian Birth Cohort 1936: a life-course study. Age Ageing 2023; 52:afad056. [PMID: 37097769 PMCID: PMC10128164 DOI: 10.1093/ageing/afad056] [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: 08/18/2022] [Revised: 12/21/2022] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION although neighbourhood may predict late-life cognitive function, studies mostly rely on measurements at a single time point, with few investigations applying a life-course approach. Furthermore, it is unclear whether the associations between neighbourhood and cognitive test scores relate to specific cognitive domains or general ability. This study explored how neighbourhood deprivation across eight decades contributed to late-life cognitive function. METHODS data were drawn from the Lothian Birth Cohort 1936 (n = 1,091) with cognitive function measured through 10 tests at ages 70, 73, 76, 79 and 82. Participants' residential history was gathered with 'lifegrid' questionnaires and linked to neighbourhood deprivation in childhood, young adulthood and mid-to-late adulthood. Associations were tested with latent growth curve models for levels and slopes of general (g) and domain-specific abilities (visuospatial ability, memory and processing speed), and life-course associations were explored with path analysis. RESULTS higher mid-to-late adulthood neighbourhood deprivation was associated with lower age 70 levels (β = -0.113, 95% confidence intervals [CI]: -0.205, -0.021) and faster decline of g over 12 years (β = -0.160, 95%CI: -0.290, -0.031). Initially apparent findings with domain-specific cognitive functions (e.g. processing speed) were due to their shared variance with g. Path analyses suggested that childhood neighbourhood disadvantage is indirectly linked to late-life cognitive function through lower education and selective residential mobility. CONCLUSIONS to our knowledge, we provide the most comprehensive assessment of the life-course neighbourhood deprivation and cognitive ageing relationship. Living in advantaged areas in mid-to-late adulthood may directly contribute to better cognitive function and slower decline, whereas an advantaged childhood neighbourhood likely affects functioning through cognitive reserves.
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Affiliation(s)
- Gergő Baranyi
- Centre for Research on Environment, Society and Health, Institute of Geography, School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | - Federica Conte
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Niamh Shortt
- Centre for Research on Environment, Society and Health, Institute of Geography, School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | - Catharine Ward Thompson
- OPENspace Research Centre, Edinburgh College of Art, The University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Lothian Birth Cohorts, Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, Institute of Geography, School of GeoSciences, The University of Edinburgh, Edinburgh, UK
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Amiri S, Jiang L, Manson SM, Buchwald DS. Trends in Alzheimer Disease Mortality Among American Indian and Alaska Native People Between 2011 and 2019. Alzheimer Dis Assoc Disord 2023; 37:93-99. [PMID: 37141452 PMCID: PMC10239373 DOI: 10.1097/wad.0000000000000555] [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: 10/14/2022] [Accepted: 03/12/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The number of American Indian and Alaska Native (AI/AN) people living with dementia is expected to increase 5-fold by 2060. Social determinants of health may explain disparities in the incidence of Alzheimer disease (AD) but remain largely overlooked. METHODS We examined the time trend of AD mortality rates and associations of the percentage of AI/ANs, density of primary care physicians and neurologists, area deprivation index, rurality, and Indian Health Service region with AD mortality in 646 purchased/referred care delivery area counties. RESULTS AD mortality rates significantly increased over time. Counties with higher concentrations of AI/AN people had lower AD mortality. More deprived counties had 34% higher AD mortality compared with less deprived counties. AD mortality was 20% lower in nonmetro counties than in metro counties. CONCLUSIONS Findings have implications for prioritizing areas where more resources for AD care, education, or outreach are needed.
