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Ball HA, Coulthard E, Fish M, Bayer A, Gallacher J, Ben-Shlomo Y. Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS). BMJ Open 2023; 13:e073205. [PMID: 37844990 PMCID: PMC10582873 DOI: 10.1136/bmjopen-2023-073205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES To understand associations between the subjective experience of cognitive decline and objective cognition. This subjective experience is often conceptualised as an early step towards neurodegeneration, but this has not been scrutinised at the population level. An alternative explanation is poor meta-cognition, the extreme of which is seen in functional cognitive disorder (FCD). DESIGN Prospective cohort (Caerphilly Prospective Study). SETTING Population-based, South Wales, UK. PARTICIPANTS This men-only study began in 1979; 1225 men participated at an average age of 73 in 2002-2004, including assessments of simple subjective cognitive decline (sSCD, defined as a subjective report of worsening memory or concentration). Dementia outcomes were followed up to 2012-2014. Data on non-completers was additionally obtained from death certificates and local health records. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was incident dementia over 10 years. Secondary outcome measures included prospective change in objective cognition and cross-sectional cognitive internal inconsistency (the existence of a cognitive ability at some times, and its absence at other times, with no intervening explanatory factors except for focus of attention). RESULTS sSCD was common (30%) and only weakly associated with prior objective cognitive decline (sensitivity 36% (95% CI 30 to 42) and specificity 72% (95% CI 68 to 75)). Independent predictors of sSCD were older age, poor sleep quality and higher trait anxiety. Those with sSCD did not have excess cognitive internal inconsistency, but results suggested a mild attentional deficit. sSCD did not predict objective cognitive change (linear regression coefficient -0.01 (95% CI -0.13 to 0.15)) nor dementia (odds ratio 1.35 (0.61 to 2.99)) 10 years later. CONCLUSIONS sSCD is weakly associated with prior objective cognitive decline and does not predict future cognition. Prior sleep difficulties and anxiety were the most robust predictors of sSCD. sSCD in the absence of objective decline appears to be a highly prevalent example of poor meta-cognition (ie, poor self-awareness of cognitive performance), which could be a driver for later FCD.
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Affiliation(s)
- Harriet A Ball
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Mark Fish
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Antony Bayer
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales, UK
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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Creavin ST, Fish M, Lawton M, Cullum S, Bayer A, Purdy S, Ben-Shlomo Y. A Diagnostic Test Accuracy Study Investigating General Practitioner Clinical Impression and Brief Cognitive Assessments for Dementia in Primary Care, Compared to Specialized Assessment. J Alzheimers Dis 2023; 95:1189-1200. [PMID: 37694368 PMCID: PMC7615275 DOI: 10.3233/jad-230320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Many health systems are interested in increasing the number of uncomplicated and typical dementia diagnoses that are made in primary care, but the comparative accuracy of tests is unknown. OBJECTIVE Calculate diagnostic accuracy of brief cognitive tests in primary care. METHODS We did a diagnostic test accuracy study in general practice, in people over 70 years who had consulted their GP with cognitive symptoms but had no prior diagnosis of dementia. The reference standard was specialist assessment, adjudicated for difficult cases, according to ICD-10. We assessed 16 index tests at a research clinic, and additionally analyzed referring GPs clinical judgement. RESULTS 240 participants had a median age of 80 years, of whom 126 were men and 132 had dementia. Sensitivity of individual tests at the recommended thresholds ranged from 56% for GP judgement (specificity 89%) to 100% for MoCA (specificity 16%). Specificity of individual tests ranged from 4% for Sniffin' sticks (sensitivity 100%) to 91% for Timed Up and Go (sensitivity 23%). The 95% centile of test duration in people with dementia ranged from 3 minutes for 6CIT and Time and Change, to 16 minutes for MoCA. Combining tests with GP judgement increased test specificity and decreased sensitivity: e.g., MoCA with GP Judgement had specificity 87% and sensitivity 55%. CONCLUSIONS Using GP judgement to inform selection of tests was an efficient strategy. Using IQCODE in people who GPs judge as having dementia and 6CIT in people who GPs judge as having no dementia, would be a time-efficient and accurate diagnostic assessment.The original protocol for the study is available at https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0475-2.
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Affiliation(s)
- Samuel Thomas Creavin
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS
| | | | - Michael Lawton
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS
| | - Sarah Cullum
- Faculty of Medical and Health Sciences, The University of Auckland, Building 507, 22-30 Park Avenue, Grafton, Auckland 1142, New Zealand
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Cardiff, CF64 2XX
| | - Sarah Purdy
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS
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Creavin S, Fish M, Bayer A, Gallacher J, Ben-Shlomo Y. Decline in Cognition from Mid-Life Improves Specificity of Mini-Mental State Examination: Diagnostic Test Accuracy in Caerphilly Prospective Study (CaPs). J Alzheimers Dis 2022; 89:1241-1248. [PMID: 35988222 DOI: 10.3233/jad-220345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The merit of using baseline cognitive assessments in mid-life to help interpret cross-sectional cognitive tests scores in later life is uncertain. OBJECTIVE Evaluate how accuracy for diagnosing dementia is enhanced by comparing cross-sectional results to a midlife measure. METHODS Cohort study of 2,512 men with repeated measures of Mini-Mental State Examination (MMSE) over approximately 10 years. Index test MMSE at threshold of 24 indicating normal, as a cross-sectional measure and in combination with decline in MMSE score from mid-life. Reference standard consensus clinical diagnosis of dementia by two clinicians according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS 1,150 men participated at phase 4 of whom 75 had dementia. A cross-sectional MMSE alone produced a sensitivity of 60% (50% to 70%) and specificity 95% (94% to 97%) with a threshold of≥24 points indicating normal. For lower-scoring men in late life, with cross sectional scores of < 22, combining cross-sectional AND a three-point or more decline over time had a sensitivity of 52% (39% to 64%) and specificity 99% (99% to 100%). For higher-scoring men in later life, with cross sectional scores < 26 combining cross-sectional OR decline of at least three points had a sensitivity of 98% (92% to 100%) and specificity 38% (32% to 44%). CONCLUSION It may be helpful in practice to formally evaluate cognition in mid-life as a baseline to compare with if problems develop in future, as this may enhance diagnostic accuracy and classification of people in later life.
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Affiliation(s)
- Sam Creavin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Fish
- Department of Neurology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Academic Centre, University Hospital Llandough, Cardiff, UK
| | - John Gallacher
- Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Creavin ST, Haworth J, Fish M, Cullum S, Bayer A, Purdy S, Ben-Shlomo Y. Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study. BJGP Open 2021; 5:BJGPO.2021.0058. [PMID: 34315715 PMCID: PMC8596317 DOI: 10.3399/bjgpo.2021.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs often report using clinical judgment to diagnose dementia. AIM To investigate the accuracy of GPs' clinical judgment for the diagnosis of dementia. DESIGN & SETTING Diagnostic test accuracy study, recruiting from 21 practices around Bristol, UK. METHOD The clinical judgment of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged ≥70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to the 10th revision of the International Classification of Diseases (ICD-10) criteria for dementia. RESULTS A total of 240 people were recruited, with a median age of 80 years (interquartile range [IQR] 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median Addenbrooke's Cognitive Examination III (ACE-III) score was 75 (IQR 65-87). GP clinical judgment had sensitivity 56% (95% confidence interval [CI] = 47% to 65%) and specificity 89% (95% CI = 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI = 2.9 to 15) compared with people aged ≥80 years (3.6, 95% CI = 1.7 to 7.6), and in women (10.4, 95% CI = 3.4 to 31.7) compared with men (3.2, 95% CI = 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. CONCLUSION A GP clinical judgment of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people whom GPs judge as not having dementia.
