Packaging and containerization of computational methods

Methods for analyzing the full complement of a biomolecule type, e.g., proteomics or metabolomics, generate large amounts of complex data. The software tools used to analyze omics data have reshaped the landscape of modern biology and become an essential component of biomedical research. These tools are themselves quite complex and often require the installation of other supporting software, libraries and/or databases. A researcher may also be using multiple different tools that require different versions of the same supporting materials. The increasing dependence of biomedical scientists on these powerful tools creates a need for easier installation and greater usability. Packaging and containerization are different approaches to satisfy this need by delivering omics tools already wrapped in additional software that makes the tools easier to install and use. In this systematic review, we describe and compare the features of prominent packaging and containerization platforms. We outline the challenges, advantages and limitations of each approach and some of the most widely used platforms from the perspectives of users, software developers and system administrators. We also propose principles to make the distribution of omics software more sustainable and robust to increase the reproducibility of biomedical and life science research.

221 BEFRIENDING SERVICES ARE ASSOCIATED WITH LESS DECLINE IN HEALTH-RELATED QUALITY OF LIFE, BUT NOT COGNITIVE FUNCTION, OVER TIME

Background

Befriending services are commonly deployed in the support of older people living alone, but lack an established evidence base, particularly in relation to their association with health outcomes.

Methods

To explore the potentially therapeutic impact of befriending on Health-Related Quality-of-Life (HR-QoL) and cognitive function, we used a single case experimental design. Data were collected from 85 new users of ALONE’s befriending service between 2019 and 2021 in an AB multiple baseline design. Generalised additive modelling was then used to assess trajectories of HR-QoL and cognitive function (semantic fluency) over the course of six months, and its association with the onset of the befriending service intervention

Results

The befriending service was associated with less decline over time in HR-QoL, and with a mitigated impact of loneliness on HR-QoL too. No such effects were observed for cognitive function as an outcome, which did not change over time.

Conclusion

Befriending may exert a positive effect on health-related quality of life, and reduce the negative impact that loneliness has on this outcome.

264 FREEDOM AND LONELINESS: SPOUSAL DEMENTIA CARE-GIVERS AND THE NURSING HOME TRANSITION

Background

Many persons with dementia transition to nursing home care, but little is known about the impact, positive and negative, that this may have on the social isolation and loneliness of their spouse.

Methods

Using our existing theoretical synthesis of loneliness to provide sensitising concepts, we conducted a deductive grounded theory study of loneliness during the nursing home transitions. We recruited 11 spousal participants to engage in semi-structured remote interviews during 2021.

Results

Participants provided their own definitions of loneliness, and spoke about their life history of loneliness, the loneliness associated with living with a spouse with dementia, and the loneliness, and alleviation of loneliness through re-engagement with social contacts, associated with their spouse moving to the nursing home. Participants agreed with the idea that loneliness has a physical feeling. More distal parts of the theoretical synthesis, such as the influence that culture and gender have on loneliness, were not corroborated by the findings.

Conclusion

We conclude that loneliness is a frequent experience among spousal caregivers whose spouse has moved to nursing home care, but that loneliness is also associated with living with a spouse with dementia. Loneliness in this population was aggravated by the COVID-19 pandemic and associated lockdowns. Further research steps will involve more targeted interviewing to focus on the link between transitions and loneliness in this and in other populations.

18 SEDATIVE LOAD IN COMMUNITY-DWELLING OLDER ADULTS WITH MILD–MODERATE ALZHEIMER’S DISEASE: LONGITUDINAL RELATIONSHIPS WITH ADVERSE EVENTS, DELIRIUM AND FALLS

Background

Older adults are frequently prescribed medications with sedative effects, which are associated with numerous adverse consequences. However, the use and longitudinal associations of sedative medication use in older adults with mild–moderate Alzheimer Disease (AD), has not been explored to date.

Methods

The association between Sedative Load (SL) and adverse events, unscheduled healthcare utilisation, delirium and falls over 18 months was assessed in older adults with mild–moderate AD from 9 Countries. Additionally, the impact of SL on dementia progression was evaluated.

Results

Over half (52.35%; 267/510) of those with mild–moderate ad (72.8 ± 8.26 years, 61.89%) were prescribed a regular medication with sedation as a primary effect or prominent side effect with 17.65% (90/510) having a high SL (≥3). The most common medications contributing to SL were antidepressants, antipsychotics, anxiolytics and hypnotics. Over 18 months, greater SL was associated with adverse events (IRR 1.18, 1.14–1.23, p < 0.001)/serious adverse events (IRR 1.32, 1.18–1.49, p < 0.001) and unscheduled GP visits (IRR 1.26, 1.15–1.38, p < 0.001). Further, increasing SL was associated with greater likelihood of incident delirium (IRR 1.47, 1.25–1.73, p < 0.001) and falls (IRR 1.25, 1.06–1.48, p = 0.007) which persisted after covariate adjustment. SL was not associated with accelerated cognitive decline or ad progression.

