1
|
Fazio-Eynullayeva E, Cunnington M, Mystkowski P, Lv L, Aly A, Yee CW, Desai R, Liu CL, Duh MS, Mattke S. Real-world healthcare resource utilization of Alzheimer's disease in the early and advanced stages: a retrospective cohort study. J Med Econ 2025; 28:81-88. [PMID: 39668705 DOI: 10.1080/13696998.2024.2442240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 11/20/2024] [Accepted: 12/11/2024] [Indexed: 12/14/2024]
Abstract
AIMS To compare all-cause and Alzheimer's disease (AD)-related healthcare resource utilization (HCRU) by cognitive stage. METHODS AND MATERIALS This retrospective study analyzed insurance claims data linked to electronic health records (01/01/2015-12/31/2021). Patients with ≥1 cognitive assessment (Mini-Mental State Examination or Montreal Cognitive Assessment) and ≥1 medical or pharmacy claim for an AD diagnosis or AD medications were included. Inverse probability of treatment weighting (IPTW) was used to address potential confounding. All-cause and AD-related HCRU were summarized per patient per year (PPPY) and compared between early AD and advanced AD cohorts (defined according to cognitive scores) using generalized linear regression models; adjusted incidence rate ratios (IRRs), and 95% confidence intervals (CI) were reported. RESULTS A total of 193 patients were included (median age: 82 years; 63.2% female), 108 with early AD and 85 with advanced AD, with similar mean follow up. All-cause HCRU, on average, was similar between early AD and advanced AD cohorts (37.4 PPPY and 38.9 encounters PPPY, respectively). For AD-related HCRU, patients with early AD had fewer encounters PPPY, on average, than patients with advanced AD (1.26 and 3.88 encounters, respectively). Following IPTW adjustment, the advanced AD cohort had significantly higher overall AD-related HCRU (IRR: 3.64 [95% CI: 1.96-6.75], p < 0.001) and outpatient visits (IRR: 2.76 [95% CI: 1.68-4.54], p < 0.001) compared to the early AD cohort. LIMITATIONS The relatively small sample size of patients with linked claims and cognitive score data limited the ability to assess contribution of all encounter types to HCRU trends, as well as generalizability to the broader AD population. CONCLUSIONS Although all-cause HCRU was similar, patients with advanced AD incurred higher AD-related HCRU compared to patients living with early AD. Further research is needed to determine whether interventions earlier in disease progression can mitigate the AD-related healthcare burden for patients with advanced AD.
Collapse
Affiliation(s)
| | | | | | - Lei Lv
- Novo Nordisk Inc., Plainsboro, NJ, USA
| | | | | | - Raj Desai
- Analysis Group, Inc., Boston, MA, USA
| | | | | | - Soeren Mattke
- The USC Brain Health Observatory, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Povedano E, Garranzo-Asensio M, Montero-Calle A, Valverde A, Dalmasso P, San Segundo-Acosta P, Cano O, Vázquez M, Mas V, Fernández-Aceñero MJ, Rivas G, Pingarrón JM, Campuzano S, Barderas R. Novel 6xHis/HaloTag mammalian expressed autoantigens for the detection of humoral response with multiplexed electrochemical biosensors: A breakthrough in colorectal cancer and Alzheimer's disease personalized diagnostics. Biosens Bioelectron 2025; 282:117506. [PMID: 40288309 DOI: 10.1016/j.bios.2025.117506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 04/02/2025] [Accepted: 04/23/2025] [Indexed: 04/29/2025]
Abstract
The integration of autoantibody detection with electrochemical biosensors allows the development of a novel strategy for managing colorectal cancer (CRC) and Alzheimer's disease (AD). This work reports the use, for the first time, of sustainable receptors, autoantigens expressed in mammalian cells, fused to 6xHis at the N-terminus and HaloTag at the C-terminus, immobilized on chloroalkane-modified magnetic beads (MBs) to selectively capture plasma autoantibodies. Detection was based on amperometric measurements using disposable multiplexed screen-printed carbon electrodes (x8 sensing surfaces), horseradish peroxidase (HRP)-conjugated secondary antibodies, and the HQ/H2O2 system. HaloTag immobilization gave rise to a great sensitivity allowing discrimination between patients and healthy individuals in comparison with HisTag or -COOH immobilization. The CRC biosensor integrated seven CRC-specific full-length autoantigens, while the AD bioplatform combined three AD-specific full-length proteins and four AD-specific peptides, which allowed a robust diagnostic performance validated by ROC analyses. These multiplexed biosensors provide minimally invasive, cost-effective, and sustainable alternatives to traditional diagnostic methods, and show ideal for discovery of new targets and for mass screening and early disease detection, supporting personalized medicine approaches.
Collapse
Affiliation(s)
- Eloy Povedano
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Plaza de Las Ciencias 2, 28040, Madrid, Spain
| | - María Garranzo-Asensio
- Chronic Disease Programme, UFIEC, Institute of Health Carlos III, Majadahonda, 28220, Madrid, Spain
| | - Ana Montero-Calle
- Chronic Disease Programme, UFIEC, Institute of Health Carlos III, Majadahonda, 28220, Madrid, Spain
| | - Alejandro Valverde
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Plaza de Las Ciencias 2, 28040, Madrid, Spain
| | - Pablo Dalmasso
- Research and Transfer Center in Environmental Chemical Engineering, CONICET, Córdoba Regional Faculty, National Technological University, Maestro López Esq. Cruz Roja Argentina, 5016, Córdoba, Argentina
| | - Pablo San Segundo-Acosta
- Chronic Disease Programme, UFIEC, Institute of Health Carlos III, Majadahonda, 28220, Madrid, Spain
| | - Olga Cano
- Respiratory Viruses Laboratory, National Center for Microbiology Instituto de Salud Carlos III Majadahonda, 28220, Madrid, Spain
| | - Mónica Vázquez
- Respiratory Viruses Laboratory, National Center for Microbiology Instituto de Salud Carlos III Majadahonda, 28220, Madrid, Spain
| | - Vicente Mas
- Respiratory Viruses Laboratory, National Center for Microbiology Instituto de Salud Carlos III Majadahonda, 28220, Madrid, Spain
| | - María Jesús Fernández-Aceñero
- Department of Legal Medicine, Psychiatry and Surgical Pathology, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Clínico San Carlos (IdISCC), Surgical Pathology Department, Hospital Universitario Clínico San Carlos, E-28040, Madrid, Spain
| | - Gustavo Rivas
- Institute of Physical-Chemical Research of Córdoba, CONICET-UNC, Faculty of Chemical Sciences, National University of Córdoba, University City, 5000, Córdoba, Argentina
| | - José M Pingarrón
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Plaza de Las Ciencias 2, 28040, Madrid, Spain.
| | - Susana Campuzano
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Plaza de Las Ciencias 2, 28040, Madrid, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 28046, Madrid, Spain.
| | - Rodrigo Barderas
- Chronic Disease Programme, UFIEC, Institute of Health Carlos III, Majadahonda, 28220, Madrid, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, 28046, Madrid, Spain.