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Affiliation(s)
| | - Judy Haworth
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark Fish
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sarah Cullum
- Depatment of Psychological Medicine, School of Medicine, The University of Auckland, Grafton, New Zealand
| | | | - Sarah Purdy
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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Ball HA, Bayer A, Coulthard E, Fish M, Gallacher J, Ben-Shlomo Y. #3122 Is subjective cognitive decline (SCD) a better marker of susceptibility to functional cognitive disorder (FCD) than to neurodegeneration?: The caerphilly prospective study. J Neurol Psychiatry 2021. [DOI: 10.1136/jnnp-2021-bnpa.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective/AimsDoes Subjective Cognitive Decline (SCD) indicate susceptibility to Functional Cognitive Disorder (FCD) more often than it indicates neurodegeneration? Prior research has focused on clinical populations where FCD is increasingly identified, but associations could differ at the community level. A clinical diagnosis of FCD requires cognitive symptoms, internal inconsistency, the absence of another explanatory disorder, and significant impairment; but we know little about its aetiology and prevalence. Cognitive internal inconsistency has not been systematically studied.Methods1,143 men were followed in the Caerphilly Prospective Study. Their subjective experience of cognitive change at average age 73 years was compared to their previous rate of objective cognitive change (using the Cambridge Cognition Examination). Logistic regression models examined potential predictors of SCD (measured in the preceding decade) including sociodemographic factors, vascular risk markers (ischaemic heart disease, vascular medications, smoking history), alcohol exposure, sleep problems, depression, anxiety trait, and objective cognition. We also looked for markers of cognitive internal inconsistency (delayed recall proportionately better than immediate recall, using the Rivermead Behavioural Memory Test). Finally, subjective and objective cognition at average age 73 were used to predict change in objective cognition nine years later.ResultsSCD was common (30%), and only weakly related to prior objective cognitive decline (sensitivity 36% [95% CI 30-42], specificity 72% [95% CI 68-75]). Longitudinal independent predictors of SCD were older age, poor sleep quality and higher trait anxiety: rate of decline in objective cognition did not independently predict subsequent SCD (adjusted OR 1.18 [95% CI 0.72 1.95]). Those with SCD (compared to those without) had mildly worse scores on immediate recall, but their delayed recall was in proportion to their immediate recall, i.e., there was no evidence of cognitive internal inconsistency. SCD did not predict future objective cognitive change (p=0.84). Important limitations include the male-only sample and the possibility of survivor bias.ConclusionsSCD is common, but is only weakly associated with prior objective cognitive decline, is not predicted by vascular risk markers (aside from age), and does not predict future objective cognitive decline. The high community prevalence of SCD is instead driven partly via sleep difficulties and anxiety. Our results suggest those with SCD may have a mild deficit in attentional processes but relatively intact memory for the items they do encode. Subjectively experiencing cognitive decline in the absence of an objective decline appears to be a highly prevalent example of poor meta-cognition, which could be a driver to later FCD.
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Ghnewa YG, Fish M, Jennings A, Carter MJ, Shankar-Hari M. Goodbye SIRS? Innate, trained and adaptive immunity and pathogenesis of organ dysfunction. Med Klin Intensivmed Notfmed 2020; 115:10-14. [PMID: 32291506 DOI: 10.1007/s00063-020-00683-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/14/2020] [Indexed: 12/15/2022]
Abstract
The novel concepts within Sepsis‑3 criteria include a focus on dysregulated host responses, removal of the systemic inflammation response syndrome (SIRS) criteria from sepsis diagnosis, the use of Sepsis-related (Sequential) Organ Failure Assessment (SOFA) scores to define organ dysfunction, and the explicit recognition of the septic shock as a subset of sepsis. Protection against infection requires a surveillance system, an effector response against "perceived" pathogens, a method for regaining immune homeostasis following an immune response, and generation of immunological memory. In comparison to normally regulated responses to infection, the innate immune system shows profoundly abnormal neutrophil and macrophage function. Similarly, the adaptive immune system is typically depleted numerically of lymphocytes and functionally with T and B cell exhaustion. Although there are numerous proposed mechanisms by which these dysregulated immune responses may be associated with organ failure, it is unclear what the unifying organ failure mechanisms in sepsis are. Furthermore, in sepsis survivors, the epigenetic changes on immune cells and widespread changes to lymphocyte populations may increase the risk of adverse events such as rehospitalisation and mortality. Finally, our current gaps in understanding of the immune response trajectory and the associated modifiable mechanisms in sepsis leave us a long way from successful immunomodulation for these patients. This article is freely available.
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Affiliation(s)
- Y G Ghnewa
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, Floor 5, Southwark Wing, SE1 9RT,, London, UK.,School of Immunology and Microbial Sciences, Kings College London, London, SE1 9RT,, UK
| | - M Fish
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, Floor 5, Southwark Wing, SE1 9RT,, London, UK.,School of Immunology and Microbial Sciences, Kings College London, London, SE1 9RT,, UK
| | - A Jennings
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, Floor 5, Southwark Wing, SE1 9RT,, London, UK.,School of Immunology and Microbial Sciences, Kings College London, London, SE1 9RT,, UK
| | - M J Carter
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, Floor 5, Southwark Wing, SE1 9RT,, London, UK.,School of Immunology and Microbial Sciences, Kings College London, London, SE1 9RT,, UK
| | - M Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, Floor 5, Southwark Wing, SE1 9RT,, London, UK. .,School of Immunology and Microbial Sciences, Kings College London, London, SE1 9RT,, UK.
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Mauri G, Kanter K, Fish M, Horick N, Allen J, Blaszkowsky L, Clark J, Ryan D, Nipp R, Giantonio B, Goyal L, Dubois J, Murphy J, Roeland E, Weekes C, Wo J, Hong T, Zhu A, Van Seventer E, Corcoran R, Parikh A. PARP-ness in metastatic colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parikh A, Kanter K, Mojtahed A, Schneider J, Van Seventer E, Fish M, Allen J, Blaszkowsky L, Wo J, Clark J, Giantonio B, Goyal L, Hong T, Nipp R, Roeland E, Weekes C, Zhu A, Ryan D, Fetter I, Horick N, Corcoran R. Serial circulating tumor DNA (ctDNA) monitoring to predict response to treatment in metastatic gastrointestinal cancers. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
We report the case of a previously well 80-year-old man who presented with subacute bilateral painful optic neuropathy with initial response to corticosteroids but ultimately progressed to a fatal skull base syndrome. Initial presentation of steroid-responsive painful bilateral posterior optic neuropathy, preliminary normal enhanced MRI, normal cerebrospinal fluid and inflammatory markers indicated atypical optic neuritis. However, this progressed to a bilateral orbital apex syndrome with ophthalmoplegia and evidence of abnormal skull base enhancement on subsequent MRI. Biopsy of radiologically abnormal dura was non-diagnostic and negative for fungal stains. He deteriorated and died 8 months after initial presentation. At postmortem, fungal skull base infection was diagnosed. This case demonstrates that chronic skull base fungal infection can: (1) present in elderly immunocompetent patients, (2) show initial improvement with corticosteroids and (3) evade diagnosis on biopsy. We encourage a high index of suspicion for fungal skull base infection in similar cases.