Conclusion

Most adults with mild–moderate ad are prescribed at least one drug with a sedative effect and a significant minority have a high SL. Increasing SL was associated with a greater likelihood of experiencing adverse events, delirium and falls, highlighting the need for optimal prescribing in this vulnerable cohort.

The roles of code in biology

The way in which computer code is perceived and used in biological research has been a source of some controversy and confusion, and has resulted in sub-optimal outcomes related to reproducibility, scalability and productivity. We suggest that the confusion is due in part to a misunderstanding of the function of code when applied to the life sciences. Code has many roles, and in this paper we present a three-dimensional taxonomy to classify those roles and map them specifically to the life sciences. We identify a "sweet spot" in the taxonomy-a convergence where bioinformaticians should concentrate their efforts in order to derive the most value from the time they spend using code. We suggest the use of the "inverse Conway maneuver" to shape a research team so as to allow dedicated software engineers to interface with researchers working in this "sweet spot." We conclude that in order to address current issues in the use of software in life science research such as reproducibility and scalability, the field must reevaluate its relationship with software engineering, and adapt its research structures to overcome current issues in bioinformatics such as reproducibility, scalability and productivity.

Family members' attitudes towards telling the patient with Alzheimer's disease their diagnosis: a 20-year repeat study

PURPOSE

Exploring family members' attitudes to an Alzheimer's disease diagnosis compared to that of a study 20 years prior by Maguire et al. (BMJ 313:529-530, 1996).

METHODS

The survey was a replica of that completed 20 years prior in the same department by Maguire et al. (BMJ 313:529-530, 1996). With ethics approval and consent, family members were surveyed regarding their attitudes towards a dementia diagnosis. Completed by doctors with 100 consecutive respondents accompanying patients to scheduled memory clinic appointments. Themes were generated, results compiled and compared to the previous study.

RESULTS

Respondents are now over four times more likely to favour disclosure over non-disclosure to a patient (chi-squared 68.142, p < 0.0001). A substantial decrease is evident in those listing fear of evoking a negative reaction. Accordingly, there is an increase in those referring to the benefits of disclosure.

CONCLUSION

The emerged theme was that of autonomy versus paternalism, with attitude shift reflecting that patient privacy is an established patient right, taking precedence over paternalistic preferences.

The democratization of bioinformatics: A software engineering perspective

Today, thanks to advances in cloud computing, it is possible for small teams of software developers to produce internet-scale products, a feat that was previously the preserve of large organizations. Herein, we describe how these advances in software engineering can be made more readily available to bioinformaticians. In the same way that cloud computing has democratized access to distributed systems engineering for generalist software engineers, access to scalable and reproducible bioinformatic engineering can be democratized for generalist bioinformaticians and biologists. We present solutions, based on our own efforts, to achieve this goal.

The impact of a national public awareness campaign on dementia knowledge and help-seeking in Ireland

Background

Dementia is a growing public health issue in Ireland primarily due to the ageing population. Increasing public knowledge of dementia has been identified as a key priority to reduce disease burden. This study evaluated the impact of a dementia communication campaign on dementia knowledge and help-seeking intention among the general public in Ireland.

Methods

In 2016, a nationally-representative sample of over 1,200 adults in Ireland was surveyed to inform a nationwide dementia awareness campaign entitled Understand Together. Multiple factors were examined including sociodemographic characteristics, dementia advertising awareness, dementia knowledge and help-seeking intention. A similar survey (N = 1,003) was conducted in 2018 to evaluate public awareness of the campaign and its association with dementia knowledge and help-seeking intention. Data from the 2016 and 2018 surveys were analysed using univariable analysis and logistic regression, adjusted for sociodemographics.

Results

Awareness of dementia advertising increased from 17% (2016) to 32% (2018) (p &lt; 0.001). Women (OR 1.51, 95%CI 1.14-2.00), rural residents (OR 1.48, 95%CI 1.10-2.00), respondents aged 40-59 years (OR 1.96, 95%CI 1.40-2.74) or 60+ years (OR 2.18, 95%CI 1.47-3.22), and those who knew someone with dementia (OR 2.06, 95%CI 1.55-2.75) were more likely to be aware of the campaign. Very good or good dementia knowledge and awareness that dementia risk is modifiable increased from 24% to 33% (p &lt; 0.05) and 46% to 52% (p &lt; 0.05), respectively. There was a linear association between campaign awareness and both help-seeking (OR 1.81, 95%CI 1.36-2.40) and holding a positive view of the potential benefits of early diagnosis (OR 1.97, 95%CI 1.35-2.88).

Conclusions

The ongoing campaign, as well as future communication strategies, should continue to focus on increasing awareness of modifiable risk to support prevention. Campaign messaging/modalities should be targeted at harder to reach population groups.

Key messages

Public communication on dementia can improve knowledge and help-seeking. Health communication campaign evaluation can identify, and inform the targeting of, hard to reach population groups.