| |
Collapse
|
3
|
Wang W, Liu Z, Cheng H, Xu M, Du Z, Liu W, Zhang C. Cerium-doped carbon dots as dual-target agents against Alzheimer's β-amyloid fibrillogenesis and reactive oxygen species. Colloids Surf B Biointerfaces 2025; 252:114655. [PMID: 40158246 DOI: 10.1016/j.colsurfb.2025.114655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 03/09/2025] [Accepted: 03/23/2025] [Indexed: 04/02/2025]
Abstract
Both fibrillogenesis of amyloid β-protein (Aβ) and elevated levels of reactive oxygen species (ROS) contribute to the pathogenesis of Alzheimer's disease (AD). Beyond Aβ aggregation inhibition, the complexity necessitates the development of comprehensive therapeutic interventions for halting AD progression. Herein, a dual-target agent capable of Aβ aggregation inhibition and ROS scavenging was synthesized by doping cerium into carbon dots (Ce CDs). Ce CDs with a high Ce (III)/Ce (IV) ratio of 0.67 can scavenge various ROS, including superoxide anion radicals, hydroxyl radicals, hydrogen peroxide, and Aβ40-induced ROS, thus mitigating cellular oxidative damage and rescuing cell viability. Additionally, Ce CDs present potent inhibition on Aβ40 on-pathway fibrillization, disrupting the formation of highly ordered β-sheet structures and increasing cell viability from 50.2 % to 91.9 %. It is validated that the electrostatic interactions between Ce CDs and Aβ40 are primarily responsible for preventing the conformational transition of Aβ40 monomers. In vivo experiments with the transgenic Caenorhabditis elegans strain further validate the bifunctionality of Ce CDs in suppression of Aβ fibrillogenesis and attenuation of oxidative stress, thereby demonstrating the potential of combination therapy for AD. This finding highlights the important role of electrostatic interactions between Aβ and inhibitors in regulating Aβ aggregation, and provides new insights into the development of multifunctional agents for AD treatment.
Collapse
Affiliation(s)
- Wenjuan Wang
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Zhaoyu Liu
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Hao Cheng
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; College of Artificial Intelligence, Taiyuan University of Technology, Taiyuan 030024, China
| | - Min Xu
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Zhi Du
- College of Artificial Intelligence, Taiyuan University of Technology, Taiyuan 030024, China
| | - Wei Liu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Chaofeng Zhang
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan 030024, China.
| |
Collapse
|
4
|
Wang Y, Li Q, Deng Y, Wu W, Zhang C, Zheng Y, Guan M, Jiang H. Liquid chromatography-tandem mass spectrometry assay for simultaneous quantification of catecholamines and metabolites in human plasma and cerebrospinal fluid. Pract Lab Med 2025; 45:e00471. [PMID: 40322294 PMCID: PMC12049989 DOI: 10.1016/j.plabm.2025.e00471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 03/31/2025] [Accepted: 04/13/2025] [Indexed: 05/08/2025] Open
Abstract
Catecholamines (CAs) and their metabolites in human cerebrospinal fluid (CSF) and plasma are potential biomarkers of Alzheimer's disease (AD) and facilitate early diagnosis. Liquid chromatography-tandem mass spectrometry is the gold standard method for analyzing CAs. The objective of this study was to develop and validate a liquid chromatography-tandem mass spectrometry assay capable of simultaneously quantifying dopamine (DA), epinephrine (E), norepinephrine (NE), metanephrine (MN), normetanephrine (NMN), and 3-methoxytyramine (3-MT) in both human CSF and plasma. Samples were processed by solid-phase extraction with a weak cation exchange adsorbent and then separated using an ultra-performance reversed-phase chromatography column. Analyte detection was performed using a triple quadrupole mass spectrometer operated in positive-ion multiple reaction monitoring mode. The developed assay was validated according to standard guidelines. The linearity, specificity, precision, accuracy, carryover and stability were assessed to ensure compliance with specified criteria. The lower limits of quantification for DA, E, NE, MN, NMN, and 3-MT were 4.5, 2.5, 4.5, 2.5, 2, and 0.3 pg mL-1, respectively. The total runtime for a single sample was 6.5 min. These results demonstrated that the method was sensitive, rapid, and reliable for the simultaneous quantification of DA, E, NE, MN, NMN, and 3-MT in clinical practice. We successfully detected CAs and their metabolites in plasma and CSF samples from patients with normal cognition and AD. This study demonstrates an efficient laboratory workflow for high-throughput analysis of CAs and their metabolites and lays a foundation for further studies on AD biomarkers.
Collapse
Affiliation(s)
- Yuting Wang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Quan Li
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yuhang Deng
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wenqing Wu
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Cuiping Zhang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yichi Zheng
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Ming Guan
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Huashan CSF Laboratory, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Haoqin Jiang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
- Huashan CSF Laboratory, Huashan Hospital, Fudan University, Shanghai, 200040, China
| |
Collapse
|
5
|
Liao R, Yang J, Huang X, Xu Y, Ji Q, Liu Q, Xu S, Liu P, Zhan Y. Dietary inflammatory index and Alzheimer's disease mortality in a prospective cohort. Exp Gerontol 2025; 206:112770. [PMID: 40318706 DOI: 10.1016/j.exger.2025.112770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 04/27/2025] [Accepted: 05/01/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVE This study examined the relationship between the Dietary Inflammatory Index (DII) and Alzheimer's disease (AD) mortality in US adults. METHODS Data from 45,093 participants in the 1988-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed, with mortality follow-up through December 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for AD mortality. Restricted cubic spline analysis explored the non-linear association of DII with AD mortality, and stratified analyses identified higher-risk subgroups. RESULTS Over a median follow-up of 14.3 years, 455 AD-related deaths occurred. Participants in the highest DII quartile (>2.41) had a 1.50-fold increased risk of AD mortality (95 % CI: 1.12-2.01) compared to the lowest quartile (≤-0.44). Pro-inflammatory diets (DII > 0) were associated with a 44 % higher risk of AD mortality (HR: 1.44, 95 % CI: 1.14-1.81). A dose-response relationship was observed, with increased risks across quartiles, and findings were consistent across demographic and clinical subgroups. CONCLUSIONS Higher DII levels were significantly associated with elevated AD mortality risk, highlighting the potential role of pro-inflammatory diets in AD-related outcomes.