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Affiliation(s)
- Pamela Sarkar
- Neurology Department, North Bristol NHS Trust, Bristol, UK
| | - Christopher Price
- Neurology Department, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Mark Fish
- Neurology Department, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Luke Bennetto
- Neurology Department, North Bristol NHS Trust, Bristol, UK
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Creavin ST, Cullum SJ, Haworth J, Wye L, Bayer A, Fish M, Purdy S, Ben-Shlomo Y. Erratum to: Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol. BMC Fam Pract 2016; 17:119. [PMID: 27565138 PMCID: PMC5002196 DOI: 10.1186/s12875-016-0510-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/11/2016] [Indexed: 11/10/2022]
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Lu CH, Allen K, Oei F, Leoni E, Kuhle J, Tree T, Fratta P, Sharma N, Sidle K, Howard R, Orrell R, Fish M, Greensmith L, Pearce N, Gallo V, Malaspina A. Systemic inflammatory response and neuromuscular involvement in amyotrophic lateral sclerosis. Neurol Neuroimmunol Neuroinflamm 2016; 3:e244. [PMID: 27308305 PMCID: PMC4897985 DOI: 10.1212/nxi.0000000000000244] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/14/2016] [Indexed: 11/20/2022]
Abstract
Objective: To evaluate the combined blood expression of neuromuscular and inflammatory biomarkers as predictors of disease progression and prognosis in amyotrophic lateral sclerosis (ALS). Methods: Logistic regression adjusted for markers of the systemic inflammatory state and principal component analysis were carried out on plasma levels of creatine kinase (CK), ferritin, and 11 cytokines measured in 95 patients with ALS and 88 healthy controls. Levels of circulating biomarkers were used to study survival by Cox regression analysis and correlated with disease progression and neurofilament light chain (NfL) levels available from a previous study. Cytokines expression was also tested in blood samples longitudinally collected for up to 4 years from 59 patients with ALS. Results: Significantly higher levels of CK, ferritin, tumor necrosis factor (TNF)–α, and interleukin (IL)–1β, IL-2, IL-8, IL-12p70, IL-4, IL-5, IL-10, and IL-13 and lower levels of interferon (IFN)–γ were found in plasma samples from patients with ALS compared to controls. IL-6, TNF-α, and IFN-γ were the most highly regulated markers when all explanatory variables were jointly analyzed. High ferritin and IL-2 levels were predictors of poor survival. IL-5 levels were positively correlated with CK, as was TNF-α with NfL. IL-6 was strongly associated with CRP levels and was the only marker showing increasing expression towards end-stage disease in the longitudinal analysis. Conclusions: Neuromuscular pathology in ALS involves the systemic regulation of inflammatory markers mostly active on T-cell immune responses. Disease stratification based on the prognostic value of circulating inflammatory markers could improve clinical trials design in ALS.
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Affiliation(s)
- Ching-Hua Lu
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Kezia Allen
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Felicia Oei
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Emanuela Leoni
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Jens Kuhle
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Timothy Tree
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Pietro Fratta
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Nikhil Sharma
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Katie Sidle
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Robin Howard
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Richard Orrell
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Mark Fish
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Linda Greensmith
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Neil Pearce
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Valentina Gallo
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
| | - Andrea Malaspina
- Centre for Neuroscience & Trauma (C.L., F.O., J.K., A.M.) and Centre of Primary Care and Public Health (V.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.L., P.F., L.G.), MRC Centre for Neuromuscular Diseases (P.F., L.G.), MRC Unit for Lifelong Health and Ageing (N.S.), Department of Molecular Neuroscience (K.S.), and Department of Clinical Neuroscience (R.O.), UCL Institute of Neurology; Basildon and Thurrock University Hospitals (K.A., A.M.), NHS Foundation Trust, Basildon; William Harvey Hospital (F.O.), Kent; Proteome Sciences plc (E.L.), South Wing Laboratory, Institute of Psychiatry, UK; Neurology (J.K.), University Hospital Basel, Switzerland; Department of Immunobiology (T.T.), King's College London; National Hospital for Neurology and Neurosurgery (N.S., R.H., R.O.), London; Musgrove Park Hospital (M.F.), Taunton; and Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, UK
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Llewelyn D, Fish M. THE MANAGEMENT OF SUSPECTED ENCEPHALITIS AT A REGIONAL DISTRICT GENERAL HOSPITAL. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AimTo determine how suspected encephalitis is managed in a regional DGH against standard of ABN/BIA (Association of British Neurologists/British Infection Association) Guidelines (2012).MethodologyA retrospective audit of notes for 21 cases with suspected encephalitis (June to December 2013). Sampling utilised case coding, records of referrals to neurology and CSF analyses. Latency from time of admission to suspicion of encephalitis, CT, LP, MRI, aciclovir administration and neurological input were determined.Results12/21 patients received aciclovir within 6 hours (average 11.5h), 18/21 patients had a CT head scan before LP and in 14/21 cases aciclovir was started before LP.
18/21 cases underwent LP (6 on MAU, 11 by medical teams and 1 by neurology), 17/18 had CSF constituents requested, 9/18 had a paired serum glucose. 5 cases had repeat HSV PCR, 5 had HIV testing and 12/21 had an EEG. The average latency to MRI was 2.34 days and time to be seen by a neurologist was 2 days. Treatment was discontinued in 7 cases after negative HSV PCR and 5 after alternative diagnosis were made.ConclusionsManagement of suspected encephalitis varied, we need to increase awareness ABN/BIA guidance and address the delay in neurology services seeing these patients.
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Green CJ, Holly JMP, Bayer A, Fish M, Ebrahim S, Gallacher J, Ben-Shlomo Y. The role of IGF-I, IGF-II, and IGFBP-3 in male cognitive aging and dementia risk: the Caerphilly Prospective Study. J Alzheimers Dis 2015; 41:867-75. [PMID: 24705546 DOI: 10.3233/jad-132183] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The increasing incidence of cognitive impairment and dementia in an aging population poses a significant burden on healthcare. Consequently, identifying modifiable physiological factors which may influence the onset of cognitive decline are becoming increasingly important. Previous studies have suggested an association between levels of insulin-like growth factors and cognitive function. OBJECTIVE To investigate whether low IGF-I, IGF-II, and IGF molar ratio is associated with greater cognitive decline and increased risk of dementia. METHODS We examined prospective associations between IGF-I, IGF-II, and IGFBP-3 and cognitive function in the Caerphilly Prospective Study (CaPS) (n = 746 men) from samples obtained around 1986, with assessment in around 2003 for clinical diagnosis of cognitive impairment but no dementia (CIND) or dementia, as well as with CAMCOG scores at three phases. RESULTS A one standard deviation increase in IGF-II was associated with a reduced odds ratio for CIND (0.76, 95% CI 0.60, 0.96) which hardly altered after further adjustment for confounders. A one standard deviation increase in IGFBP-3 among participants without dementia or CIND was associated with greater decline in cognition (p = 0.002) equivalent to 2.4 years difference in age. All the associations between IGF-I and our outcomes were consistent with chance. CONCLUSION In this study of men, we found that both IGF-II and IGFBP-3 are associated with normal age-related cognitive decline and clinical pathology associated with CIND, but we failed to replicate previous associations with IGF-I. Assuming these findings are replicated, they may provide new insights into potential biological mechanisms that underlie age-related cognitive changes and development of dementia.
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Affiliation(s)
| | | | - Antony Bayer
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK
| | - Mark Fish
- Department of Neurology, Musgrove Park Hospital, Taunton, UK
| | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, UK
| | - John Gallacher
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, UK
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Creavin S, Fish M, Gallacher J, Bayer A, Ben-Shlomo Y. Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study. Br J Gen Pract 2015; 65:e489-99. [PMID: 26212844 PMCID: PMC4513736 DOI: 10.3399/bjgp15x686053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/16/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Diagnosis of dementia often requires specialist referral and detailed, time-consuming assessments. AIM To investigate the utility of simple clinical items that non-specialist clinicians could use, in addition to routine practice, to diagnose all-cause dementia syndrome. DESIGN AND SETTING Cross-sectional diagnostic test accuracy study. Participants were identified from the electoral roll and general practice lists in Caerphilly and adjoining villages in South Wales, UK. METHOD Participants (1225 men aged 45-59 years) were screened for cognitive impairment using the Cambridge Cognitive Examination, CAMCOG, at phase 5 of the Caerphilly Prospective Study (CaPS). Index tests were a standardised clinical evaluation, neurological examination, and individual items on the Informant Questionnaire for Cognitive Disorders in the Elderly (IQCODE). RESULTS Two-hundred and five men who screened positive (68%) and 45 (4.8%) who screened negative were seen, with 59 diagnosed with dementia. The model comprising problems with personal finance and planning had an area under the curve (AUC) of 0.92 (95% confidence interval [CI] = 0.86 to 0.97), positive likelihood ratio (LR+) of 23.7 (95% CI = 5.88 to 95.6), negative likelihood ratio (LR-) of 0.41 (95% CI = 0.27 to 0.62). The best single item for ruling out was no problems learning to use new gadgets (LR- of 0.22, 95% CI = 0.11 to 0.43). CONCLUSION This study found that three simple questions have high utility for diagnosing dementia in men who are cognitively screened. If confirmed, this could lead to less burdensome assessment where clinical assessment suggests possible dementia.