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Affiliation(s)
- Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA
| | - Spero M Manson
- Department of Community and Behavioral Health, Centers for American Indian and Alaska Native Health, University of Colorado, Aurora, CO
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA
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12
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Wigglesworth S, Neligan A, Dickson JM, Pullen A, Yelland E, Anjuman T, Reuber M. The incidence and prevalence of epilepsy in the United Kingdom 2013-2018: A retrospective cohort study of UK primary care data. Seizure 2023; 105:37-42. [PMID: 36702018 DOI: 10.1016/j.seizure.2023.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The aim of this study was to update overall incidence and prevalence calculations for epilepsy of the United Kingdom (UK) and its constituent nations (England, Northern Ireland, Scotland, and Wales). METHODS We used data from primary care practices contributing to the Clinical Practice Research Datalink (CRPD), based on the electronic health records of 14 million patients, representing approximately 20% of the population. CPRD contains data from two different health record systems: the Vision clinical system (CPRD GOLD database) and the EMIS Web® clinical system (CPRD Aurum database). We calculated incidence and prevalence rates with 95% confidence intervals (CIs). Data were stratified by age, gender, deprivation, country (England, Scotland, Wales and Northern Ireland) and region (England only). RESULTS In the UK, the estimated overall point prevalence for epilepsy was 9.37 per 1000 persons / year (95% CI 9.34-9.40) and the overall estimated incidence rate was 42.68 per 100,000 person-years (95% 42.18-43.18) using the CPRD GOLD database. In England, the estimated incidence (37.41 (95% CI 36.96-37.83)) and prevalence (8.85 (95% CI 8.83-8.87)) was lower (combined databases) compared to figures for Scotland (incidence 47.76 (95% CI 46.15-49.42)); prevalence 10.13 (95% CI 10.06-10.20)) (CPRD GOLD only), Wales (incidence 54.84 (95% CI 52.79-56.95); prevalence 11.40 (95% CI 11.31-11.49)) (CPRD GOLD only) and Northern Ireland (incidence 46.18 (95% CI 43.13-49.90); prevalence 12.08 (95% CI 11.93-12.23))(combined databases). Prevalence and incidence were higher in more deprived regions. CONCLUSION The prevalence and incidence of epilepsy in the UK is broadly in line with other high income countries, showing the usual pattern of high incidence in the young and the old, with a nadir in middle age. The prevalence of epilepsy has fallen slightly since 2011. There is significant geographical variation (between countries and between regions), and a suggestion of a relationship between deprivation and epilepsy which needs further investigation.
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Affiliation(s)
- S Wigglesworth
- Former employee of Epilepsy Action, Yeadon, Leeds, United Kingdom.
| | - A Neligan
- Homerton University Hospital Foundation Trust, Homerton Row, London E9 6SR, United Kingdom; DCEE, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - J M Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, United Kingdom
| | - A Pullen
- Epilepsy Research UK, London, United Kingdom
| | - E Yelland
- Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - T Anjuman
- Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - M Reuber
- Academic Neurology Unit, University of Sheffield, Sheffield, United Kingdom
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13
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Marshall CR, Uchegbu I. Artificial intelligence for detection of Alzheimer's disease: demonstration of real-world value is required to bridge the translational gap. Lancet Digit Health 2022; 4:e768-e769. [PMID: 36192348 DOI: 10.1016/s2589-7500(22)00190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Neurology Department, Barts Health NHS Trust, London, UK.
| | - Ijeoma Uchegbu
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, London, UK
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Alothman D, Card T, Lewis S, Tyrrell E, Fogarty AW, Marshall CR. Risk of Suicide After Dementia Diagnosis. JAMA Neurol 2022; 79:2796654. [PMID: 36190708 PMCID: PMC9531071 DOI: 10.1001/jamaneurol.2022.3094] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/01/2022] [Indexed: 11/14/2022]
Abstract
Importance Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services. Objectives To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups. Design, Setting, and Participants This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date. Exposures Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases. Main Outcomes and Measures Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date. Results From the total sample of 594 674 patients, 580 159 (97.6%) were controls (median [IQR] age at death, 81.6[72.0-88.4] years; 289 769 male patients [50.0%]), and 14 515 (2.4%) died by suicide (median [IQR] age at death, 47.4 [36.0-59.7] years; 10 850 male patients [74.8%]). Among those who died by suicide, 95 patients (1.9%) had a recorded dementia diagnosis (median [IQR] age at death, 79.5 [67.1-85.5] years; median [IQR] duration of follow-up, 2.3 [1.0-4.4] years). There was no overall significant association between a dementia diagnosis and suicide risk (adjusted OR, 1.05; 95% CI, 0.85-1.29). However, suicide risk was significantly increased in patients diagnosed with dementia before age 65 years (adjusted OR, 2.82; 95% CI, 1.84-4.33), in the first 3 months after diagnosis (adjusted OR, 2.47; 95% CI, 1.49-4.09), and in patients with dementia and psychiatric comorbidity (adjusted OR, 1.52; 95% CI, 1.21-1.93). In patients younger than 65 years and within 3 months of diagnosis, suicide risk was 6.69 times (95% CI, 1.49-30.12) higher than in patients without dementia. Conclusions and Relevance Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.