Collapse
Affiliation(s)
- Ruitong Liao
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Jinzhao Yang
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Xiaoping Huang
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Yue Xu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Qianqian Ji
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Qi Liu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Shan Xu
- Shenzhen Nanshan Center for Chronic Disease Control & Shenzhen Nanshan Mental Health Center, Shenzhen, China.
| | - Peiyi Liu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
| | - Yiqiang Zhan
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Guangdong Engineering Technology Research Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen, China.
| |
Collapse
|
6
|
Bernini S, Ballante E, Picascia M, Barbieri M, Costa A, Cavallini E, Tassorelli C, Vecchi T, Bottiroli S. Equating conversion norms for the Mini-Mental State Examination and Montreal Cognitive Assessment in healthy subjects and patients with neurodegenerative disorders. Exp Gerontol 2025; 205:112756. [PMID: 40250739 DOI: 10.1016/j.exger.2025.112756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 04/14/2025] [Accepted: 04/16/2025] [Indexed: 04/20/2025]
Abstract
INTRODUCTION The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are globally recognized as validated cognitive screening tests widely used. OBJECTIVE/AIM The present study attempted to provide conversion tables from the MMSE to the MoCA and vice versa, deriving them from a large population of healthy older adults and a representative clinical sample of subjects with different types of cognitive decline within the spectrum of Alzheimer's (AD) and Parkinson's (PD) diseases. METHODS A total of 1423 Italian participants, including healthy adults (n = 1203), individuals with AD (n = 93), and with PD (n = 127) were assessed using the MMSE and MoCA. Conversion tables were developed using log-linear smoothing equipercentile equating (LSEE). The reliability of the conversion was assessed through the Root Mean Square Error (RMSE) in a train-test approach confirmed in the whole sample. RESULTS The findings demonstrated that the LSEE method enables the development of conversion tables allowing users to identify the corresponding MoCA score for each MMSE score within the studied groups, and vice versa. The estimation error RMSE was 1.8, 2.9, and 3.2 for the conversion of MoCA from MMSE and 1.2, 2.3, and 2.2 for the conversion of MMSE from MoCA in healthy subjects, AD, and PD, respectively. The reliability of the conversion is higher in healthy subjects and for higher values of MoCA and MMSE. CONCLUSION Results report easy-to-use conversion norms for transforming raw MMSE score to MoCA and vice versa, highlighting areas were the conversion has a strong or low reliability depending on the score range.
Collapse
Affiliation(s)
| | - Elena Ballante
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy; BioData Science Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Unit of Behavioral Neurology and Center for Cognitive Disorders and Dementia (CDCD), IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Cavallini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Headache Science and Rehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Applied Psychology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Bottiroli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Applied Psychology Research Unit, IRCCS Mondino Foundation, Pavia, Italy.
| |
Collapse
|
7
|
Shi J, Zhang M, Hu Y, Liu J, Li K, Sun X, Chen S, Liu J, Ye L, Fan J, Jia J. Differences in transcriptome characteristics and drug repositioning of Alzheimer's disease according to sex. Neurobiol Dis 2025; 210:106909. [PMID: 40220916 DOI: 10.1016/j.nbd.2025.106909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 04/09/2025] [Accepted: 04/09/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND Previous studies have shown significant sex differences in AD with regarding its epidemiology, pathophysiology, clinical presentation, and treatment response. However, the transcriptome variances associated with sex in AD remain unclear. METHODS RNA sequencing (RNA-seq) and transcriptomic analyses were performed on peripheral blood samples from total of 54 patients, including male AD patients (n = 15), female AD patients (n = 10), male MCI patients (n = 7), female MCI patients (n = 11), male healthy controls (n = 6), female healthy controls (n = 5). The snRNA-seq dataset (GSE167494, GSE157827) of prefrontal cortex tissues was obtained from the Gene Expression Omnibus (GEO). We conducted an investigation into differentially expressed genes and pathways in the peripheral blood cells as well as prefrontal cortex tissues of both male and female AD patients with consideration to sex-related factors. Additionally, we analyzed the distribution and characteristics of cells in the cerebral cortex as well as the interaction and communication between cells of male and female AD patients. Connectivity Map (CMap) was utilized for predicting and screening potential sex-specific drugs for AD. RESULTS The transcriptome profile and associated biological processes in the peripheral blood of male and female AD and MCI patients exhibit discernible differences, including upregulation of BASP1 in AD male patients and arousing TNS1 in AD female patients. The distribution of various cell types in the prefrontal cortex tissues differs between male and female AD patients, like neuron and oligodendrocyte decreased and endothelial cell and astrocyte increased in female compared with male, while a multitude of genes exhibit significant differential expression. The results of cell communication analysis, such as collagen signaling pathway, suggest that sex disparities impact intercellular interactions within prefrontal cortex tissues among individuals with AD. By drug repositioning, several drugs, including torin-2 and YM-298198, might have the potential to therapeutic value of MCI or AD, while drugs like homoharringtonine and teniposide have potential opposite effects in different sexes. CONCLUSION The characteristics of the transcriptome in peripheral blood and single-cell transcriptome in the prefrontal cortex exhibit significant differences between male and female patients with AD, which providing a basis for future sex stratified treatment of AD.
Collapse
Affiliation(s)
- Jingqi Shi
- Institute of Geriatrics, National Clinical Research Center of Geriatrics Disease, the Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - Minghua Zhang
- Medical Supplies Center of PLA General Hospital, Beijing 100853, China
| | - Yazhuo Hu
- Institute of Geriatrics, National Clinical Research Center of Geriatrics Disease, the Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - Jing Liu
- Institute of Geriatrics, National Clinical Research Center of Geriatrics Disease, the Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - Ke Li
- Geriatric Neurological Department of the Second Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xuan Sun
- Geriatric Neurological Department of the Second Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Siyu Chen
- Geriatric Neurological Department of the Second Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianwei Liu
- Institute of Geriatrics, National Clinical Research Center of Geriatrics Disease, the Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - Ling Ye
- Institute of Geriatrics, National Clinical Research Center of Geriatrics Disease, the Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - Jiao Fan
- Institute of Geriatrics, National Clinical Research Center of Geriatrics Disease, the Second Medical Center of PLA General Hospital, Beijing 100853, China.
| | - Jianjun Jia
- Institute of Geriatrics, National Clinical Research Center of Geriatrics Disease, the Second Medical Center of PLA General Hospital, Beijing 100853, China.
| |
Collapse
|
8
|
Johnson CN, Evans MR, Blankenship AE, John CS, Rekowski MJ, Washburn MP, Phan A, Gouvion CM, Haeri M, Swerdlow RH, Geiger PC, Morris JK. Human skeletal muscle mitochondrial pathways are impacted by a neuropathologic diagnosis of Alzheimer's disease. Neurobiol Dis 2025; 210:106916. [PMID: 40250718 DOI: 10.1016/j.nbd.2025.106916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 03/21/2025] [Accepted: 04/14/2025] [Indexed: 04/20/2025] Open
Abstract
Alzheimer's disease (AD) is associated with reduced lean mass and impaired skeletal muscle mitochondrial and motor function. Although primary mitochondrial defects in AD may underlie these findings, molecular alterations in AD have not been thoroughly examined in human skeletal muscle. Here, we used two human skeletal muscle types, quadriceps (n = 81) and temporalis (n = 66), to compare the proteome of individuals with a neuropathologic AD diagnosis based on AD Neuropathologic Change (ADNPC+: n = 54 temporalis, 44 quadriceps) to controls (ADNPC-: n = 27 temporalis, 22 quadriceps). We determined the effects of ADNPC status within each muscle and within apolipoprotein E4 (APOE4) carriers and APOE4 non-carriers. Pathways that support mitochondrial metabolism, including oxidative phosphorylation, were downregulated in skeletal muscle of ADNPC+ versus ADNPC- individuals. Similar mitochondrial effects were observed across muscle types and APOE4 carrier groups, but nearly four times as many proteins were altered in temporalis versus quadriceps tissue and mitochondrial effects were most pronounced in APOE4 carriers compared to APOE4 non-carriers. Of all detected oxidative phosphorylation proteins, the expression of ∼29-61 % (dependent on muscle/APOE4 carrier group) significantly correlated with AD progression, ranked by Clinical Dementia Rating and ADNPC scores. Of these, 23 proteins decreased in expression with greater AD progression in all skeletal muscle type and APOE4 carrier groups. This is the first study to assess differences in the human skeletal muscle proteome in the context of AD. Our work shows that systemic mitochondrial alterations in AD extend to skeletal muscle and these effects are amplified by APOE4 and correlate with AD progression.
