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Godard-Sebillotte C, Navani S, Hacker G, Vedel I. Considering inequities in national dementia strategies: breadth, depth, and scope. Int J Equity Health 2024; 23:75. [PMID: 38627768 PMCID: PMC11022480 DOI: 10.1186/s12939-024-02166-8] [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] [Received: 12/08/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Considering that dementia is an international public health priority, several countries have developed national dementia strategies outlining initiatives to address challenges posed by the disease. These strategies aim to improve the care, support, and resources available to meet the needs of persons living with dementia and their care partners and communities. Despite the known impact of social determinants of health on dementia risk, care, and outcomes, it is unclear whether dementia strategies adequately address related inequities. This study aimed to describe whether and how national dementia strategies considered inequities associated with social determinants of health. METHODS We conducted an environmental scan of the national dementia strategies of countries that are part of the Organisation for Economic Cooperation and Development (OECD). Included strategies had to be accessible in English or French. Sub-national or provincial plans were excluded. We synthesised information on strategies' considerations of inequity through a thematic analysis. RESULTS Of the 15 dementia strategies that met inclusion criteria, 13 mentioned at least one inequity (M = 2.4, median = 2, range:0-7) related to Race/Ethnicity; Religion; Age; Disability; Sexual Orientation/Gender Identity; Social Class; or Rurality. Age and disability were mentioned most frequently, and religion most infrequently. Eleven strategies included general inequity-focused objectives, while only 5 had specific inequity-focused objectives in the form of tangible percentage changes, deadlines, or allocated budgets for achieving equity-related goals outlined in their strategies. CONCLUSIONS Understanding if and how countries consider inequities in their dementia strategies enables the development of future strategies that adequately target inequities of concern. While most of the strategies mentioned inequities, few included tangible objectives to reduce them. Countries must not only consider inequities at a surface-level; rather, they must put forth actionable objectives that intend to lessen the impact of inequities in the care of all persons living with dementia.
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Affiliation(s)
- Claire Godard-Sebillotte
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Department of Medicine, Division of Geriatrics, McGill University, Montreal, QC, Canada.
| | - Sanjna Navani
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Georgia Hacker
- The Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Isabelle Vedel
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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Wang HT, Meisler SL, Sharmarke H, Clarke N, Gensollen N, Markiewicz CJ, Paugam F, Thirion B, Bellec P. Continuous evaluation of denoising strategies in resting-state fMRI connectivity using fMRIPrep and Nilearn. PLoS Comput Biol 2024; 20:e1011942. [PMID: 38498530 PMCID: PMC10977879 DOI: 10.1371/journal.pcbi.1011942] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 03/28/2024] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
Reducing contributions from non-neuronal sources is a crucial step in functional magnetic resonance imaging (fMRI) connectivity analyses. Many viable strategies for denoising fMRI are used in the literature, and practitioners rely on denoising benchmarks for guidance in the selection of an appropriate choice for their study. However, fMRI denoising software is an ever-evolving field, and the benchmarks can quickly become obsolete as the techniques or implementations change. In this work, we present a denoising benchmark featuring a range of denoising strategies, datasets and evaluation metrics for connectivity analyses, based on the popular fMRIprep software. The benchmark prototypes an implementation of a reproducible framework, where the provided Jupyter Book enables readers to reproduce or modify the figures on the Neurolibre reproducible preprint server (https://neurolibre.org/). We demonstrate how such a reproducible benchmark can be used for continuous evaluation of research software, by comparing two versions of the fMRIprep. Most of the benchmark results were consistent with prior literature. Scrubbing, a technique which excludes time points with excessive motion, combined with global signal regression, is generally effective at noise removal. Scrubbing was generally effective, but is incompatible with statistical analyses requiring the continuous sampling of brain signal, for which a simpler strategy, using motion parameters, average activity in select brain compartments, and global signal regression, is preferred. Importantly, we found that certain denoising strategies behave inconsistently across datasets and/or versions of fMRIPrep, or had a different behavior than in previously published benchmarks. This work will hopefully provide useful guidelines for the fMRIprep users community, and highlight the importance of continuous evaluation of research methods.