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Affiliation(s)
- Sam Creavin
- NIHR academic clinical fellow in general practice
| | - Mark Fish
- Department of Neurology, Musgrove Park Hospital, Taunton
| | - John Gallacher
- Department of Primary Care and Public Health, Cardiff University, Cardiff
| | - Antony Bayer
- Department of Primary Care and Public Health, Cardiff University, Academic Centre, University Hospital Llandough, Cardiff
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol
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Lu CH, Macdonald-Wallis C, Gray E, Pearce N, Petzold A, Norgren N, Giovannoni G, Fratta P, Sidle K, Fish M, Orrell R, Howard R, Talbot K, Greensmith L, Kuhle J, Turner MR, Malaspina A. Neurofilament light chain: A prognostic biomarker in amyotrophic lateral sclerosis. Neurology 2015; 84:2247-57. [PMID: 25934855 PMCID: PMC4456658 DOI: 10.1212/wnl.0000000000001642] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/20/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test blood and CSF neurofilament light chain (NfL) levels in relation to disease progression and survival in amyotrophic lateral sclerosis (ALS). METHODS Using an electrochemiluminescence immunoassay, NfL levels were measured in samples from 2 cohorts of patients with sporadic ALS and healthy controls, recruited in London (ALS/control, plasma: n = 103/42) and Oxford (ALS/control, serum: n = 64/36; paired CSF: n = 38/20). NfL levels in patients were measured at regular intervals for up to 3 years. Change in ALS Functional Rating Scale-Revised score was used to assess disease progression. Survival was evaluated using Cox regression and Kaplan-Meier analysis. RESULTS CSF, serum, and plasma NfL discriminated patients with ALS from healthy controls with high sensitivity (97%, 89%, 90%, respectively) and specificity (95%, 75%, 71%, respectively). CSF NfL was highly correlated with serum levels (r = 0.78, p < 0.0001). Blood NfL levels were approximately 4 times as high in patients with ALS compared with controls in both cohorts, and maintained a relatively constant expression during follow-up. Blood NfL levels at recruitment were strong, independent predictors of survival. The highest tertile of blood NfL at baseline had a mortality hazard ratio of 3.91 (95% confidence interval 1.98-7.94, p < 0.001). CONCLUSION Blood-derived NfL level is an easily accessible biomarker with prognostic value in ALS. The individually relatively stable levels longitudinally offer potential for NfL as a pharmacodynamic biomarker in future therapeutic trials. CLASSIFICATION OF EVIDENCE This report provides Class III evidence that the NfL electrochemiluminescence immunoassay accurately distinguishes patients with sporadic ALS from healthy controls.
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Affiliation(s)
- Ching-Hua Lu
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Corrie Macdonald-Wallis
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Elizabeth Gray
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Neil Pearce
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Axel Petzold
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Niklas Norgren
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Gavin Giovannoni
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Pietro Fratta
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Katie Sidle
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Mark Fish
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Richard Orrell
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Robin Howard
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Kevin Talbot
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Linda Greensmith
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Jens Kuhle
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK
| | - Martin R Turner
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK.
| | - Andrea Malaspina
- From the Centre for Neuroscience & Trauma (C.-H.L., G.G., J.K., A.M.), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Sobell Department of Motor Neuroscience and Movement Disorders (C.-H.L., L.G.), Departments of Neuroinflammation (A.P.), Neurodegenerative Disease (P.F.), Molecular Neuroscience (K.S.), and Clinical Neuroscience (R.O.), and MRC Centre for Neuromuscular Diseases (R.O., L.G.), UCL Institute of Neurology, London; MRC Integrative Epidemiology Unit (C.M.-W.), University of Bristol; Nuffield Department of Clinical Neurosciences (E.G., K.T., M.R.T.), University of Oxford; Department of Medical Statistics (N.P.), London School of Hygiene and Tropical Medicine, London, UK; UmanDiagnostics (N.N.), Umeå, Sweden; Medicine Clinical Trial Unit (M.F.), Musgrove Park Hospital, Taunton, UK; National Hospital for Neurology and Neurosurgery (R.O., R.H., A.M.), London, UK; Neurology (J.K.), University Hospital Basel, Switzerland; North-East London and Essex MND Care and Research Centre (A.M.), London; and Basildon and Thurrock University Hospitals NHS Foundation Trust (A.M.), Basildon, UK.
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Lu CH, Petzold A, Topping J, Allen K, Macdonald-Wallis C, Clarke J, Pearce N, Kuhle J, Giovannoni G, Fratta P, Sidle K, Fish M, Orrell R, Howard R, Greensmith L, Malaspina A. Plasma neurofilament heavy chain levels and disease progression in amyotrophic lateral sclerosis: insights from a longitudinal study. J Neurol Neurosurg Psychiatry 2015; 86:565-73. [PMID: 25009280 PMCID: PMC4413806 DOI: 10.1136/jnnp-2014-307672] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 06/16/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the role of longitudinal plasma neurofilament heavy chain protein (NfH) levels as an indicator of clinical progression and survival in amyotrophic lateral sclerosis (ALS). METHODS A cross-sectional study involving 136 clinically heterogeneous patients with ALS and 104 healthy and neurological controls was extended to include a prospective analysis of 74 of these ALS cases, with samplings at approximately 3-month intervals in a follow-up period of up to 3 years. We analysed the correlation between longitudinal NfH-phosphoform levels and disease progression. Temporal patterns of NfH changes were evaluated using multilevel linear regression. RESULTS Baseline plasma NfH levels were higher than controls only in patients with ALS with short disease duration to baseline sampling. Compared with controls, fast-progressing patients with ALS, particularly those with a short diagnostic latency and disease duration, had higher plasma NfH levels at an early stage and lower levels closer to end-stage disease. Lower NfH levels between visits were associated with rapid functional deterioration. We also detected antibodies against NfH, NfH aggregates and NfH cleavage products. CONCLUSIONS Disease progression in ALS involves defined trajectories of plasma NfH levels, reflecting speed of neurological decline and survival. Intervisit plasma NfH changes are also indicative of disease progression. This study confirms that longitudinal measurements of NfH plasma levels are more informative than cross-sectional studies, where the time of sampling may represent a bias in the interpretation of the results. Autoantibodies against NfH aggregates and NfH cleavage products may explain the variable expression of plasma NfH with disease progression. TRAIL REGISTRATION NUMBER NIHRID6160.