Simplicity DiffExpress: A Bespoke Cloud-Based Interface for RNA-seq Differential Expression Modeling and Analysis

One of the key challenges for transcriptomics-based research is not only the processing of large data but also modeling the complexity of features that are sources of variation across samples, which is required for an accurate statistical analysis. Therefore, our goal is to foster access for wet lab researchers to bioinformatics tools, in order to enhance their ability to explore biological aspects and validate hypotheses with robust analysis. In this context, user-friendly interfaces can enable researchers to apply computational biology methods without requiring bioinformatics expertise. Such bespoke platforms can improve the quality of the findings by allowing the researcher to freely explore the data and test a new hypothesis with independence. Simplicity DiffExpress is a data-driven software platform dedicated to enabling non-bioinformaticians to take ownership of the differential expression analysis (DEA) step in a transcriptomics experiment while presenting the results in a comprehensible layout, which supports an efficient results exploration, information storage, and reproducibility. Simplicity DiffExpress’ key component is the bespoke statistical model validation that guides the user through any necessary alteration in the dataset or model, tackling the challenges behind complex data analysis. The software utilizes edgeR, and it is implemented as part of the Simplicity^TM platform, providing a dynamic interface, with well-organized results that are easy to navigate and are shareable. Computational biologists and bioinformaticians can also benefit from its use since the data validation is more informative than the usual DEA resources. Wet-lab collaborators can benefit from receiving their results in an organized interface. Simplicity DiffExpress is freely available for academic use, and it is cloud-based (https://simplicity.nsilico.com/dea).

Field of genes: using Apache Kafka as a bioinformatic data repository

Background

Bioinformatic research is increasingly dependent on large-scale datasets, accessed either from private or public repositories. An example of a public repository is National Center for Biotechnology Information's (NCBI’s) Reference Sequence (RefSeq). These repositories must decide in what form to make their data available. Unstructured data can be put to almost any use but are limited in how access to them can be scaled. Highly structured data offer improved performance for specific algorithms but limit the wider usefulness of the data. We present an alternative: lightly structured data stored in Apache Kafka in a way that is amenable to parallel access and streamed processing, including subsequent transformations into more highly structured representations. We contend that this approach could provide a flexible and powerful nexus of bioinformatic data, bridging the gap between low structure on one hand, and high performance and scale on the other. To demonstrate this, we present a proof-of-concept version of NCBI’s RefSeq database using this technology. We measure the performance and scalability characteristics of this alternative with respect to flat files.

Results

The proof of concept scales almost linearly as more compute nodes are added, outperforming the standard approach using files.

Conclusions

Apache Kafka merits consideration as a fast and more scalable but general-purpose way to store and retrieve bioinformatic data, for public, centralized reference datasets such as RefSeq and for private clinical and experimental data.

Brain complications of diabetes mellitus: a cross-sectional study of awareness among individuals with diabetes and the general population in Ireland

AIMS

To identify awareness of potential brain complications of diabetes among individuals with diabetes and the public.

METHODS

For this observational, cross-sectional survey study, we recruited consecutive adult attendees of a specialist diabetes clinic and two primary care practices. Primary care attendees represented members of the general population of Ireland. An interviewer-administered questionnaire was used to gather data on respondents' awareness of brain complications of diabetes and modifiable risk factors for dementia. Multivariable logistic regression was undertaken to identify variables independently associated with awareness.

RESULTS

Respondents included a total of 502 adults: 250 in the diabetes group (37% women, mean age 63 ± 14 years, 88% with Type 2 diabetes) and 252 in the general population group (51% women, mean age 47 ± 17 years, 7% with Type 2 diabetes). The diabetes group had significantly greater awareness of diabetes complications, except for depression, compared with the general population group. In the group as a whole, respondent awareness of dementia (35%) and memory problems (47%) as potential complications of diabetes was poor compared with awareness of kidney (84%) and eye damage (84%). Respondents were 1.5 times more likely to identify that individuals can modify their risk of developing Type 2 diabetes than their risk of dementia.

CONCLUSIONS

This study shows that there is poor awareness of brain complications of diabetes among individuals with diabetes and the general population in Ireland. The results suggest a need for expansion of public awareness campaigns and diabetes education programmes to promote awareness of the brain complications of diabetes and of the modifiable risk factors for dementia, as part of a life-course approach to dementia prevention.