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Affiliation(s)
- Hao-Ting Wang
- Centre de recherche de l’institut Universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - Steven L. Meisler
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Massachusetts, United States of America
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Massachusetts, United States of America
| | - Hanad Sharmarke
- Centre de recherche de l’institut Universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - Natasha Clarke
- Centre de recherche de l’institut Universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | | | | | - François Paugam
- Centre de recherche de l’institut Universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Computer Science and Operations Research Department, Université de Montréal, Montréal, Québec, Canada
- Mila—Institut Québécois d’Intelligence Artificielle, Montréal, Canada
| | | | - Pierre Bellec
- Centre de recherche de l’institut Universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Psychology Department, Université de Montréal, Montréal, Québec, Canada
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3
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Trenaman SC, Quach J, Bowles SK, Kirkland S, Andrew MK. An investigation of psychoactive polypharmacy and related gender-differences in older adults with dementia: a retrospective cohort study. BMC Geriatr 2023; 23:683. [PMID: 37864154 PMCID: PMC10590009 DOI: 10.1186/s12877-023-04353-8] [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] [Received: 03/14/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Older adults living with dementia may express challenging responsive behaviours. One management strategy is pharmacologic treatment though these options often have limited benefit, which may lead to multiple treatments being prescribed. METHODS The aim of the present study was to describe psychoactive medication polypharmacy and explore factors associated with psychoactive polypharmacy in a cohort of older adults living with dementia in Nova Scotia, Canada, including a gender-stratified analysis. This was a retrospective cohort study of those aged 65 years or older with a recorded diagnosis of dementia between 2005 and 2015. Medication dispensation data was collected from April 1, 2010, or dementia diagnosis (cohort entry) to either death or March 31, 2015 (cohort exit). Psychoactive medication claims were captured. Psychoactive medication polypharmacy was defined as presence of three or more psychoactive prescription medications dispensed to one subject and overlapping for more than 30 days. Psychoactive polypharmacy episodes were described in duration, quantity, and implicated medications. Regression analysis examined factors associated with experience and frequency of psychoactive polypharmacy. All analysis were stratified by gender. RESULTS The cohort included 15,819 adults living with dementia (mean age 80.7 years; 70.0% female), with 99.4% (n = 15,728) receiving at least one psychoactive medication over the period of follow-up. Psychoactive polypharmacy was present in 19.3% of the cohort. The gender specific logistic regressions demonstrated that for both men and women a younger age was associated with an increased risk of psychoactive polypharmacy (women: OR 0.97, 95%CI[0.96, 0.98], men: OR 0.96, 95%CI[0.95, 0.97]). Men were less likely to experience psychoactive polypharmacy if their location of residence was urban (OR 0.86, 95%CI[0.74, 0.99]). There was no significant association between location of residence (urban or rural) and psychoactive polypharmacy for women living with dementia. Antidepressants were the most dispensed medication class, while quetiapine was the most dispensed medication. CONCLUSIONS This study suggests that of adults living with dementia those of younger ages were more likely to experience psychoactive polypharmacy and that men living with dementia in rural locations may benefit from increased access to non-pharmacological options for dementia management.
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Affiliation(s)
- Shanna C Trenaman
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, B3H 4R2, Halifax, NS, Canada.
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada.
| | - Jack Quach
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Susan K Bowles
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, B3H 4R2, Halifax, NS, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - Susan Kirkland
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Rojas-Rozo L, Lee L, Khanassov V, Sivananthan S, Ismail Z, Gauthier S, Vedel I. Latest Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: What's in It for Primary Care? Can J Aging 2023:1-12. [PMID: 37855225 DOI: 10.1017/s0714980823000521] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
In 2020, the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) published up-to-date recommendations for the clinical management of persons living with dementia (PLWD) and their caregivers. During the CCCDTD5 meetings, a list of recommendations for dementia care was compiled. With the aid of family physicians and the Canadian Consortium on Neurodegeneration in Aging, we selected the most relevant CCCDTD5 recommendations for primary care and tailored and summarized them in the present manuscript to facilitate their reference and use. These recommendations focus on (a) risk reduction, (b) screening and diagnosis, (c) deprescription of dementia medications, and (d) non-pharmacological interventions. The development of recommendations for the ongoing management of dementia is an iterative process as new evidence on interventions for dementia is published. These recommendations are important in the primary care setting as the entry point for PLWD into the health system.