Collapse
Affiliation(s)
- Chelsea N Johnson
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA; University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS 66205, USA.
| | - Mara R Evans
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Anneka E Blankenship
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS 66205, USA
| | - Casey S John
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS 66205, USA.
| | - Michaella J Rekowski
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Michael P Washburn
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Andy Phan
- Bruker Daltonics, Inc, Billerica, MA 01821, USA.
| | - Cynthia M Gouvion
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS 66205, USA.
| | - Mohammad Haeri
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS 66205, USA; Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS 66205, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Paige C Geiger
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Jill K Morris
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS 66205, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| |
Collapse
|
9
|
Cho H, Hwang Y. Social determinants of health and their impact on depression in family caregivers of those with dementia: The importance of intermediary determinants. Alzheimers Dement 2025; 21:e70325. [PMID: 40448376 DOI: 10.1002/alz.70325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 04/28/2025] [Accepted: 05/05/2025] [Indexed: 06/02/2025]
Abstract
INTRODUCTION Dementia family caregivers face a significant burden due to the progressive nature of the disease, which places them at high risk for depression. Because a lack of information is available on the social determinants of health that impact depression, this study investigated this relationship. METHODS This study was a secondary data analysis using the 2017 National Health and Aging Trends Study (NHATS) Round 11 and the National Study of Caregiving (NSOC) Round 4, which included a nationally representative sample of American older adults and their family caregivers. Weighted multivariate logistic regression models were used for data analysis. RESULTS Among 528 family caregivers of persons living with dementia, ≈15.9% had depression. The final logistic regression model showed that intermediary determinants, such as living with a spouse/partner or utilizing a caregiver training program, lowered the likelihood of depression. DISCUSSION Health care professionals should pay greater attention to these individuals, and caregiver training programs should be made widely accessible and available. HIGHLIGHTS Approximately 15.9% of dementia family caregivers had depression. Family caregivers who were married or living with a partner were less likely to have depression. Family caregivers involved in caregiving training programs were less likely to have depression.
Collapse
Affiliation(s)
- Hannah Cho
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yeji Hwang
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
10
|
Zheng DD, Lee DJ, Rundek T, Lam BL, Gregori NZ, Curiel RE, Loewenstein DA. Visual Impairment and Cognitive Function in Aging Adults: Sex and Age Differences in Mediating Effect of Social Isolation and Depression. Am J Ophthalmol 2025; 274:196-208. [PMID: 40054544 PMCID: PMC12043430 DOI: 10.1016/j.ajo.2025.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 02/25/2025] [Accepted: 02/26/2025] [Indexed: 04/04/2025]
Abstract
PURPOSE Visual impairment (VI) is prevalent in older adults and associated with cognitive decline. However, the mechanisms through which visual impairment affects cognitive functioning during the aging process are poorly understood. Our study aims to estimate the direct effect of visual acuity on cognitive function and its indirect effect through social isolation and depressive symptoms by sex and age. DESIGN Cross-sectional study. PARTICIPANTS 117,231 individuals aged 40-70 participated in the UK Biobank baseline and ocular assessment. Of these, 81% were white, 54% were female, and 45.6% were aged 60-70. The mean age was 56.8 (SD 8.1) years. METHODS Path analyses with multiple equations were conducted to examine the direct and indirect effects of visual acuity (VA). Stratified analyses by gender and age were performed. MAIN OUTCOME MEASURES LogMAR VA was the exposure, with social isolation and depressive symptoms as mediators. Cognitive functions, including visual memory, verbal-numerical reasoning, processing speed, and prospective memory, were the outcomes. RESULTS VA had a direct effect on cognitive function (β = -0.979 for reasoning and OR = 0.67 for prospective memory). VA also influenced cognition indirectly through social isolation and depressive symptoms. The direct effect of VA on cognitive function was similar in men vs. women and middle-aged vs. older. However, there is a marked difference in the mediating effect via social isolation and depressive symptoms by age and sex. The mediating effect of VI on cognition via social isolation was stronger in older adults than middle-aged and in men than women; while the mediating effect via depressive symptoms was stronger in women and middle-aged individuals. VI had the largest mediating effect via social isolation in older males. CONCLUSION AND RELEVANCE Vision, social isolation, and depressive symptoms are modifiable factors and can be treated to preserve cognition. Encouraging social engagement among male and older adults with VI and promoting mental health awareness in women and middle-aged individuals with VI will reduce the negative impact of VI on cognition, lower dementia risk, and improve the well-being of aging adults.
Collapse
Affiliation(s)
- D Diane Zheng
- Center for Cognitive Neurosciences & Aging (D.D.Z., R.E.C., D.A.L.), Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - David J Lee
- Department of Public Health Sciences (D.J.E.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tatjana Rundek
- Department of Neurology (T.R.), Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Byron L Lam
- Bascom Palmer Eye Institute (B.L.L.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ninel Z Gregori
- Bascom Palmer Eye Institute (B.L.L.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rosie E Curiel
- Center for Cognitive Neurosciences & Aging (D.D.Z., R.E.C., D.A.L.), Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David A Loewenstein
- Center for Cognitive Neurosciences & Aging (D.D.Z., R.E.C., D.A.L.), Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
11
|
Meng A, Cabán M, Tran E, Wetmore JB, Ottman R, Siegel K. Anticipated Responses to Genetic Testing for Alzheimer's Disease Susceptibility among Latinos in Northern Manhattan. J Community Health 2025; 50:472-482. [PMID: 39720972 PMCID: PMC12068976 DOI: 10.1007/s10900-024-01434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2024] [Indexed: 12/26/2024]
Abstract
Alzheimer's disease (AD) is a debilitating neurodegenerative illness that has become a growing concern for older adults. As such, apolipoprotein E (APOE) genetic testing has become more commonly used to identify individuals' susceptibility to AD. An underrepresented population in AD research, Latinos will be disproportionately affected by AD in the coming decades. To better aid efforts in education and genetic risk counseling for Latino populations, we must first understand the anticipated psychological and behavioral consequences of APOE genetic risk counseling. We conducted semi-structured interviews with 216 Latinos between the ages of 40 and 64 (average age = 53 years) in northern Manhattan to ascertain their hypothetical reactions to learning that they had a higher risk of developing AD compared to other Latinos within their community. Responses were categorized as emotional, practical, and mixed responses. Among our sample, women were more likely to anticipate an emotional response to hearing that they had a higher risk of AD, and participants above the age of 60 were more likely to anticipate disclosing their risk information to immediate family members. Findings support the tailoring of genetic risk counseling sessions across different ethnic groups, genders and age groups. Future work may include the development of psychological and practical support tools for Latinos seeking APOE genetic testing and counseling.