Antimicrobial resistance and molecular epidemiology using whole-genome sequencing of Neisseria gonorrhoeae in Ireland, 2014-2016: focus on extended-spectrum cephalosporins and azithromycin

High-level resistance and treatment failures with ceftriaxone and azithromycin, the first-line agents for gonorrhoea treatment are reported and antimicrobial-resistant Neisseria gonorrhoeae is an urgent public health threat. Our aims were to determine antimicrobial resistance rates, resistance determinants and phylogeny of N. gonorrhoeae in Ireland, 2014-2016. Overall, 609 isolates from four University Hospitals were tested for susceptibility to extended-spectrum cephalosporins (ESCs) and azithromycin by the MIC Test Strips. Forty-three isolates were whole-genome sequenced based on elevated MICs. The resistance rate to ceftriaxone, cefixime, cefotaxime and azithromycin was 0, 1, 2.1 and 19%, respectively. Seven high-level azithromycin-resistant (HLAzi-R) isolates were identified, all susceptible to ceftriaxone. Mosaic penA alleles XXXIV, X and non-mosaic XIII, and G120K plus A121N/D/G (PorB1b), H105Y (MtrR) and A deletion (mtrR promoter) mutations, were associated with elevated ESC MICs. A2059G and C2611T mutations in 23S rRNA were associated with HLAzi-R and azithromycin MICs of 4-32 mg/L, respectively. The 43 whole-genome sequenced isolates belonged to 31 NG-MAST STs. All HLAzi-R isolates belonged to MLST ST1580 and some clonal clustering was observed; however, the isolates differed significantly from the published HLAzi-R isolates from the ongoing UK outbreak. There is good correlation between previously described genetic antimicrobial resistance determinants and phenotypic susceptibility categories for ESCs and azithromycin in N. gonorrhoeae. This work highlights the advantages and potential of whole-genome sequencing to be applied at scale in the surveillance of antibiotic resistant strains of N. gonorrhoeae, both locally and internationally.

Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union?

The association between exposure to head injury and increased risk of neurodegenerative disease, specifically chronic traumatic encephalopathy (CTE), is widely recognized. Historically, this was largely considered a phenomenon restricted to boxers, with more recent case series identifying further 'high risk' individuals, such as former American footballers, or military personnel. However, in all cases thus far reported, it is clear that it is the exposure to head injury which is associated with increased dementia risk, and not the circumstances or environment of exposure. As such, there is considerable potential for under-recognition of CTE in patients presenting with neurodegenerative disease, particularly where head injury exposure might have been historical and through sport. This article reviews current understanding of CTE and, via an illustrative case in rugby union, highlights the value of a detailed history on head injury and also draws attention to imaging studies in assessing patients with neurodegenerative disease.

Engineering bioinformatics: building reliability, performance and productivity into bioinformatics software

There is a lack of software engineering skills in bioinformatic contexts. We discuss the consequences of this lack, examine existing explanations and remedies to the problem, point out their shortcomings, and propose alternatives. Previous analyses of the problem have tended to treat the use of software in scientific contexts as categorically different from the general application of software engineering in commercial settings. In contrast, we describe bioinformatic software engineering as a specialization of general software engineering, and examine how it should be practiced. Specifically, we highlight the difference between programming and software engineering, list elements of the latter and present the results of a survey of bioinformatic practitioners which quantifies the extent to which those elements are employed in bioinformatics. We propose that the ideal way to bring engineering values into research projects is to bring engineers themselves. We identify the role of Bioinformatic Engineer and describe how such a role would work within bioinformatic research teams. We conclude by recommending an educational emphasis on cross-training software engineers into life sciences, and propose research on Domain Specific Languages to facilitate collaboration between engineers and bioinformaticians.

A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD)

INTRODUCTION

Although there is evidence for distinct behavioural sub-phenotypes in Alzheimer's disease (AD), their inter-relationships and the effect of clinical variables on their expression have been little investigated.

METHODS

We have analysed a sample of 1850 probable AD patients from the UK and Greece with 10 item Neuropsychiatric Inventory (NPI) data. We applied a Multiple Indicators Multiple Causes (MIMIC) approach to investigate the effect of MMSE, disease duration, gender, age and age of onset on the structure of a four-factor model consisting of "psychosis", "moods", "agitation" and "behavioural dyscontrol".

RESULTS

Specific clinical variables predicted the expression of individual factors. When the inter-relationship of factors is modelled, some previously significant associations are lost. For example, lower MMSE scores predict psychosis, agitation and behavioural dyscontrol factors, but psychosis and mood predict the agitation factor. Taking these associations into account MMSE scores did not predict agitation.

CONCLUSIONS

The complexity of the inter-relations between symptoms, factors and clinical variables is efficiently captured by this MIMIC model.

Association analysis of dynamin-binding protein (DNMBP) on chromosome 10q with late onset Alzheimer's disease in a large caucasian UK sample

A recent scan of single nucleotide polymorphisms (SNPs) in the region 40-107 Mb on chromosome 10q in a large Japanese case-control cohort identified six SNPs in or near the dynamin-binding protein gene (DNMBP) that were associated with late onset Alzheimer's disease (LOAD) in individuals lacking the APOE epsilon4 allele [Kuwano et al. (2006); Hum Mol Genet 15:2170-2182]. We genotyped these six SNPs in 1,212 unrelated Caucasian patients of UK origin with LOAD and 1,389 ethnically, gender and age matched control subjects. We did not observe a statistically significant association with the risk of LOAD for any of the six SNPs in the sample as a whole. When stratifying the sample by APOE one SNP (intergenic SNP rs11190302) was associated with LOAD in individuals lacking the epsilon4 allele (genotypic P = 0.027, allelic P = 0.066). However this association was in the opposite direction to that detected in the Japanese population. It remains to be determined whether DNMBP is associated with LOAD.