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Affiliation(s)
- Laura Rojas-Rozo
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge Gauthier
- Departments of Neurology and Neurosurgery, and Psychiatry, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
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Reveret L, Leclerc M, Emond V, Tremblay C, Loiselle A, Bourassa P, Bennett DA, Hébert SS, Calon F. Higher angiotensin-converting enzyme 2 (ACE2) levels in the brain of individuals with Alzheimer's disease. Acta Neuropathol Commun 2023; 11:159. [PMID: 37784209 PMCID: PMC10544218 DOI: 10.1186/s40478-023-01647-1] [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] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023] Open
Abstract
Cognitive decline due to Alzheimer's disease (AD) is frequent in the geriatric population, which has been disproportionately affected by the COVID-19 pandemic. In this study, we investigated the levels of angiotensin-converting enzyme 2 (ACE2), a regulator of the renin-angiotensin system and the main entry receptor of SARS-CoV-2 in host cells, in postmortem parietal cortex samples from two independent AD cohorts, totalling 142 persons. Higher concentrations of ACE2 protein (p < 0.01) and mRNA (p < 0.01) were found in individuals with a neuropathological diagnosis of AD compared to age-matched healthy control subjects. Brain levels of soluble ACE2 were inversely associated with cognitive scores (p = 0.02) and markers of pericytes (PDGFRβ, p = 0.02 and ANPEP, p = 0.007), but positively correlated with concentrations of soluble amyloid-β peptides (Aβ) (p = 0.01) and insoluble phospho-tau (S396/404, p = 0.002). However, no significant differences in ACE2 were observed in the 3xTg-AD mouse model of tau and Aβ neuropathology. Results from immunofluorescence and Western blots showed that ACE2 protein is predominantly localized in microvessels in the mouse brain whereas it is more frequently found in neurons in the human brain. The present data suggest that higher levels of soluble ACE2 in the human brain may contribute to AD, but their role in CNS infection by SARS-CoV-2 remains unclear.
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Affiliation(s)
- Louise Reveret
- Faculty of Pharmacy, Laval University, Quebec, QC, Canada
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada
| | - Manon Leclerc
- Faculty of Pharmacy, Laval University, Quebec, QC, Canada
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada
| | - Vincent Emond
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada
| | - Cyntia Tremblay
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada
| | - Andréanne Loiselle
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada
| | - Philippe Bourassa
- Faculty of Pharmacy, Laval University, Quebec, QC, Canada
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Sébastien S Hébert
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada
- Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Frédéric Calon
- Faculty of Pharmacy, Laval University, Quebec, QC, Canada.
- CHU de Quebec Research Center, 2705, Boulevard Laurier, Room T2-05, Québec, QC, G1V 4G2, Canada.
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Bray NW, Pieruccini-Faria F, Witt ST, Bartha R, Doherty TJ, Nagamatsu LS, Almeida QJ, Liu-Ambrose T, Middleton LE, Bherer L, Montero-Odasso M. Combining exercise with cognitive training and vitamin D 3 to improve functional brain connectivity (FBC) in older adults with mild cognitive impairment (MCI). Results from the SYNERGIC trial. GeroScience 2023:10.1007/s11357-023-00805-6. [PMID: 37162700 PMCID: PMC10170058 DOI: 10.1007/s11357-023-00805-6] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
Changes in functional brain connectivity (FBC) may indicate how lifestyle modifications can prevent the progression to dementia; FBC identifies areas that are spatially separate but temporally synchronized in their activation and is altered in those with mild cognitive impairment (MCI), a prodromal state between healthy cognitive aging and dementia. Participants with MCI were randomly assigned to one of five study arms. Three times per week for 20-weeks, participants performed 30-min of (control) cognitive training, followed by 60-min of (control) physical exercise. Additionally, a vitamin D3 (10,000 IU/pill) or a placebo capsule was ingested three times per week for 20-weeks. Using the CONN toolbox, we measured FBC change (Post-Pre) across four statistical models that collapsed for and/or included some or all study arms. We conducted Pearson correlations between FBC change and changes in physical and cognitive functioning. Our sample included 120 participants (mean age: 73.89 ± 6.50). Compared to the pure control, physical exercise (model one; p-False Discovery Rate (FDR) < 0.01 & < 0.05) with cognitive training (model two; p-FDR = < 0.001), and all three interventions combined (model four; p-FDR = < 0.01) demonstrated an increase in FBC between regions of the Default-Mode Network (i.e., hippocampus and angular gyrus). After controlling for false discovery rate, there were no significant correlations between change in connectivity and change in cognitive or physical function. Physical exercise alone appears to be as efficacious as combined interventional strategies in altering FBC, but implications for behavioral outcomes remain unclear.