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Affiliation(s)
- Ching-Hua Lu
- Centre for Neuroscience & Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Axel Petzold
- Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Jo Topping
- Centre for Neuroscience & Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kezia Allen
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Essex, UK
| | | | - Jan Clarke
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jens Kuhle
- Centre for Neuroscience & Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gavin Giovannoni
- Centre for Neuroscience & Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pietro Fratta
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Katie Sidle
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Mark Fish
- Clinical Trial Unit, Musgrove Park Hospital, Taunton, UK
| | - Richard Orrell
- National Hospital for Neurology and Neurosurgery, London, UK Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Robin Howard
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Linda Greensmith
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Andrea Malaspina
- Centre for Neuroscience & Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Basildon and Thurrock University Hospitals NHS Foundation Trust, Essex, UK North-East London and Essex MND Care and Research Centre, London, UK
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Morgan GS, Gallacher J, Bayer A, Fish M, Ebrahim S, Ben-Shlomo Y. Physical activity in middle-age and dementia in later life: findings from a prospective cohort of men in Caerphilly, South Wales and a meta-analysis. J Alzheimers Dis 2013; 31:569-80. [PMID: 22647258 DOI: 10.3233/jad-2012-112171] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies suggest that physical activity may be protective for dementia and cognitive impairment. We report findings comparing leisure-time and work-related physical activity from the Caerphilly Prospective study (CaPS) with dementia and cognitive impairment not dementia (CIND) after around 16 years of follow-up. We synthesized our results with a meta-analysis specifically testing if length of follow-up was associated with the size of any association. Age-adjusted models found no real association with dementia, and if anything increased risk for CIND (odds ratio (OR) highest versus lowest tertile 2.61, 95% CI 1.58 to 4.31), though this was attenuated after adjustment for other confounders (OR highest versus lowest tertile 1.38, 95% CI 0.78 to 2.44). There was no evidence that this differed by type (vascular versus non-vascular) of cognitive disease. Meta-analysis of other published effect estimates showed a protective effect of physical activity on cognitive impairment (OR 0.66, 95% CI 0.52 to 0.85) but with significant heterogeneity which was partially explained by length of follow up (p = 0.03). A protective association was also seen for dementia (OR 0.78, 95% CI 0.65, 0.94), which did not appear to be related to follow-up length but there was evidence of small study bias (p = 0.002) suggesting an absence of small null studies. The apparent protective effects of physical activity on cognitive health may partially reflect reverse causation and current estimates may be overly optimistic in terms of cognitive benefits.
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Affiliation(s)
- Gemma S Morgan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
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Gallacher J, Ilubaera V, Ben-Shlomo Y, Bayer A, Fish M, Babisch W, Elwood P. Auditory threshold, phonologic demand, and incident dementia. Neurology 2012; 79:1583-90. [DOI: 10.1212/wnl.0b013e31826e263d] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Creavin ST, Gallacher J, Bayer A, Fish M, Ebrahim S, Ben-Shlomo Y. Metabolic syndrome, diabetes, poor cognition, and dementia in the Caerphilly prospective study. J Alzheimers Dis 2012; 28:931-9. [PMID: 22133761 DOI: 10.3233/jad-2011-111550] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have examined whether metabolic syndrome is associated with intermediate risk of impaired cognition between people with and without diabetes. Men aged 45 to 59 years were identified from Caerphilly in South Wales, United Kingdom. Participation rate was 89% (41% of the original cohort) and 2,512 men were examined in phase one from July 1979 until September 1983. Follow-up examinations occurred at four intervals until 2004 when 1,225 men participated. Participants were categorized on the basis of their exposure to metabolic syndrome not diabetes (MSND) and diabetes (with or without metabolic syndrome) at each of the first three phases. Neuropsychological outcomes and clinical diagnosis of cognitive impairment not dementia (CIND) and dementia were assessed at phase five. The prevalence of MSND increased from 1% to 5% and for diabetes from 3% to 9% between phase one and phase three. 15% of participants had CIND and 8% dementia. People with diabetes, but not those with MSND, at phases one, two, or three had poorer cognition at phase five (adjusted β coefficient AH4 -4.3 95% CI -7.9, -0.7; phase two: -2.5 95% CI -4.7, -0.3; phase three: -2.3 95% CI -4.2, -0.5). The adjusted odds ratio (phase one) for diabetes and CIND was 4.0 (95% CI 1.4, 11.5) and dementia 0.61 (95% CI 0.07, 5.37). After adjustment, higher systolic blood pressure was the only component of the metabolic syndrome associated with worse cognitive outcomes. Diabetes in mid-life, but not MSND, is associated with impaired cognition and increased odds of CIND in later life.
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Affiliation(s)
- Samuel T Creavin
- University of Bristol, School of Social and Community Medicine, Canynge Hall, Bristol, UK
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Creavin ST, Gallacher J, Pickering J, Fehily A, Fish M, Ebrahim S, Bayer A, Ben-Shlomo Y. High caloric intake, poor cognition and dementia: the Caerphilly Prospective Study. Eur J Epidemiol 2012; 27:197-203. [PMID: 22392589 DOI: 10.1007/s10654-012-9667-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 02/17/2012] [Indexed: 11/28/2022]
Abstract
To examine the hypothesis that caloric intake in mid-life is associated with later dementia or cognitive impairment not dementia (CIND). A prospective cohort study was conducted in Caerphilly, South Wales, United Kingdom. Men aged 45-59 years were identified from the electoral roll and general practice. 2,512 men were examined between July 1979 until September 1983. Four follow-up examinations were conducted every 4-5 years until 2004. Participants were categorized on the basis of their average daily caloric intake over each of the first three phases. Outcomes were CIND and dementia ascertained at phase five (2004). 192 men (15% of 1,248 participants at phase five) had CIND and 100 (8%) dementia. Age adjusted odds ratios demonstrated strongest associations between average energy consumption and vascular CIND or dementia (OR 1.62 95% CI 1.25-2.10). Adjustment for nutritional factors, vascular disease, diabetes, smoking, BP and BMI if anything increased the association (OR 1.64, 95% CI 1.03-2.60). After adjusting for social class, associations were attenuated and consistent with chance (OR 1.48, 95% CI 0.92-2.38). When adjusted for social class, the previously observed association between caloric intake and cognitive outcomes is modest, consistent with chance, and may be due to residual confounding.
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Affiliation(s)
- Samuel Thomas Creavin
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Schulze PC, Biolo A, Gopal D, Shahzad K, Balog J, Fish M, Siwik D, Colucci WS. Dynamics in insulin resistance and plasma levels of adipokines in patients with acute decompensated and chronic stable heart failure. J Card Fail 2011; 17:1004-11. [PMID: 22123363 PMCID: PMC3226951 DOI: 10.1016/j.cardfail.2011.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/17/2011] [Accepted: 08/18/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with heart failure (HF) develop metabolic derangements including increased adipokine levels, insulin resistance, inflammation and progressive catabolism. It is not known whether metabolic dysfunction and adipocyte activation worsen in the setting of acute clinical decompensation, or conversely, improve with clinical recovery. METHODS AND RESULTS We assessed insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR), and measured plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), adiponectin, visfatin, resistin, leptin, and tumor necrosis factor (TNF) α in 44 patients with acute decompensated HF (ADHF) due to left ventricular (LV) systolic dysfunction and again early (<1 wk) and late (> 6 mo) after clinical recovery, in 26 patients with chronic stable HF, and in 21 patients without HF. NT-proBNP was not increased in control subjects, mildly elevated in patients with stable HF, markedly elevated in patients with ADHF, and decreased progressively early and late after treatment. Compared to control subjects, plasma adiponectin, visfatin, leptin, resistin, and TNF-α were elevated in patients with chronic stable HF and increased further in patients with ADHF. Likewise, HOMA-IR was increased in chronic stable HF and increased further during ADHF. Adiponectin, visfatin, and HOMA-IR remained elevated at the time of discharge from the hospital, but returned to chronic stable HF levels. Adipokine levels were not related to body mass index in HF patients. HOMA-IR correlated positively with adipokines and TNF-α in HF patients. CONCLUSIONS ADHF is associated with worsening of insulin resistance and elevations of adipokines and TNF-α, indicative of adipocyte activation. These metabolic abnormalities are reversible, but they temporally lag behind the clinical resolution of decompensated HF.
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Affiliation(s)
- P Christian Schulze
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York 10032, USA.