Association analysis of 528 intra-genic SNPs in a region of chromosome 10 linked to late onset Alzheimer's disease

Late-onset Alzheimer's disease (LOAD) is a genetically complex neurodegenerative disorder. Currently, only the epsilon4 allele of the Apolipoprotein E gene has been identified unequivocally as a genetic susceptibility factor for LOAD. Others remain to be found. In 2002 we observed genome-wide significant evidence of linkage to a region on chromosome 10q11.23-q21.3 [Myers et al. (2002) Am J Med Genet 114:235-244]. Our objective in this study was to test every gene within the maximum LOD-1 linkage region, for association with LOAD. We obtained results for 528 SNPs from 67 genes, with an average density of 1 SNP every 10 kb within the genes. We demonstrated nominally significant association with LOAD for 4 SNPs: rs1881747 near DKK1 (P = 0.011, OR = 1.24), rs2279420 in ANK3 (P = 0.022, OR = 0.79), rs2306402 in CTNNA3 (P = 0.024, OR = 1.18), and rs5030882 in CXXC6 (P = 0.046, OR = 1.29) in 1,160 cases and 1,389 controls. These results would not survive correction for multiple testing but warrant attempts at confirmation in independent samples.

The attitudes and practices of general practitioners regarding dementia diagnosis in Ireland

BACKGROUND

The diagnosis of dementia poses difficulties for general practitioners (GPs) particularly when access to specialist diagnostic services is delayed. Ireland is soon to witness an increase in numbers of people presenting with dementia, yet little is known about the service needs of GPs when attempting to diagnose dementia.

OBJECTIVES

To detail the service needs of GPs, especially their training needs, access to diagnostic resources such as CT and MRI brain scans and access to specialist services such as Old Age Psychiatry (OAP), Geriatric Medicine (GM) and Neuropsychology (NP).

METHODS

The paper is based on survey data collected from a sample of GPs (n = 300) registered with the Irish College of General Practitioners (ICGP) and on qualitative data collected from a Focus Group (n = 7).

RESULTS

GPs were more likely to blame themselves than either the health care system, their patients or family members for the late presentation of dementia in primary care. Stigma was a major obstacle preventing GPs from being more proactive in this area. Rural GPs felt geographically disadvantaged accessing diagnostic services and both rural and urban GPs experienced considerable time delays accessing specialist diagnostic services.

CONCLUSIONS

Findings provide compelling evidence that training and access to diagnostic services are only two of several different structural and ideological obstacles that GPs encounter when attempting to diagnose dementia. Future educational supports for GPs need to be developed which concentrate on these areas.

Association studies of 23 positional/functional candidate genes on chromosome 10 in late-onset Alzheimer's disease

Late-onset Alzheimer's disease (LOAD) is a common neurodegenerative disorder, with a complex etiology. APOE is the only confirmed susceptibility gene for LOAD. Others remain yet to be found. Evidence from linkage studies suggests that a gene (or genes) conferring susceptibility for LOAD resides on chromosome 10. We studied 23 positional/functional candidate genes from our linkage region on chromosome 10 (APBB1IP, ALOX5, AD037, SLC18A3, DKK1, ZWINT, ANK3, UBE2D1, CDC2, SIRT1, JDP1, NET7, SUPV3L1, NEN3, SAR1, SGPL1, SEC24C, CAMK2G, PP3CB, SNCG, CH25H, PLCE1, ANXV111) in the MRC genetic resource for LOAD. These candidates were screened for sequence polymorphisms in a sample of 14 LOAD subjects and detected polymorphisms tested for association with LOAD in a three-stage design involving two stages of genotyping pooled DNA samples followed by a third stage in which markers showing evidence for association in the first stages were subjected to individual genotyping. One hundred and twenty polymorphisms were identified and tested in stage 1 (4 case + 4 control pools totaling 366 case and 366 control individuals). Single nucleotide polymorphisms (SNPs) showing evidence of association with LOAD were then studied in stage 2 (8 case + 4 control pools totaling 1,001 case and 1,001 control individuals). Five SNPs, in four genes, showed evidence for association (P < 0.1) at stage 2 and were individually genotyped in the complete dataset, comprising 1,160 LOAD cases and 1,389 normal controls. Two SNPs in SGPL1 demonstrated marginal evidence of association, with uncorrected P values of 0.042 and 0.056, suggesting that variation in SGPL1 may confer susceptibility to LOAD.