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Affiliation(s)
- Danah Alothman
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Timothy Card
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Edward Tyrrell
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andrew W. Fogarty
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Charles R. Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, London, United Kingdom
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Foote IF, Jacobs BM, Mathlin G, Watson CJ, Bothongo PLK, Waters S, Dobson R, Noyce AJ, Bhui KS, Korszun A, Marshall CR. The shared genetic architecture of modifiable risk for Alzheimer's disease: a genomic structural equation modelling study. Neurobiol Aging 2022; 117:222-235. [DOI: 10.1016/j.neurobiolaging.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
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Rodriguez-Loureiro L, Gadeyne S, Bauwelinck M, Lefebvre W, Vanpoucke C, Casas L. Long-term exposure to residential greenness and neurodegenerative disease mortality among older adults: a 13-year follow-up cohort study. Environ Health 2022; 21:49. [PMID: 35525977 PMCID: PMC9077872 DOI: 10.1186/s12940-022-00863-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/29/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND Living in greener areas is associated with slower cognitive decline and reduced dementia risk among older adults, but the evidence with neurodegenerative disease mortality is scarce. We studied the association between residential surrounding greenness and neurodegenerative disease mortality in older adults. METHODS We used data from the 2001 Belgian census linked to mortality register data during 2001-2014. We included individuals aged 60 years or older and residing in the five largest Belgian urban areas at baseline (2001). Exposure to residential surrounding greenness was assessed using the 2006 Normalized Difference Vegetation Index (NDVI) within 500-m from residence. We considered all neurodegenerative diseases and four specific outcomes: Alzheimer's disease, vascular dementia, unspecified dementia, and Parkinson's disease. We fitted Cox proportional hazard models to obtain hazard ratios (HR) and 95% confidence intervals (CI) of the associations between one interquartile range (IQR) increment in surrounding greenness and neurodegenerative disease mortality outcomes, adjusted for census-based covariates. Furthermore, we evaluated the potential role of 2010 air pollution (PM2.5 and NO2) concentrations, and we explored effect modification by sociodemographic characteristics. RESULTS From 1,134,502 individuals included at baseline, 6.1% died from neurodegenerative diseases during follow-up. After full adjustment, one IQR (0.22) increment of surrounding greenness was associated with a 4-5% reduction in premature mortality from all neurodegenerative diseases, Alzheimer's disease, vascular and unspecified dementia [e.g., for Alzheimer's disease mortality: HR 0.95 (95%CI: 0.93, 0.98)]. No association was found with Parkinson's disease mortality. Main associations remained for all neurodegenerative disease mortality when accounting for air pollution, but not for the majority of specific mortality outcomes. Associations were strongest in the lower educated and residents from most deprived neighbourhoods. CONCLUSIONS Living near greener spaces may reduce the risk of neurodegenerative disease mortality among older adults, potentially independent from air pollution. Socioeconomically disadvantaged groups may experience the greatest beneficial effect.
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Affiliation(s)
| | - Sylvie Gadeyne
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wouter Lefebvre
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Lidia Casas
- Department of Family Medicine and Population Health, Social Epidemiology and Health Policy, University of Antwerp, Wilrijk, Belgium
- Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Antwerp, Belgium
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Marshall CR, Noyce AJ, Neligan A, Dobson R. Brain health: The hidden casualty of a humanitarian crisis. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100374. [PMID: 35531495 PMCID: PMC9072995 DOI: 10.1016/j.lanepe.2022.100374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Charles R. Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
| | - Alastair J. Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
| | - Aidan Neligan
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Homerton University Hospital, London E9 6SR, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
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Daly T. Are trailblazing trials for reducing cognitive decline putting the cart before the horse? ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12298. [PMID: 35733646 PMCID: PMC9191824 DOI: 10.1002/trc2.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Timothy Daly
- Sorbonne Université, UMR 8011, Science, Norms, Democracy Philosophy Department Paris France
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