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Gallacher J, Elwood P, Pickering J, Bayer A, Fish M, Ben-Shlomo Y. Benzodiazepine use and risk of dementia: evidence from the Caerphilly Prospective Study (CaPS). J Epidemiol Community Health 2011; 66:869-73. [DOI: 10.1136/jech-2011-200314] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Elwood PC, Bayer AJ, Fish M, Pickering J, Mitchell C, Gallacher JEJ. Sleep disturbance and daytime sleepiness predict vascular dementia. J Epidemiol Community Health 2010; 65:820-4. [PMID: 20675705 DOI: 10.1136/jech.2009.100503] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Disturbed sleep is common throughout the community and is associated with an increase in daytime sleepiness, both of which, in turn are associated with an increased risk of ischaemic vascular disease. The hypothesis that sleep disturbances are predictive of dementia, and in particular vascular dementia was tested in a large community-based cohort of older men. METHODS A questionnaire on sleep disturbances was administered to 1986 men aged 55-69 years in the Caerphilly Cohort Study and 10 years later the men were examined clinically for evidence of dementia or cognitive impairment with no dementia (CIND). FINDINGS Approximately 20% of the men reported disturbed sleep and 30% reported 'severe' daytime sleepiness. Ten years later 1,225 men (75% of the surviving men in the cohort) were tested and 268 (22%) were found to be cognitively impaired with 93 (7.6%) showing clear evidence of dementia and the remaining 175 (14.3%) showing evidence of CIND. After adjustment for possible confounding, including cognitive function and the taking of sleeping tablets at baseline, sleep disturbances appeared to be predictive of dementia and CIND of vascular origin, while there was no suggestion of prediction of non-vascular cognitive impairment by sleep. Prediction of vascular dementia appeared to be particularly strong for daytime sleepiness, with an adjusted OR of 4.44 (95% CI 2.05 to 9.61). Further adjustments for psychological distress at baseline reduced the size of the relationships, but the ORs remain large, consistent with a direct positive effect of sleep disturbance on vascular dementia. INTERPRETATION Sleep disturbances, and in particular severe daytime sleepiness, appear to be strongly predictive of vascular dementia, but have no predictive power for non vascular dementia.
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Affiliation(s)
- Peter C Elwood
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff CF14 4XN UK.
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Newsway V, Fish M, Rohrer JD, Majounie E, Williams N, Hack M, Warren JD, Morris HR. Perry syndrome due to the DCTN1 G71R mutation: a distinctive levodopa responsive disorder with behavioral syndrome, vertical gaze palsy, and respiratory failure. Mov Disord 2010; 25:767-70. [PMID: 20437543 DOI: 10.1002/mds.22950] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Perry syndrome is a rare form of autosomal dominant Parkinsonism with respiratory failure recently defined as being due to mutations in the DCTN1 gene. We describe a new family carrying a G71R mutation in the DCTN1 gene. The proband displayed a series of distinctive features not previously described in Perry syndrome: a disorder of vertical downward saccades accompanied by progressive midbrain atrophy, predominant nonmotor symptoms responsive to levodopa, distinctive craniocervical levodopa induced dyskinesias, and a good response to high-dose levodopa therapy and respiratory support. The family was initially thought to have autosomal dominant behavioral variant frontotemporal dementia with Parkinsonism. This report expands the clinical definition of this distinctive syndrome.
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Affiliation(s)
- Victoria Newsway
- MRC Centre for Neuropsychatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, United Kingdom
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Gallacher J, Bayer A, Lowe G, Fish M, Pickering J, Pedro S, Dunstan F, White J, Yarnell J, Ben-Shlomo Y. Is sticky blood bad for the brain?: Hemostatic and inflammatory systems and dementia in the Caerphilly Prospective Study. Arterioscler Thromb Vasc Biol 2009; 30:599-604. [PMID: 19965782 DOI: 10.1161/atvbaha.109.197368] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hemostasis and inflammation have been implicated in dementia. This study investigates the role of specific hemostatic and inflammatory pathways with incident vascular and nonvascular dementia. METHODS AND RESULTS This was a prospective study of a population sample of men aged 65 to 84 years, with baseline assessment of hemostatic and inflammatory factors and cognition measured 17 years later. The sample included 865 men (59 had dementia and 112 had cognitive impairment, not dementia), free of vascular disease at baseline and for whom hemostatic and inflammatory marker data were available and cognitive status was known. A total of 15 hemostatic and 6 inflammatory markers were assessed. Factor analysis was used to identify hemostatic subsystems. The National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurologie criteria were used to identify vascular dementia. By using standardized (z) scores for hemostatic and inflammatory markers, and after adjustment for age and risk factors, vascular dementia was associated with fibrinogen (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.02-2.76), factor VIII (HR, 1.79; 95% CI, 1.09-3.00), and plasminogen activator inhibitor 1 (HR, 3.13; 95% CI, 1.73-5.70). For vascular dementia, the HR risk from high levels of all three hemostatic variables (fibrinogen, factor VIII, and plasminogen activator inhibitor 1) was 2.97 (P<0.001). Inflammatory factors were not associated with vascular dementia. CONCLUSIONS The associations of these hemostatic markers with vascular dementia may implicate clot formation as the primary mechanism and are consistent with a microinfarct model of vascular dementia.
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Affiliation(s)
- John Gallacher
- Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, Heath Park, Cardiff CF14 4XN, Wales, England.
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Fish M, Bayer AJ, Gallacher JEJ, Bell T, Pickering J, Pedro S, Dunstan FD, Ben-Shlomo Y, Ebrahim S. Prevalence and pattern of cognitive impairment in a community cohort of men in South Wales: methodology and findings from the Caerphilly Prospective Study. Neuroepidemiology 2008; 30:25-33. [PMID: 18259098 DOI: 10.1159/000115439] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 11/02/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The prevalence of dementia and cognitive impairment not dementia was investigated in the Caerphilly Prospective Study cohort (men currently aged 65-84 years). METHODS Of 1,633 men eligible for cognitive screening, 1,225 (75%) were seen, with those failing the screening criteria (CAMCOG <83 or decline in CAMCOG >9) being neurologically examined. RESULTS For dementia, diagnosed by DSM-IV criteria, the population prevalence was 5.2% rising to 6.1% in the screened population. For cognitive impairment not dementia, the prevalence in the screened population was 15.6% giving an overall prevalence of cognitive impairment of 21.8%. Prevalence rose fivefold between ages of 65 and 84 years to reach over 50%. CONCLUSION These figures are likely to underestimate actual prevalence in this population, and developing effective interventions should be a public health priority.
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Affiliation(s)
- M Fish
- Department of Geriatric Medicine, Centre for Health Sciences Research, Cardiff University, Cardiff, UK
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Affiliation(s)
- Ceri Lynch
- Critical Care Rotation, Morriston Hospital, Swansea SA69NL
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Abstract
BACKGROUND A care pathway for the end-of-life had been implemented onto the two renal wards. An audit was performed to highlight potential issues and areas for development. METHOD The audit consisted of a base review of documentation from the medical notes of 10 patients who had died an 'expected' death prior to commencing the renal Integrated Care Pathway (ICP) for the end of life and then 10 patients who had died whilst using the ICP documentation. A questionnaire was also given out to nursing staff who had used the ICP documentation. The results were collated and analysed. RESULTS In the base review 100% of the documentation looked at did not provide a regular documented assessment of symptoms that are common in the terminal phase of life. The ICP provided a documented assessment of all of these main symptoms. The base review indicated a good response by doctors to meet the potential needs of the patient, but the ICP improved on this. This was through the use of a pre-emptive prescription. 80% of all patients were pain free, not agitated, had no nausea or vomiting or respiratory secretions. The 2 patients that had pain received further analgesia and were then pain free at the next assessment. One of the most positive aspects of the audit was that 90% of relatives were aware that the patient was dying and 100% had the plan of care discussed with them. CONCLUSION Implementing the ICP has generated the opportunity to deliver a hospice model of care to a busy renal unit. It has allowed best practice, and a measurable standard of care, in the final stages of patients' lives. Staff find the documentation easy to use and also see it as enhancing patient care.