Hereditary spastic paraparesis and psychosis

Hereditary spastic paraparesis (HSP) is characterized by progressive spasticity and weakness of the legs with or without additional abnormalities. Reports of psychiatric disorders in patients with HSP are limited to mood disturbances rather than to psychosis. We had noted significant psychotic illness in several patients recruited to a survey of HSP in Ireland and therefore set about examining the frequency and nature of psychosis in our patients with HSP. Cases with HSP and psychotic illness were identified from a nationwide epidemiological and clinical study. Psychiatric case notes were reviewed and Operational Diagnostic Criteria Checklist (OPCRIT) applied. Six patients from four families with HSP had evidence of psychosis in addition to paraparesis. OPCRIT diagnoses were 'narrow schizophrenia' (n = 2), 'broad schizophrenia' (n = 2) and 'schizo-affective/manic disorder' (n = 2). Patients were from families with Kjellin's syndrome and SPG4-HSP but not other kindreds and psychosis was not evident in family members without HSP. We found a higher than expected rate of psychosis in the Irish HSP population. Two groups of HSP patients may have increased risk of developing psychosis: those with Kjellin's syndrome and those with SPG4-HSP.

Late onset Alzheimer's disease and apolipoprotein association in the Irish population: relative risk and attributable fraction

BACKGROUND

Familial and sporadic late onset Alzheimer's disease (LOAD) shows a consistent genetic association with APOE epsilon4.

AIMS

To examine the role of APOE in the AD Irish population.

METHODS

One hundred and ten Irish LOAD patients and 217 ethnically-matched controls were genotyped for APOE marker as described by Crook et al. Chi square test was used to compare allelic and genotypic frequencies between patients and controls samples. Attributable fractions were calculated as described by Levin.

RESULTS

A highly significant association between AD and APOE epsilon4 was observed (chi2=37.9, p=0.0000000, RR=2.18). Further, the influence of APOEepsilon4 seems to follow a dose-dependent manner whereby individuals with the genotype APOEepsilon4/4 have a higher relative risk than those heterozygous for the epsilon4 allele (RR=4.03 and 1.76 respectively). The relative risk and the attributable fraction calculated for APOE epsilon4 are consistent with those reported for other European populations. This places the influence of this locus on AD development in the Irish population between those of the Spanish and New York white populations.

CONCLUSION

These findings provide further evidence for the importance of APOE in the development of AD.

Low serum cholesteryl ester-docosahexaenoic acid levels in Alzheimer's disease: a case-control study

Low n-3 polyunsaturated fatty acid (PUFA) status may be associated with neuro-degenerative disorders, in particular Alzheimer's disease, which has been associated with poor dietary fish or n-3 PUFA intake, and low docosahexaenoic acid (DHA) status. The present case-control study used an established biomarker of n-3 PUFA intake (serum cholesteryl ester-fatty acid composition) to determine n-3 PUFA status in patients with Alzheimer's disease, who were free-living in the community. All cases fulfilled the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria for Alzheimer's disease. Detailed neuropsychological testing and neuroimaging established the diagnosis in all cases. The subjects (119 females and twenty-nine males) aged 76.5 (SD 6.6) years had a clinical dementia rating (CDR) of 1 (SD 0.62) and a mini mental state examination (MMSE) score of 19.5 (SD 4.8). The control subjects (thirty-six females and nine males) aged 70 (SD 6.0) years were not cognitively impaired (defined as MMSE score <24): they had a mean MMSE score of 28.9 (SD 1.1). Serum cholesteryl ester-eicosapentaenoic acid and DHA levels were significantly lower (P<0.05 and P<0.001 respectively) in all MMSE score quartiles of patients with Alzheimer's disease compared with control values. Serum cholesteryl ester-DHA levels were progressively reduced with severity of clinical dementia. DHA levels did not differ in patients with Alzheimer's disease across age quartiles: all were consistently lower than in control subjects. Step-wise multiple regression analysis showed that cholesteryl ester-DHA and total saturated fatty acid levels were the important determinants of MMSE score and CDR. It remains to be determined whether low DHA status in Alzheimer's disease is a casual factor in the pathogenesis and progression of Alzheimer's disease.

A pilot study of the reliability and validity of the Caregiver Activity Survey - Intellectual Disability (CAS-ID)

BACKGROUND

People with Down's syndrome (DS) are at increased risk of Alzheimer-type dementia (AD) when compared to the general population. Despite AD being a serious progressive disorder, little attention has been paid to the impact of the illness on formal caregivers. In the general population, the Caregiver Activity Survey (CAS) is used to measure time spent by family caregivers assisting people with AD in their day-to-day activities of living. In order to plan appropriate models of health and social care effectively for people with AD and DS, it is imperative that the care requirements of individuals at different stages of dementia are realized. An amended version of this survey, the Caregiver Activity Survey - Intellectual Disability (CAS-ID), was developed and tested for use by professional caregivers in the present study.

METHODS

The CAS-ID was administered to 30 people with DS and their caregivers. Convergent validity was tested by comparing the results of the CAS-ID to other validated tests for cognitive and functional impairment in individuals with DS. Test-retest and inter-rater reliability were investigated.