Collapse
Affiliation(s)
- Alicia Meng
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - María Cabán
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Evelyn Tran
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - John B Wetmore
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ruth Ottman
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, Division of Translational Epidemiology and Mental Health Equity, New York, NY, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| |
Collapse
|
12
|
Li Q, Cui L, Guan Y, Li Y, Xie F, Guo Q. Prediction Model and Nomogram for Amyloid Positivity Using Clinical and MRI Features in Individuals With Subjective Cognitive Decline. Hum Brain Mapp 2025; 46:e70238. [PMID: 40439500 PMCID: PMC12121204 DOI: 10.1002/hbm.70238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 04/10/2025] [Accepted: 05/17/2025] [Indexed: 06/02/2025] Open
Abstract
There is an urgent need for the precise prediction of cerebral amyloidosis using noninvasive and accessible indicators to facilitate the early diagnosis of individuals with the preclinical stage of Alzheimer's disease (AD). Two hundred and four individuals with subjective cognitive decline (SCD) were enrolled in this study. All subjects completed neuropsychological assessments and underwent 18F-florbetapir PET, structural MRI, and functional MRI. A total of 315 features were extracted from the MRI, demographics, and neuropsychological scales and selected using the least absolute shrinkage and selection operator (LASSO). The logistic regression (LR) model, based on machine learning, was trained to classify SCD as either β-amyloid (Aβ) positive or negative. A nomogram was established using a multivariate LR model to predict the risk of Aβ+. The performance of the prediction model and nomogram was assessed with area under the curve (AUC) and calibration. The final model was based on the right rostral anterior cingulate thickness, the grey matter volume of the right inferior temporal, the ReHo of the left posterior cingulate gyrus and right superior temporal gyrus, as well as MoCA-B and AVLT-R. In the training set, the model achieved a good AUC of 0.78 for predicting Aβ+, with an accuracy of 0.72. The validation of the model also yielded a favorable discriminatory ability with an AUC of 0.88 and an accuracy of 0.83. We have established and validated a model based on cognitive, sMRI, and fMRI data that exhibits adequate discrimination. This model has the potential to predict amyloid status in the SCD group and provide a noninvasive, cost-effective way that might facilitate early screening, clinical diagnosis, and drug clinical trials.
Collapse
Affiliation(s)
- Qinjie Li
- Department of GerontologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Liang Cui
- Department of GerontologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Yihui Guan
- PET Center, Huashan HospitalFudan UniversityShanghaiChina
| | - Yuehua Li
- Department of RadiologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Fang Xie
- PET Center, Huashan HospitalFudan UniversityShanghaiChina
| | - Qihao Guo
- Department of GerontologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| |
Collapse
|
13
|
Cao Y, Xu Y, Cao M, Chen N, Zeng Q, Lai MKP, Fan D, Sethi G, Cao Y. Fluid-based biomarkers for neurodegenerative diseases. Ageing Res Rev 2025; 108:102739. [PMID: 40122396 DOI: 10.1016/j.arr.2025.102739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 03/10/2025] [Accepted: 03/18/2025] [Indexed: 03/25/2025]
Abstract
Neurodegenerative diseases, such as Alzheimer's Disease (AD), Multiple Sclerosis (MS), Parkinson's Disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are increasingly prevalent as global populations age. Fluid biomarkers, derived from cerebrospinal fluid (CSF), blood, saliva, urine, and exosomes, offer a promising solution for early diagnosis, prognosis, and disease monitoring. These biomarkers can reflect critical pathological processes like amyloid-beta (Aβ) deposition, tau protein hyperphosphorylation, α-syn misfolding, TDP-43 mislocalization and aggregation, and neuronal damage, enabling detection long before clinical symptoms emerge. Recent advances in blood-based biomarkers, particularly plasma Aβ, phosphorylated tau, and TDP-43, have shown diagnostic accuracy equivalent to CSF biomarkers, offering more accessible testing options. This review discusses the current challenges in fluid biomarker research, including variability, standardization, and sensitivity issues, and explores how combining multiple biomarkers with clinical symptoms improves diagnostic reliability. Ethical considerations, future directions involving extracellular vehicles (EVs), and the integration of artificial intelligence (AI) are also highlighted. Continued research efforts will be key to overcoming these obstacles, enabling fluid biomarkers to become crucial tools in personalized medicine for neurodegenerative diseases.
Collapse
Affiliation(s)
| | - Yifei Xu
- Institute of Gastroenterology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Meiqun Cao
- Department of Neurology, Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, China
| | - Nan Chen
- Institute of Gastroenterology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Qingling Zeng
- Institute of Gastroenterology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen 518033, China
| | - Mitchell K P Lai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 16 Medical Drive, Singapore, 117600, Singapore; Memory, Aging and Cognition Centre, National University Health System, Singapore
| | - Dahua Fan
- Institute of Maternal-Fetal Medicine,Shunde Women and Children's Hospital, Guangdong Medical University, Foshan 528300, China.
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 16 Medical Drive, Singapore, 117600, Singapore; NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore.
| | - Yongkai Cao
- Department of Neurology, Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, China.
| |
Collapse
|
14
|
Chen J, Jang S. Top-Rated Health Care and Ease of Access to Medications Linked to Lower Medicare and ADRD Costs. Med Care 2025; 63:405-412. [PMID: 40272264 PMCID: PMC12061373 DOI: 10.1097/mlr.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
IMPORTANCE Little is known about the extent to which patient self-perception of care experience is associated with costs, especially for people with Alzheimer disease and related dementias (ADRD). OBJECTIVE This study explores the relationship between self-reported quality measures and Medicare costs and examines whether the ease of obtaining prescribed medications is associated with reduced overall Medicare costs, focusing on Medicare beneficiaries with ADRD. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, Medicare Beneficiary Summary File data from 2018, 2019, and 2021 were linked to the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey using beneficiary IDs. The study sample included community-dwelling Medicare fee-for-service beneficiaries. EXPOSURES Five quality measures were used as key exposure variables: (1) beneficiary's rating on health care; (2) ease of getting care/tests/treatment through the health plan; (3) whether the doctor always explained, listened, respected; and spent enough time with the patient; (4) ease of obtaining prescribed medications; and (5) whether doctor always talked about all the prescription medicines the beneficiary was taking. MAIN OUTCOME AND MEASURE Annual total Medicare payments per person. RESULTS The study included 230,617 Medicare fee-for-service beneficiaries aged 65 and older, including 16,452 beneficiaries with ADRD. Among the total beneficiaries, 53% were females (vs. 56% of ADRD beneficiaries), with a mean (SD) age of 75.8 (SD 7.27) years [vs. 82.5 (SD 7.97) years for ADRD beneficiaries]. Fully adjusted analyses showed significant negative associations between quality measures and total per-capita payments, with more pronounced cost reductions among patients with ADRD. Specifically, patients with ADRD who reported it was always easy to get care had reductions of $1,922.0 (95% CI, -$3304.8 to -$539.2), while those who reported it was always easy to get prescribed medications had reductions of $2964.5 (95% CI, -$4518.8 to -$1410.1). In addition, beneficiaries who reported that doctors always discussed the medicines experienced cost reductions of $2299.7 (95% CI, -$3800.5 to -$799.0) in medicare costs. CONCLUSION AND RELEVANCE Our findings suggest that high-quality care is not necessarily associated with high costs. Meanwhile, focusing on the ease of access to needed care, obtaining prescription drugs, and effective communication about medication is critical in improving care quality while reducing costs.
