Cost-Effectiveness of the Comprehensive Interdisciplinary Program-Care in Informal Caregivers of People with Alzheimer's Disease

Machine Learning Approach for Improved Longitudinal Prediction of Progression from Mild Cognitive Impairment to Alzheimer's Disease

Mild cognitive impairment (MCI) is cognitive decline that can indicate future risk of Alzheimer's disease (AD). We developed and validated a machine learning algorithm (MLA), based on a gradient-boosted tree ensemble method, to analyze phenotypic data for individuals 55-88 years old (n = 493) diagnosed with MCI. Data were analyzed within multiple prediction windows and averaged to predict progression to AD within 24-48 months. The MLA outperformed the mini-mental state examination (MMSE) and three comparison models at all prediction windows on most metrics. Exceptions include sensitivity at 18 months (MLA and MMSE each achieved 0.600); and sensitivity at 30 and 42 months (MMSE marginally better). For all prediction windows, the MLA achieved AUROC ≥ 0.857 and NPV ≥ 0.800. With averaged data for the 24-48-month lookahead timeframe, the MLA outperformed MMSE on all metrics. This study demonstrates that machine learning may provide a more accurate risk assessment than the standard of care. This may facilitate care coordination, decrease healthcare expenditures, and maintain quality of life for patients at risk of progressing from MCI to AD.

Long-Term Effectiveness of Physical Exercise-Based Swallowing Interventions for Older Adults with Dementia in a Day-Care Center

Swallowing safety is one of the top health concerns of dementia. Coughing and choking (coughing/choking) are signs of impaired swallowing safety. This study aimed to investigate the effectiveness of regular physical exercise-based swallowing intervention for reducing coughing-choking at the dementia day-care center. This was a retrospective analysis with data from medical records, including age, the clinical dementia rating (CDR), and the frequencies of coughing/choking in ten days (10-day coughing/choking). Those who complied with the exercise programs were assigned to the exercise-based group (n = 22), and those who could not comply were assigned to the non-exercised-based group (n = 7). The non-exercised-based group showed more advanced age and higher CDR than the exercise-based group (p < 0.05). The 10-day coughing/choking showed significant decreases at the 5-month and 19-month in the exercise-based group and at the 5-month in the non-exercise-based group (p < 0.05). Our findings suggested that regular physical exercise-based swallowing intervention effectively alleviated coughing/choking problems of older adults with dementia and its effectiveness was long-lasting. For those who could not comply with exercise programs, noticeably with more advanced age and dementia, the effective swallowing intervention period was short-term.