RESULTS

The final version of the CAS-ID consists of eight items: dressing, bathing/showering, grooming, toileting, eating and drinking, housekeeping, nursing care-related activities, and supervision/ behaviour management. The scale had excellent test-retest reliability, and correlated strongly with the Down Syndrome Mental Status Examination (DSMSE; r = -0.770), the Test for Severe Impairment (TSI; r = -0.881) and the Daily Living Skills Questionnaire (DLSQ; r = -0.855).

CONCLUSIONS

The present authors provide preliminary evidence for the validity and reliability of the CAS-ID. This instrument offers a means of identifying and measuring care and resources requirements as this population experiences symptoms of dementia. Such information may help assist healthcare professionals in planning supports and services to address the care challenges evidenced at different stages of the disease process.

Psychosis and behavioural symptoms of dementia: defining the role of neuroleptic interventions

Neuroleptics have a definite role in dementia but the treatment targets need to be more narrowly defined. Symptom clusters that are neuroleptic-responsive (e.g., aggression, psychomotor agitation and psychosis) appear to be emerging but need clearer definition and measurement. A number of these symptom clusters are relatively persistent over time and associated with increased risk of institutionalization, underscoring the need for treatment. The frequency, severity and persistence of the symptom or behaviour, the context in which it occurs and its impact on the carer must be considered before prescribing a neuroleptic. Given the modest effect size for neuroleptic interventions, the safety and tolerability of the agent is also a key factor in determining drug choice. Novel neuroleptics are safer and better tolerated and therefore should be used in preference to conventional agents when neuroleptic treatment is indicated for behavioural and psychological symptoms of dementia.

Presenilin 1 and alpha-1-antichymotrypsin polymorphisms in Down syndrome: no effect on the presence of dementia

As people with Down syndrome (DS) age, they are at greater risk for Alzheimer disease (AD) than the general population. It has been suggested that polymorphisms at the genes for presenilin-1 (PS-1) and alpha-1-antichymotrypsin (ACT) confer an increased risk for AD in the general population, and therefore potentially to AD in people with DS. We obtained DNA from 231 individuals with DS and 233 population controls. People with DS were evaluated for dementia. Allele frequencies at PS-1 and ACT polymorphisms in people with DS were compared to those in age-matched controls. There were no frequency differences between the control sample and DS sample for PS-1 or ACT alleles or genotypes. Similarly, there were no differences in allele frequencies between the demented and age-matched non-demented DS samples. However a higher frequency of PS-1 heterozygotes in the demented DS group was noted. We conclude that unlike the general population, neither PS-1 nor ACT polymorphisms appear to have a similar detrimental effect on dementia in DS. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:616-620, 1999.

The safety and efficacy of electroconvulsive therapy in patients over age 75

OBJECTIVES

To examine the safety and efficacy of electroconvulsive therapy (ECT) in patients over the age of 75 years.

METHOD

Retrospective study of all patients over 75 years treated with ECT in three hospitals between 1995 and 1997.

RESULTS

Ninety-three ECT courses were administered during the study period. Ten patients (10.8%) suffered complications following ECT. The most common adverse events were prolonged confusion and hypomania, all of which resolved within 2 weeks of the cessation of treatment. Eighty-five per cent of patients made a marked or moderate response to treatment.

CONCLUSIONS

ECT is a relatively safe and effective procedure in patients over age 75.

Mental health expectancy--the European perspective: a synopsis of results presented at the Conference of the European Network for the Calculation of Health Expectancies (Euro-REVES). Medical Research Council Cognitive Function and Ageing Study Group

The increase in life expectancy observed over the last decade has particular relevance for mental health conditions of old age, such as dementia. Although mental disorders have been estimated to be responsible for 60% of all disabilities, until recently population health indicators such as health expectancies have concentrated on calculating disability-free life expectancy based on physical functioning. In 1994, a European Network for the Calculation of Health Expectancies (Euro-REVES) was established, one of its aims being the development and promotion of mental health expectancies. Such indicators may have an important role in monitoring future changes in the mental health of populations and predicting service needs. This article summarizes the proceedings and recommendations of the first European Conference on Mental Health Expectancy.

A protective effect of apolipoprotein E e2 allele on dementia in Down's syndrome

BACKGROUND

The apolipoprotein E (ApoE) e4 allele has been associated with an increased risk for Alzheimer's disease, whereas the e2 allele has been shown to be protective. Similar effects in Down's syndrome (DS) have been postulated but not yet demonstrated.

METHODS

We obtained DNA from 221 DS individuals and from 162 population controls, and 77 DS children. Older DS subjects were evaluated for dementia and compared to age-matched DS controls.

RESULTS

The DS sample with dementia (n = 31) had a significantly lower frequency of the ApoE e2 allele compared to age-matched nondemented DS controls (0% vs. 8.3%, p = .0136). The older DS population had a significantly lower frequency of ApoE e4 compared to population controls (11.7% vs. 20.6%, chi-square 8.9, p = .0028).