Collapse
|
15
|
Chee W, Ryu S, Quan J, Kim D, Im EO. Why is it Difficult to Recruit/Retain Asian American Family Caregivers in a Virtual Intervention? West J Nurs Res 2025; 47:503-509. [PMID: 40099354 PMCID: PMC12069824 DOI: 10.1177/01939459251325719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
BACKGROUND Virtual interventions using computers and mobile devices have increasingly been developed and tested among racial and ethnic minorities in recent years. Yet, few virtual interventions have been developed for Asian American midlife women who are family caregivers of persons living with Alzheimer's disease (AD). Furthermore, little is known about the feasibility of recruiting this specific group of racial/ethnic minority midlife women to a virtual intervention study. OBJECTIVE The purpose of this paper is to discuss practical issues in recruiting and retaining this specific group of racial/ethnic minority midlife women for a virtual intervention study. METHODS The ongoing parent study is to develop and test a preliminary version of a virtual intervention for this specific population. During the research process, the research team had regular meetings to have discussions on recruitment and retention issues and each team member wrote research diaries. A content analysis was conducted with the written records including the research team's research diaries and meeting minutes. RESULTS The issues were: (1) an extremely small pool of Asian American midlife women who were family caregivers of persons living with AD; (2) competitions with other studies, (3) practicality of inclusion/exclusion criteria, (4) lack of time and interests in research participation, and (5) negative perception of small monetary incentives. CONCLUSION Future researchers need to consider the unique cultural and social dynamics of this specific population, foster trusted connections with the communities before initiating the study, and obtain feedback from potential gatekeepers and the communities in advance.
Collapse
Affiliation(s)
- Wonshik Chee
- The University of Texas at Austin, College of Education, Austin, TX, USA
| | - Seulgi Ryu
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Jianing Quan
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Dongmi Kim
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Eun-Ok Im
- The University of Texas at Austin, School of Nursing, Austin, TX, USA
| |
Collapse
|
16
|
Zhang B, Wang J, Chen J, Pan X. Arsenic exposure activates microglia, inducing neuroinflammation and promoting the occurrence and development of Alzheimer's disease-like neurodegeneration in mice. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 297:118251. [PMID: 40294499 DOI: 10.1016/j.ecoenv.2025.118251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/27/2025] [Accepted: 04/24/2025] [Indexed: 04/30/2025]
Abstract
Health damage caused by environmental arsenic pollution has attracted widespread attention, with Alzheimer's disease (AD) thought to be one of the adverse effects of long-term arsenic exposure. In this study, we sought to investigate the relationship between arsenic exposure and AD-like neurodegeneration and to determine the role of microglia in the process of AD-like neurodegeneration induced by arsenic exposure. The relationship between arsenic exposure and AD-like neurodegeneration was investigated using cognitive assessments and biological experiments. Arsenic exposure induced memory impairment in C57BL/6 mice and resulted in a significant increase in the number of Aβ+ and pTau+ cells in the entorhinal cortex and hippocampus with neuronal granular vacuolar degeneration and necroptosis, accompanied by upregulated expression of related proteins, which showed dose- and time-response relationships. Arsenic exposure intensified memory decline in FAD4T mice with accelerated AD-like neurodegeneration. Correlation analysis showed a negative correlation between memory impairment and neurodegeneration in the entorhinal cortex and hippocampus in mice. Arsenic exposure also activated microglia in the entorhinal cortex and hippocampus, with enlargement of the cytosol, shortened and thickened cell protrusions, hypertrophic changes, and abnormal proliferation, as well as upregulated expression of the pro-inflammatory cytokines TNF-α and IL-1β. Arsenic exposure induced overactivation of microglia in the entorhinal cortex and hippocampus of FAD4T mice, resulting in de-branching or bulbous protrusions and fragmented cytoplasm. Our findings suggest that arsenic exposure promotes the occurrence and development of AD-like neurodegeneration via the activation of microglia, which induces neuroinflammation in mice.
Collapse
Affiliation(s)
- Bo Zhang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang 561113, China; Collaborative Innovation Center for Prevention and Control of Endemic and Ethnic Regional Diseases Co-constructed by the Province and Ministry, Guizhou Medical University, Guiyang 561113, China.
| | - Jiaojiao Wang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang 561113, China; Collaborative Innovation Center for Prevention and Control of Endemic and Ethnic Regional Diseases Co-constructed by the Province and Ministry, Guizhou Medical University, Guiyang 561113, China
| | - Junhong Chen
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang 561113, China; Collaborative Innovation Center for Prevention and Control of Endemic and Ethnic Regional Diseases Co-constructed by the Province and Ministry, Guizhou Medical University, Guiyang 561113, China
| | - Xueli Pan
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang 561113, China; Collaborative Innovation Center for Prevention and Control of Endemic and Ethnic Regional Diseases Co-constructed by the Province and Ministry, Guizhou Medical University, Guiyang 561113, China.
| |
Collapse
|
17
|
Sabbagh MN, Zhao C, Mahendran M, Jang SR, Laliberté F, Toyosaki H, Zhang K, Frech F, Nair KV. Characterizing the Journey of Early Alzheimer's Disease in Patients Initiating Lecanemab Treatment in the United States: A Real-World Evidence Study. Neurol Ther 2025; 14:1115-1127. [PMID: 40319433 PMCID: PMC12089008 DOI: 10.1007/s40120-025-00756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2025] [Accepted: 04/15/2025] [Indexed: 05/07/2025] Open
Abstract
INTRODUCTION With the advent of disease-modifying therapies for early Alzheimer's disease (AD), a comprehensive characterization of patients initiating lecanemab in the USA is needed to understand its use in real-world settings. METHODS This retrospective observational study used administrative claims from the Komodo Research Database (1/1/2023-6/30/2024). Eligible patients had ≥ 1 lecanemab administration (first claim defined the index date) and ≥ 12 months of clinical activity/insurance eligibility before the index date. Patient characteristics, diagnostic process, and AD-related medications were evaluated within 12 months before the index date (baseline), whereas lecanemab treatment patterns and concomitant medications were evaluated on or after the index date (follow-up). Outcomes were reported using descriptive statistics and persistence to lecanemab was evaluated using Kaplan-Meier analysis. RESULTS Of 3155 patients included in the study, mean age was 75.0 years, 55.8% were female, 44.2% were male, and most (93.3%) received their index lecanemab administration in an urban setting. Diagnoses of AD (83.8%) and mild cognitive impairment (60.8%) were common at baseline, and 67.6% of patients used AD symptomatic medications. Average time from earliest diagnosis to first lecanemab administration was 4.9 months among patients with a diagnosis in January 2023 (accelerated approval date) or onwards. Over a mean follow-up of 138.8 days, the monthly mean number of administrations of lecanemab was 1.9, with an average of 16.5 days between consecutive administrations and 47.4 days to the first follow-up head magnetic resonance imaging. Persistence to lecanemab was 87.6% at 4 months after treatment initiation. CONCLUSION Lecanemab was utilized in appropriate patient populations according to the prescribing information approved by the US Food and Drug Administration. Findings from our study provide first insights into the real-world use of lecanemab in the USA and shed light on the need for increased and timely lecanemab initiation for the long-term management of early AD.