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Affiliation(s)
- Nick W Bray
- Cumming School of Medicine, Department of Physiology & Pharmacology, University of Calgary, Calgary, AB, T2N 1N4, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 1N4, Canada.
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, 550 Wellington Road, Room A3-116, London, ON, N6C-0A7, Canada.
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, 550 Wellington Road, Room A3-116, London, ON, N6C-0A7, Canada
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A-5C1, Canada
| | - Suzanne T Witt
- BrainsCAN, Western University, London, ON, N6A-3K7, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A-5C1, Canada
- Robarts Research Institute, Western University, London, ON, N6A-5B7, Canada
| | - Timothy J Doherty
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A-5C1, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A-5C1, Canada
| | - Lindsay S Nagamatsu
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, N6G-2V4, Canada
| | - Quincy J Almeida
- Faculty of Science, Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, N2L-3C5, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, V6T-1Z3, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L-3G1, Canada
| | - Louis Bherer
- Department of Medicine, University of Montréal, Montréal, QC, H3T-1J4, Canada
- Research Centre, Montreal Heart Institute, Montréal, QC, H1T-1C8, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, 550 Wellington Road, Room A3-116, London, ON, N6C-0A7, Canada.
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A-5C1, Canada.
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A-5C1, Canada.
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7
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Senkevich K, Alipour P, Chernyavskaya E, Yu E, Noyce AJ, Gan-Or Z. Potential Protective Link Between Type I Diabetes and Parkinson's Disease Risk and Progression. Mov Disord 2023. [PMID: 37148456 DOI: 10.1002/mds.29424] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Epidemiological studies suggested an association between Parkinson's disease (PD) and type 2 diabetes, but less is known about type 1 diabetes (T1D) and PD. OBJECTIVE This study sought to explore the association between T1D and PD. METHODS We used Mendelian randomization, linkage disequilibrium score regression, and multi-tissue transcriptome-wide analysis to examine the association between PD and T1D. RESULTS Mendelian randomization showed a potentially protective role of T1D for PD risk (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.94-0.99; P = 0.039), as well as motor (OR, 0.94; 95% CI, 0.88-0.99; P = 0.044) and cognitive progression (OR, 1.50; 95% CI, 1.08-2.09; P = 0.015). We further found a negative genetic correlation between T1D and PD (rg = -0.17; P = 0.016), and we identified eight genes in cross-tissue transcriptome-wide analysis that were associated with both traits. CONCLUSIONS Our results suggest a potential genetic link between T1D and PD risk and progression. Larger comprehensive epidemiological and genetic studies are required to validate our findings. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Konstantin Senkevich
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada
| | - Paria Alipour
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | | | - Eric Yu
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Ziv Gan-Or
- Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
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8
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O'Connor A, Rice H, Barnes J, Ryan NS, Liu KY, Allegri RF, Berman S, Ringman JM, Cruchaga C, Farlow MR, Hassenstab J, Lee JH, Perrin RJ, Xiong C, Gordon B, Levey AI, Goate A, Graff-Radford N, Levin J, Jucker M, Benzinger T, McDade E, Mori H, Noble JM, Schofield PR, Martins RN, Salloway S, Chhatwal J, Morris JC, Bateman R, Howard R, Reeves S, Fox NC. First presentation with neuropsychiatric symptoms in autosomal dominant Alzheimer's disease: the Dominantly Inherited Alzheimer's Network Study. J Neurol Neurosurg Psychiatry 2023; 94:403-405. [PMID: 36522155 PMCID: PMC10145026 DOI: 10.1136/jnnp-2022-329843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Antoinette O'Connor
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK antoinette.o'
- UK Dementia Research Institute at UCL, London, UK
| | - Helen Rice
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Natalie S Ryan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Ricardo Francisco Allegri
- Cognitive Neurology, Neurological Research Institute FLENI, Buenos Aires (Argentina), Buenos Aires, Argentina
| | - Sarah Berman
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Carlos Cruchaga
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Martin R Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jason Hassenstab
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Richard J Perrin
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University in St Louis MO, St Louis, Missouri, USA
| | - Chengjie Xiong
- Division of Biostatistics, Washington University in St Louis MO, St Louis, Missouri, USA
| | - Brian Gordon