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Abstract
The ethical principles of beneficence (or non-maleficence), respect for persons and justice apply to both good medical practice and clinical research. Doctors have a duty to offer to their patients, of all ages, the opportunity to take part in clinical trials and to ensure that research is appropriately designed and conducted. Barriers to participation of elderly patients in clinical trials include complex protocols with onerous outcome measures, a research focus on aggressive therapies with substantial toxicity, restrictive entry criteria unnecessarily excluding concurrent conditions and medication, patients' and families' limited expectations of benefits and lack of financial, logistic and social support.Participation is encouraged when attitudes of care staff towards research are positive, altruistic motives are acknowledged, approval of family members is gained and protocols are designed for patient rather than staff convenience. Special consideration should be given to ensuring that patient consent is fully informed and freely given. Elderly patients may have more difficulty comprehending consent information and particular attention should be given to compensating for communication and sensory deficits, improving readability of information sheets and consent forms, and considering the use of innovative consent procedures. Those with cognitive impairment and the institutionalised are vulnerable to exploitation and require special consideration and management.
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Affiliation(s)
- Antony Bayer
- Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, UK.
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Abstract
The ethical principles of beneficence (or non-maleficence), respect for persons and justice apply to both good medical practice and clinical research. Doctors have a duty to offer to their patients, of all ages, the opportunity to take part in clinical trials and to ensure that research is appropriately designed and conducted. Barriers to participation of elderly patients in clinical trials include complex protocols with onerous outcome measures, a research focus on aggressive therapies with substantial toxicity, restrictive entry criteria unnecessarily excluding concurrent conditions and medication, patients' and families' limited expectations of benefits and lack of financial, logistic and social support.Participation is encouraged when attitudes of care staff towards research are positive, altruistic motives are acknowledged, approval of family members is gained and protocols are designed for patient rather than staff convenience. Special consideration should be given to ensuring that patient consent is fully informed and freely given. Elderly patients may have more difficulty comprehending consent information and particular attention should be given to compensating for communication and sensory deficits, improving readability of information sheets and consent forms, and considering the use of innovative consent procedures. Those with cognitive impairment and the institutionalised are vulnerable to exploitation and require special consideration and management.
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Affiliation(s)
- Antony Bayer
- Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, UK.
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Abstract
This article explores the anxiety level of, and coping strategies used by, hospital nurses, during a national state of emergency. The study was guided by a stress and coping framework, developed by Lazarus & Folkman, and was conducted at a large teaching hospital, located in the centre of Israel, during the Iraqi crisis in January and February, 1998. Data were collected from a sample of 100 female nurses, and a descriptive correlational design was used. The findings indicated that approximately 33% of the nurses expressed feelings of stress, tension and a sense of discomfort. The dominant coping strategy used by the nurses was direct-active, which was found to be the most effective strategy. As they were unable to remove or control the stressor, stress management intervention by nursing managers focused mainly on communicating with staff and providing social support - informational and emotional--to buffer the stressful experience. Providing support and help in finding practical solutions is important for maintaining emotional stability of staff, thereby helping them to improve their nursing interventions in assisting people to cope with stressful situations.
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Affiliation(s)
- T Hendel
- Rabin Medical Center, Petach-Tikvah, Israel.
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Nusse R, Rulifson E, Fish M, Harryman-Samos C, Brink M, Wu CH, Cadigan K. Interactions between wingless and frizzled molecules in Drosophila. Ernst Schering Res Found Workshop 2000:1-11. [PMID: 10943301 DOI: 10.1007/978-3-662-04264-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R Nusse
- Howard Hughes Medical Institute, Department of Developmental Biology, Beckman Center, Stanford University Medical School, CA 94305-5323, USA
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Staten PL, Hines JF, Kost ER, Fish M, Rouse E, Hall KL. A descriptive evaluation with follow-up of the clinical significance of atypical immature squamous metaplasia of the cervix. J Low Genit Tract Dis 2000; 4:30-3. [PMID: 25950788 DOI: 10.1046/j.1526-0976.2000.41006.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We set out to determine the clinical significance of atypical immature squamous metaplasia (AIM). METHODS We performed in a military, hospital-based colposcopy clinic a descriptive, retrospective review of patients who had a diagnosis of AIM. Patients were examined at 3- to 4-month intervals for at least 1 year after a diagnosis of AIM was established. A gynecological pathologist reviewed all histological and cytological specimens. Initial histological or cytological specimens were tested for the presence of HPV DNA using in situ hybridization. RESULTS High-risk HPV DNA types 16 or 18 were detected in 3% of patients with AIM. Concurrent cervical intraepithelial neoplasia 3 (CIN3) was noted in 3% of patients with AIM. One-third of patients with initially diagnosed AIM had complete resolution of this lesion after 1 year of follow-up. CONCLUSIONS This descriptive, retrospective review shows that AIM does not appear to be associated with high-risk HPV DNA or with CIN3. In this limited study, a concurrent diagnosis of AIM likely does not influence the 1-year behavior of CIN. The degree of CIN should dictate treatment recommendations. A larger prospective trial is needed.
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Affiliation(s)
- P L Staten
- *Departments of Obstetrics and Gynecology and †Pathology, Brooke Army Medical Center, Fort Sam Houston, and the ‡Department of Pathology, Wilford Hall Medical Center, Lackland AFB, TX
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Bhanot P, Fish M, Jemison JA, Nusse R, Nathans J, Cadigan KM. Frizzled and Dfrizzled-2 function as redundant receptors for Wingless during Drosophila embryonic development. Development 1999; 126:4175-86. [PMID: 10457026 DOI: 10.1242/dev.126.18.4175] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In cell culture assays, Frizzled and Dfrizzled2, two members of the Frizzled family of integral membrane proteins, are able to bind Wingless and transduce the Wingless signal. To address the role of these proteins in the intact organism and to explore the question of specificity of ligand-receptor interactions in vivo, we have conducted a genetic analysis of frizzled and Dfrizzled2 in the embryo. These experiments utilize a small gamma-ray-induced deficiency that uncovers Dfrizzled2. Mutants lacking maternal frizzled and zygotic frizzled and Dfrizzled2 exhibit defects in the embryonic epidermis, CNS, heart and midgut that are indistinguishable from those observed in wingless mutants. Epidermal patterning defects in the frizzled, Dfrizzled2 double-mutant embryos can be rescued by ectopic expression of either gene. In frizzled, Dfrizzled2 mutant embryos, ectopic production of Wingless does not detectably alter the epidermal patterning defect, but ectopic production of an activated form of Armadillo produces a naked cuticle phenotype indistinguishable from that produced by ectopic production of activated Armadillo in wild-type embryos. These experiments indicate that frizzled and Dfrizzled2 function downstream of wingless and upstream of armadillo, consistent with their proposed roles as Wingless receptors. The lack of an effect on epidermal patterning of ectopic Wingless in a frizzled, Dfrizzled2 double mutant argues against the existence of additional Wingless receptors in the embryo or a model in which Frizzled and Dfrizzled2 act simply to present the ligand to its bona fide receptor. These data lead to the conclusion that Frizzled and Dfrizzled2 function as redundant Wingless receptors in multiple embryonic tissues and that this role is accurately reflected in tissue culture experiments. The redundancy of Frizzled and Dfrizzled2 explains why Wingless receptors were not identified in earlier genetic screens for mutants defective in embryonic patterning.