CONCLUSIONS

The lower frequency of the e2 allele in demented DS subjects compared to age-matched nondemented DS controls suggests a protective effect for ApoE e2 in the development of dementia in DS. The lower frequency of ApoE e4 in our older DS sample compared to population controls points to a detrimental effect of the e4 allele on longevity.

Reporting vaccine-associated adverse events

OBJECTIVE

To determine family physicians' awareness of the need to monitor and report vaccine-associated adverse events (VAAE) in Canada and to identify mechanisms that could facilitate reporting.

DESIGN

Mailed survey.

SETTING

Canadian family practices.

PARTICIPANTS

Random sample of 747 family physicians. Overall response rate was 32% (226 of 717 eligible physicians).

MAIN OUTCOME MEASURES

Access to education on VAAE; knowledge about VAAE monitoring systems, reporting criteria, and reporting forms; method of reporting VAAEs and reasons for not reporting them; and current experience with VAAEs.

RESULTS

Of 226 respondents, 55% reported observing VAAEs, and 42% reported the event. Fewer than 50% were aware of a monitoring system for VAAE, and only 39% had had VAAE-related education during medical training. Only 28% knew the reporting criteria. Reporting was significantly associated with knowledge of VAAE monitoring systems and reporting criteria (P < 0.01).

CONCLUSION

Physicians need more feedback and education on VAAE reporting and more information about the importance of reporting and about reporting criteria and methods.

Elevated alpha 1-antichymotrypsin serum levels in a subset of nondemented first-degree relatives of Alzheimer's disease patients

A portion of Alzheimer's disease (AD) patients have elevated serum levels of the acute phase reactant alpha 1-antichymotrypsin (A1ACT) compared to age-matched controls. We measured serum levels of A1ACT in AD patients, age-matched controls, Down's syndrome patients, and nondemented first-degree relatives of AD patients. Significantly elevated levels of A1ACT were found in both AD patients and first-degree-relatives. In AD patients, serum A1ACT concentrations decreased with increasing severity of cognitive impairment. These results may suggest that inflammatory phenomena may be an early component of AD pathophysiology.

A strategy of "combination chemotherapy" in Alzheimer's disease: rationale and preliminary results with physostigmine plus deprenyl

Although the central cholinergic deficits are still considered to be of primary importance in Alzheimer's disease, there is great need for an expansion of the pharmacological approach in this illness beyond the simple cholinergic replacement hypothesis. This report focuses on the concept of "combination chemotherapy" in Alzheimer's disease as the next generation of therapeutic strategies. Based on earlier positive findings in Alzheimer patients with the monoamine oxidase B inhibitor, 1-deprenyl, the authors speculate that a combination of physostigmine, the short-acting cholinesterase inhibitor, and 1-deprenyl might be more beneficial than either agent alone. The authors outline a sample paradigm for such combination studies, report preliminary data on the first 16 Alzheimer subjects to have received an initial combination of physostigmine and deprenyl, and point to other possible "combination chemotherapy" strategies for future study.

Elevated circulating tumor necrosis factor levels in Alzheimer's disease

Recent investigations have demonstrated a local inflammatory response in Alzheimer's disease (AD), including microglia and cytokines. Levels of the cytokine tumor necrosis factor alpha (TNF-alpha) in sera from patients with AD and age-matched controls were measured by an enzyme-linked immunoassay and a cytotoxicity bioassay. Significantly elevated levels of TNF were found in AD sera compared to controls. Elevated circulating TNF may be derived from the local CNS inflammatory reaction in AD, and may account for some systemic manifestations of AD such as weight loss. Future studies may determine if, in the absence of complicating disorders which may elevate TNF, circulating TNF could be a marker of AD inflammatory activity.

Automatic memory processes in patients with dementia-Alzheimer's type (DAT)

We examined patients with Dementia-Alzheimer's Type, depression, and matched controls on tasks designed to compare automatic (monitoring frequency and modality) and effortful (free recall) processing of words and pictures. The results demonstrated that depressed patients performed poorly only when conditions required effortful processing, but DAT patients performed poorly under all conditions. There was almost no overlap in scores between DAT and elderly depressed patients on one of the measures of automatic processing suggesting that this measure may be clinically useful. The results suggest that automatic memory processes can be partially dissociated from effortful memory processes, but that both types of operations are impaired in DAT patients.

Nongonococcal urethritis incidence has fallen at one university health service: are "safer sex" messages being heard?

The authors determined the incidence of nongonococcal urethritis (NGU) longitudinally in patients attending a university health service between August 1986, and May 1988. During this period, the authors observed a statistically significant fall in NGU incidence. This fall coincided with awareness of AIDS risks due to national and local media encouragement of condom use and avoidance of anonymous or promiscuous contacts. Although the authors have no evidence that these educational efforts resulted in the observed fall in NGU incidence, other examined, potentially intervening variables can not completely explain the observed changes. A fall in NGU incidence may be a marker for a more generally decreased risk of sexually transmitted diseases (STDs) in at least some men.