- Department of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Allan I Levey
- Department of Neurology, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | - Alison Goate
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neil Graff-Radford
- Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology, (SyNergy), Munich, Germany
- Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany
| | - Mathias Jucker
- German Center for Neurodegenerative Diseases, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tammie Benzinger
- Department of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Eric McDade
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - James M Noble
- Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Ralph N Martins
- Sir James McCusker Alzheimer's Disease Research Unit, Edith Cowan University, Perth, Western Australia, Australia
| | - Stephen Salloway
- Department of Neurology, Butler Hospital & Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jasmeer Chhatwal
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Randall Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rob Howard
- Division of Psychiatry, University College London, London, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
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Joza S, Camicioli R, Martin WRW, Wieler M, Gee M, Ba F. Pedunculopontine Nucleus Dysconnectivity Correlates With Gait Impairment in Parkinson’s Disease: An Exploratory Study. Front Aging Neurosci 2022; 14:874692. [PMID: 35875799 PMCID: PMC9304714 DOI: 10.3389/fnagi.2022.874692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Gait impairment is a debilitating and progressive feature of Parkinson’s disease (PD). Increasing evidence suggests that gait control is partly mediated by cholinergic signaling from the pedunculopontine nucleus (PPN). Objective We investigated whether PPN structural connectivity correlated with quantitative gait measures in PD. Methods Twenty PD patients and 15 controls underwent diffusion tensor imaging to quantify structural connectivity of the PPN. Whole brain analysis using tract-based spatial statistics and probabilistic tractography were performed using the PPN as a seed region of interest for cortical and subcortical target structures. Gait metrics were recorded in subjects’ medication ON and OFF states, and were used to determine if specific features of gait dysfunction in PD were related to PPN structural connectivity. Results Tract-based spatial statistics revealed reduced structural connectivity involving the corpus callosum and right superior corona radiata, but did not correlate with gait measures. Abnormalities in PPN structural connectivity in PD were lateralized to the right hemisphere, with pathways involving the right caudate nucleus, amygdala, pre-supplementary motor area, and primary somatosensory cortex. Altered connectivity of the right PPN-caudate nucleus was associated with worsened cadence, stride time, and velocity while in the ON state; altered connectivity of the right PPN-amygdala was associated with reduced stride length in the OFF state. Conclusion Our exploratory analysis detects a potential correlation between gait dysfunction in PD and a characteristic pattern of connectivity deficits in the PPN network involving the right caudate nucleus and amygdala, which may be investigated in future larger studies.
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Affiliation(s)
- Stephen Joza
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Marguerite Wieler
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Myrlene Gee
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Fang Ba,
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Trenaman SC, Kennie-Kaulbach N, d'Entremont-MacVicar E, Isenor JE, Goodine C, Jarrett P, Andrew MK. Implementation of pharmacist-led deprescribing in collaborative primary care settings. Int J Clin Pharm 2022; 44:1216-1221. [PMID: 35794285 PMCID: PMC9261167 DOI: 10.1007/s11096-022-01449-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
In many jurisdictions pharmacists share prescribing responsibilities with other members of the primary care team. Responsibility for deprescribing, the healthcare professional supervised withdrawal of medications that are no longer needed, has not been assumed by a specific member of the primary care team. In this commentary we describe implementation of pharmacist-led deprescribing in collaborative primary care settings using the seven components of knowledge translation. Patient and stakeholder engagement shaped the deprescribing intervention. The intervention was implemented in three collaborative primary care clinics in two Canadian provinces. The evaluation included measures of medication appropriateness, patient satisfaction, and healthcare professional satisfaction. Pharmacist-led deprescribing in primary care was acceptable to both patients and healthcare professionals and demonstrated a reduction of medications deemed to confer more risk than benefit. Our findings support successes in pharmacist-led deprescribing. Future work is needed to understand how to successfully implement and evaluate pharmacist-led deprescribing more widely.