Collapse
Affiliation(s)
- Marwan N Sabbagh
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Chenyue Zhao
- Eisai Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA.
| | | | | | | | | | | | - Feride Frech
- Eisai Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA
| | - Kavita V Nair
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
18
|
Chamorro LB, Zulli B, Barone E. Insulin resistance: fueling oxidative stress and neurodegeneration. J Neural Transm (Vienna) 2025:10.1007/s00702-025-02956-6. [PMID: 40448828 DOI: 10.1007/s00702-025-02956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 05/21/2025] [Indexed: 06/02/2025]
Abstract
The growing prevalence of age-related neurodegenerative diseases is a consequence of population aging and demands urgent treatment strategies. This literature review aims to provide a comprehensive overview of the contribution of oxidative stress and insulin resistance in neurodegenerative diseases, specifically Alzheimer's disease (AD). In addition, current therapeutic approaches to treat oxidative stress and insulin resistance in this age-related neurodegenerative disease will be discussed. AD is the most prevalent form of neurodegenerative disease and is marked at early stages by oxidative stress and insulin resistance. Results indicate that insulin resistance may be central in generating oxidative stress and exacerbating AD hallmarks. In turn, insulin resistance can be influenced by other factors, including amyloid beta (Aβ), impaired biliverdin-reductase A (BVR-A) activity, and the gut microbiota. Defective insulin signaling in the brain comes with consequences ranging from declined cognitive functions, impaired autophagy, mitochondrial dysfunction, hyperphosphorylation of Tau, and increased Aβ production. Multiple therapeutic approaches that target oxidative stress or brain insulin resistance, such as antioxidant supplementation and anti-diabetic drugs, have mostly been inconclusive, except for intranasal insulin. Positive results have been obtained in clinical trials using nasal delivery devices to administer insulin; however, results are inconsistent across studies likely due to inconsistencies in the delivery method. Future investigations should focus on investigating the molecular link between oxidative stress, insulin resistance, and AD to address current knowledge gaps. Moreover, more focus should be given to optimizing the reliability and efficacy of nasal delivery devices before considering such an approach viable to treat neurodegenerative diseases.
Collapse
Affiliation(s)
| | - Barbara Zulli
- Department of Biochemical Sciences "A. Rossi-Fanelli", Sapienza University of Rome, Rome, Italy
| | - Eugenio Barone
- Department of Biochemical Sciences "A. Rossi-Fanelli", Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
19
|
Azizzadeh A, Najafi M, Nafar Z, Salehzehi S, Azadikhah Jahromi S, Fallah H, Ghoshouni H, Alzheimer′s Disease Neuroimaging Initiative (ADNI). Postmortem neuropathologies are associated with retrospective tensor-based morphometry findings in Alzheimer's dementia continuum. Neurol Sci 2025:10.1007/s10072-025-08268-7. [PMID: 40448884 DOI: 10.1007/s10072-025-08268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 05/19/2025] [Indexed: 06/02/2025]
Abstract
BACKGROUND Understanding the relationship between postmortem neuropathological findings and in vivo imaging biomarkers is crucial for advancing the early diagnosis and treatment of Alzheimer's disease (AD). This study investigates the association between postmortem neuropathologies and retrospective Tensor-Based Morphometry (TBM) findings across the Alzheimer's dementia continuum. METHODS This study utilized tensor-based morphometry (TBM) to investigate structural brain changes associated with AD neuropathology. Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were analyzed, including MRI scans and neuropathological findings from 98 participants. Logistic regression was used to explore the relationship between TBM indices and neuropathological outcomes. The diagnostic performance of TBM was evaluated using accuracy analysis. RESULTS Significant differences in TBM indices (StatROI and TempROI) were observed between the dementia and non-dementia groups. Logistic regression indicated that higher StatROI and TempROI indices were associated with lower odds of AD pathology, such as amyloid plaques (OR = 0.939 and 0.927), neurofibrillary tangles (OR = 0.961 and 0.931), and neuritic plaques (OR = 0.943 and 0.916). Accuracy analysis demonstrated good discriminatory power of TBM indices in differentiating pathologically confirmed AD from non-AD dementia (sensitivity up to 61.29, specificity up to 93.33%) and cognitively normal individual (sensitivity up to 82.26, specificity up to 75%). CONCLUSION TBM is a promising tool for predicting the underlying neuropathology of AD and distinguishing between different causes of dementia. Integrating TBM into clinical assessments can enhance the accuracy of AD diagnosis and improve patient management.
Collapse
Affiliation(s)
| | - Mahla Najafi
- Department of Neurosciences and Cognition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Nafar
- Educational Psychology, Allameh Tabataba'i University, Tehran, Iran
| | | | - Sahba Azadikhah Jahromi
- School of Mechanical Engineering, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Hamed Fallah
- Basic Sciences Department, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Hamed Ghoshouni
- Cardiovascular Epidemiology Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | | |
Collapse
|
20
|
Simone SM, Kaplan M, Giovannetti T. Self-Efficacy is Key: Examining the Role of Motivation to Engage in Healthy Lifestyle Behaviors for Dementia Prevention in Midlife. J Appl Gerontol 2025:7334648251345191. [PMID: 40448532 DOI: 10.1177/07334648251345191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2025] Open
Abstract
Modifiable risk factors account for nearly half of dementia cases, with the greatest impact on dementia prevention in midlife. Little is known about what motivates middle-aged adults to engage in healthy behaviors for dementia risk reduction. This study examined associations between motivation to make lifestyle changes for dementia risk reduction and engagement in health behaviors associated with dementia risk in 347 middle-aged adults. Multivariate linear regressions examined associations between motivation and engagement in health behaviors. Greater self-efficacy and higher education significantly predicted greater physical and cognitive activity and better sleep quality. Greater perceived barriers and general health motivation, lower self-efficacy, and younger age significantly predicted greater perceived loneliness. Self-efficacy consistently predicted engagement in health behaviors associated with dementia risk reduction in midlife. Thus, incorporating empirically supported strategies to increase self-efficacy in lifestyle interventions for dementia prevention may increase long-term adherence and overall success of dementia prevention efforts.