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Affiliation(s)
- P Bhanot
- Department of Molecular Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Abstract
The vertebrate Axin protein, the product of the mouse fused gene, binds to beta-catenin to inhibit Wnt signaling. We have identified a homolog of Axin in Drosophila, Daxin. Using double-stranded RNA interference, we generated loss-of-function phenotypes that are similar to overexpression of the Drosophila Wnt gene wingless (wg). Overexpression of Daxin produces phenotypes similar to loss of wg. In addition, we show that Daxin overexpression can modify phenotypes elicited by wg and another Drosophila Wnt gene, DWnt-2. Using immunoprecipitation of endogenous Daxin protein from embryos we show that Daxin interacts with Armadillo and Zeste-white 3. The loss-of-function and overexpression phenotypes show that Daxin, like its mammalian counterpart, acts as a negative regulator of wg/Wnt signaling.
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Affiliation(s)
- K Willert
- Howard Hughes Medical Institute, Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Nusse R, Samos CH, Brink M, Willert K, Cadigan KM, Wodarz A, Fish M, Rulifson E. Cell culture and whole animal approaches to understanding signaling by Wnt proteins in Drosophila. Cold Spring Harb Symp Quant Biol 1998; 62:185-90. [PMID: 9598351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Nusse
- Howard Hughes Medical Institute, Department of Developmental Biology, Beckman Center, Stanford University Medical Center, California 94305-5428, USA
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Abstract
BACKGROUND This case report describes a unique palatal tumor with features of a dermal neoplasm. Microscopically, the lesion appeared similar to a trichoepithelioma and trichoadenoma. METHODS Light microscopic and immunohistochemical studies were performed to arrive at the final diagnosis. RESULTS The lesion arose from the surface epithelium and had features of a dermal tumor. CONCLUSIONS The case report describes a unique benign palatal neoplasm.
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Affiliation(s)
- A M Manganaro
- Department of Oral and Maxillofacial Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA
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Abstract
The neuroanatomic or neuropathologic basis of Gilles de la Tourette's syndrome (GTS) remains unknown. Recent studies have suggested abnormalities of cerebral asymmetry and basal ganglia volumes. We studied 17 patients with GTS and eight normal controls using volumetric MRI techniques for measuring the caudate nucleus, amygdala, and corpus callosum. One subject with GTS was subsequently excluded because he was left handed. No absolute differences in caudate nucleus volumes between patient and control groups were evident. There was an increase in corpus callosum (CC) cross-sectional area and a loss of the normal asymmetry of the caudate nucleus in the patient group. A loss of the normal correlation between cross-sectional area of the CC and whole brain index (WBI) in the patient group also was found. The amygdala measurements had a poor interrater reliability.
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Affiliation(s)
- J Moriarty
- Raymond-Way Neuropsychiatry Research Group, Institute of Neurology, London, UK
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Abstract
Self-assessment is significant for the accurate evaluation of patient' needs. This study examined the frequency and severity of symptoms reported by 39 patients with Parkinson's disease and compared them with symptoms suggested by the literature and by specialists as bothering Parkinson's patients. Four categories of symptoms were examined: (a) motor disability or activity loss, (b) mental change, (c) psychosocial difficulties, and (d) nonspecific symptoms. The findings show that there was correspondence between expert judgements and subjects' reports regarding symptoms such as dyskinesia/tremor as well as walking, freezing gait, and changing position. Symptoms such as dressing self, getting in/out of bed, morning stiffness and deficit in cognitive sequencing, which experts described as characteristic of Parkinson's disease patients, bothered subjects less. In general, patients mental and psychosocial symptoms were higher in their frequencies and perceived severity than problems of performing activities of daily living.
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Affiliation(s)
- S Abudi
- Department of Nursing, School of Health Professions, Tel-Aviv University, Israel
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Abstract
This study examined the effects of maternal employment and separation anxiety on maternal interactive behavior and infant attachment. 73 mother-infant pairs participated in a laboratory free-play session when infants were 5 and 10 months of age and in the Strange Situation when the infants were 18 months of age. Maternal feelings about being separated from her infant were assessed by questionnaire at 5 months. Employed mothers returned to work before the infants' fifth month, and nonemployed mothers did not work outside the home through their infants' tenth month. Employed mothers who reported high levels of separation anxiety were more likely to exhibit intrusive behaviors at 10 months. While employment was not directly related to attachment, we found infants of high-anxiety employed mothers to develop anxious-avoidant attachments. The results suggest that maternal separation anxiety and interactive style may be important mediators between employment and later infant outcome.
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Affiliation(s)
- C A Stifter
- Department of Human Development and Family Studies, Pennsylvania State University, University Park 16802
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Fish M. Second thoughts on "second thoughts". Hastings Cent Rep 1992; 22:42. [PMID: 1506185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Fish M, Stifter CA, Belsky J. Conditions of continuity and discontinuity in infant negative emotionality: newborn to five months. Child Dev 1991; 62:1525-37. [PMID: 1786733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study investigated infant and caregiving-environment variables associated with continuity and discontinuity in infant negative emotionality between the newborn period and 5 months of age. Comparisons were made between groups of infants who evidenced similar levels of crying as neonates but differed by 5 months of age. For initially high-crying infants, mother personality traits, marital quality, and infant variables measured neonatally discriminated stable from changing infants. Ratings of mother sensitivity and infant responsiveness made at 5 months of age also related to continuity and discontinuity in negative emotionality over the first 5 months.
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Affiliation(s)
- M Fish
- Pennsylvania State University
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Abstract
In an effort to establish the sensitivity of the Kendrick Battery (KB) to mortality effects among institutionalized aged, the residualized pre-death KB scores (Digit Copying, Object Learning Subtests), as well as measures of affect (Zung Depression), and organicity (Luria Pathognomic Scale, Orientation Test) were compared in a sample of fifty-three elderly persons (M age = 82.7, SD = 7.76). Forty-two were female, eleven were male. Twenty-two of these individuals had subsequently died during an eighteen-month period following assessment. Six years after testing, thirty-six of these individuals had died. Step-wise discriminant analyses at each occasion yielded functions defined by the KB subtests, measures of organicity and depression, age of institutionalization, sex, and length of institutionalization that differentiated survivors and nonsurvivors. These data suggested that the Kendrick Battery subtests, measures of depression and organicity, in combination with length of institutionalization and age of admittance predict death among the elderly, for the most part, replicating previous research.
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Affiliation(s)
- B Hayslip
- Department of Psychology, University of North Texas, Denton 76203
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Abstract
In this study, we attempted to explore the construct validity of the Kendrick Battery by using an American sample and psychometric tests as indexes of diffuse organicity, depression, and normality. Institutionalized residents (N = 53) were tested twice (6-week interval). When organicity was defined by disorientation and memory deficits, then both the Object Learning test and the Digit Copying test were accurate in differentiating preestablished criterion groups. When organicity was defined more broadly, including sensorimotor function, the Digit Copying test alone was more accurate when depression was defined in terms of irritability, restlessness, and despair. These data suggest that although the Kendrick scales appeared to be sensitive to organicity and depression in this sample, their validity varied with the criteria for each when such were defined psychometrically.
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Hess AF, Fish M. Nutrition Classics. American Journal of Diseases of Children 8(6):399-405, 1914. Infantile scurvy: the blood, the blood vessels and the diet. Nutr Rev 1977; 35:12-4. [PMID: 320505 DOI: 10.1111/j.1753-4887.1977.tb06479.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Winchell HS, Stahelin H, Kusubov N, Slanger B, Fish M, Pollycove M, Lawrence JH. Kinetics of CO2-HCO3 minus in normal adult males. J Nucl Med 1970; 11:711-5. [PMID: 5490399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Winchell HS, Wiley K, Fish M, Pollycove M. Computer analysis of breath 14 CO2 data. J Nucl Med 1967; 8:326. [PMID: 6032604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Prokhorov YV, Fish M. A Characterization of Normal Distributions in Hilbert Space. Theory Probab Appl 1957. [DOI: 10.1137/1102034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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