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Affiliation(s)
- Shanna C Trenaman
- Department of Medicine (Geriatrics), Dalhousie University, Veterans Memorial Building, 5955 Veterans Memorial Lane, Halifax, NS, B3H 2E1, Canada.
- Geriatric Medicine Research, Dalhousie University / Nova Scotia Health Authority, 1427-5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.
| | - Natalie Kennie-Kaulbach
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | | | - Jennifer E Isenor
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada
- Department of Community Health and Epidemiology, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Carole Goodine
- Horizon Health Network, Doctor Everett Chalmers Hospital, 700 Priestman Street, PO Box 9000, Fredericton, NB, E3B 5N5, Canada
| | - Pamela Jarrett
- Department of Medicine (Geriatrics), Dalhousie University, Veterans Memorial Building, 5955 Veterans Memorial Lane, Halifax, NS, B3H 2E1, Canada
- Horizon Health Network, 400 University Avenue, PO Box 2100, Saint John, NB, E2L 4L2, Canada
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Veterans Memorial Building, 5955 Veterans Memorial Lane, Halifax, NS, B3H 2E1, Canada
- Geriatric Medicine Research, Dalhousie University / Nova Scotia Health Authority, 1427-5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
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Urqueta Alfaro A, McGraw C, Guthrie DM, Wittich W. Optimizing Evaluation of Older Adults With Vision and/or Hearing Loss Using the interRAI Community Health Assessment and Deafblind Supplement. Front Rehabilit Sci 2021; 2:764022. [PMID: 36188820 PMCID: PMC9397811 DOI: 10.3389/fresc.2021.764022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022]
Abstract
Purpose: Service providers must identify and assess older adults who have concurrent vision and hearing loss, or dual sensory impairment (DSI). An assessment tool suitable for this purpose is the interRAI Community Health Assessment (CHA) and its Deafblind Supplement. This study's goal was to explore this assessment's administration process and to generate suggestions for assessors to help them optimize data collection. Methods: A social worker with experience working with adults who have sensory loss, who was also naïve to the interRAI CHA, administered the assessment with 200 older adults (65+) who had visual and/or hearing loss. The assessor evaluated the utility of the instrument for clinical purposes, focusing on sections relevant to identifying/characterizing adults with DSI. Results: Suggestions include the recommendation to ask additional questions regarding the person's functional abilities. This will help assessors deepen their understanding of the person's sensory status. Recommendations are also provided regarding sensory impairments and rehabilitation, in a general sense, to help assessors administer the interRAI CHA. Conclusions: Suggestions will help assessors to deepen their knowledge about sensory loss and comprehensively understand the assessment's questions, thereby allowing them to optimize the assessment process and increase their awareness of sensory loss in older adults.
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Affiliation(s)
- Andrea Urqueta Alfaro
- School of Optometry, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain/Centre de réadaptation Lethbridge-Layton-Mackay du Centres Intégrés Universitaires de Santé et de Services Sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain/Institut Nazareth et Louis-Braille du Centres Intégrés de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC, Canada
| | - Cathy McGraw
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain/Centre de réadaptation Lethbridge-Layton-Mackay du Centres Intégrés Universitaires de Santé et de Services Sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Dawn M. Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Walter Wittich
- School of Optometry, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain/Centre de réadaptation Lethbridge-Layton-Mackay du Centres Intégrés Universitaires de Santé et de Services Sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montréal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain/Institut Nazareth et Louis-Braille du Centres Intégrés de Santé et de Services Sociaux de la Montérégie-Centre, Longueuil, QC, Canada
- *Correspondence: Walter Wittich
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