Collapse
|
21
|
Wu J, Yin X, Ji W, Liu Y, Tang J, Zhang H, Qi S, Li J, Lin L, Yang X, Xu C, Du Q. Hypertension and diabetes on cognitive impairment: a case-control study in China. Alzheimers Res Ther 2025; 17:120. [PMID: 40448207 PMCID: PMC12123983 DOI: 10.1186/s13195-025-01761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Accepted: 05/09/2025] [Indexed: 06/02/2025]
Abstract
BACKGROUND Cognitive impairment, hypertension and diabetes are prevalent chronic conditions in populations of older ages. Previous studies have shown that hypertension and diabetes are risk factors for the development of cognitive impairment. However, the impact of hypertension combined with diabetes (HD) and their cumulative effects on cognitive impairment remain unclear. We aimed to investigate whether HD influences development of cognitive impairment and whether the effect is cumulative. METHODS A case-control study was conducted. From 40,103 subjects aged 60 years or older, enrolled from 28 representative communities of 9 provinces of China between January 2015 and December 2021 into the Prevention and Intervention on Neurodegenerative Disease for Elderly in China program using multi-stage stratified random sampling, individuals not meeting our propensity score matching criteria were excluded, and 13,252 individuals were finally selected for the study. Exposure factors included hypertension, diabetes and their comorbidity. Odds ratios (ORs) of exposure factors on cognitive impairment were measured using multiple logistic regression. RESULTS We found significant impacts of hypertension, diabetes and their comorbidity on cognitive impairment occurrence. The OR values for dementia were 1.18 for individuals with hypertension only, 1.26 for those with diabetes only, and 1.53 for those with HD. Compared to participants without hypertension and diabetes, the OR values for mild cognitive impairment (MCI) were 1.11 for individuals with hypertension only, 1.32 for those with diabetes only, and 1.27 for those with HD. For subjects with HD longer than 5 years, the comorbidity significantly impacted on MCI and dementia, and the degree of impact increased with the duration of comorbidity. For hypertension, the influence of hypertension on dementia were most influential in middle-aged (45-64 years old) people. By contrast, the influence of diabetes on people younger than 45-year-old was most significant, with the middle-age group being the second most impacted subjects. CONCLUSIONS The elderly with HD have a heightened risk of developing cognitive impairment, particularly dementia, compared to those with either hypertension or diabetes alone. The study revealed a significant cumulative impact of HD on cognitive impairment.
Collapse
Affiliation(s)
- Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
- Guangdong Basic Research Center of Excellence for Integrated Traditional and Western Medicine for Qingzhi Diseases, Guangzhou, 510515, China.
| | - Xiangjun Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Weiqiang Ji
- Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou, 510315, China
| | - Yang Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
- Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou, 510315, China
| | - Jing Tang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Han Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Shige Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Jie Li
- School of Geography and Remote Sensing, Guangzhou University, Guangzhou, 510006, China
| | - Li Lin
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Xueqing Yang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Qingfeng Du
- Guangdong Basic Research Center of Excellence for Integrated Traditional and Western Medicine for Qingzhi Diseases, Guangzhou, 510515, China.
- Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou, 510315, China.
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China.
- Guangdong Provincial Key Laboratory of Chinese Medicine Pharmaceutics, Guangzhou, 510515, China.
| |
Collapse
|
22
|
Wu F, Li W, Lu H, Li L. Recent Advances in Mass Spectrometry-Based Studies of Post-translational Modifications in Alzheimer's Disease. Mol Cell Proteomics 2025:101003. [PMID: 40449795 DOI: 10.1016/j.mcpro.2025.101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 04/18/2025] [Accepted: 05/26/2025] [Indexed: 06/03/2025] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline. There are over 10 million new cases of AD each year worldwide, implying one new case every 3.2 seconds. Post-translational modifications (PTMs) such as phosphorylation, glycosylation, and citrullination have emerged as key modulators of protein function in AD, influencing protein aggregation, clearance, and toxicity. Mass spectrometry (MS) has become an indispensable tool for detecting and quantifying these PTMs, offering valuable insights into their role in AD pathogenesis. This review explores recent advancements in MS-based studies of PTMs in AD, with emphasis on MS techniques like data-dependent acquisition (DDA) and data-independent acquisition (DIA), as well as enrichment methods used to characterize PTMs. The applications of these MS-based approaches to the study of various PTMs are highlighted, which have significantly accelerated the biomarker discovery process, providing new avenues for early diagnosis and therapeutic targeting. Advances in biological understanding and analytical techniques, while addressing the challenges and future directions, will be discussed.
Collapse
Affiliation(s)
- Feixuan Wu
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Wei Li
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Haiyan Lu
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Lingjun Li
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA; Department of Chemistry, University of Wisconsin-Madison, Madison, WI 53706, USA; Biophysics Graduate Program, University of Wisconsin-Madison, WI 53706, USA; Lachman Institute for Pharmaceutical Development, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA; Wisconsin Center for NanoBioSystems, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA.
| |
Collapse
|
23
|
Powers JS. Implementation of a virtual dementia system of care in a VA health setting. BMC Geriatr 2025; 25:380. [PMID: 40437383 PMCID: PMC12117758 DOI: 10.1186/s12877-025-06034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Accepted: 05/08/2025] [Indexed: 06/01/2025] Open
Abstract
OBJECTIVE Dementia care remains supportive and geriatric resources are scarce. We describe a dementia system of care consisting of virtual and e-consults working through the primary care provider, as well as providing virtual group caregiver support. These models were developed based on patient and caregiver preferences and necessitated by the Covid public health emergency. METHODS A geriatrician supported dementia consult clinic transitioned to a virtual model of care. A centrally located caregiver support group providing a 4-week curriculum and delivered in conjunction with a social worker similarly transitioned to virtual support. Primary care providers generated consults and were provided educational consultations regarding dementia diagnoses and management in the primary care setting. RESULTS Between 2018 and 2024, 1176 consultations were provided during this period as the clinic transitioned from in-person to virtual consultation. Recommendation categories included: (1) diagnostic testing, (2) medication recommendations and deprescribing, (3) referral for formal neuropsychological testing, (4) psychiatric referral for behavioral concerns, (5) primary care management and goals of care, (6) safety considerations, (7) home and community-based services, and (8) caregiver support. Providers continue to send new consultations and request follow-up advice on previous consults. A total of 72 family caregivers participated in a virtual 4-class support curriculum. CONCLUSIONS/IMPACT Virtual and e-consult dementia care working through the primary care provider, as well as virtual group caregiver support, are feasible, acceptable and sustainable models of dementia care to efficiently utilize scarce geriatrics resources serving a wide geographic area. A virtual dementia system of care may facilitate PCP delivery of supportive care for persons living with dementia, dementia care navigation, and caregiver support.
Collapse
Affiliation(s)
- James S Powers
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, 37212, USA.
| |
Collapse
|
24
|
Bregman N, Nathan T, Shir D, Omer N, Levy MH, David AB, Aizenstien O, Lotan E, Alcalay Y, Awad AA, Gadoth A, Ash E, Shiner T. Lecanemab in clinical practice: real-world outcomes in early Alzheimer's disease. Alzheimers Res Ther 2025; 17:119. [PMID: 40437535 PMCID: PMC12117801 DOI: 10.1186/s13195-025-01763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Accepted: 05/12/2025] [Indexed: 06/01/2025]
Abstract
BACKGROUND Lecanemab, a monoclonal antibody targeting amyloid beta, has recently been approved for treatment of early-stage Alzheimer's disease (AD), demonstrating amyloid plaque reduction and slowing of cognitive decline in clinical trials. However, real-world data on its efficacy and safety remain limited. The Cognitive Neurology Unit at Tel Aviv Medical Center (TLVMC) established an infrastructure to facilitate advanced treatments for AD, utilising a multidisciplinary approach to patient screening, diagnosis, treatment initiation and follow up. METHODS Lecanemab administration at the TLVMC commenced in November 2023. Patients with biomarker-confirmed early-stage AD were screened via a structured referral system, including neurological evaluations, MRI, lumbar puncture or Amyloid-PET, genetic testing, and multidisciplinary team (MDT) consensus discussions. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline, six months, and twelve months. Safety monitoring included routine MRI scans for amyloid-related imaging abnormalities (ARIA). RESULTS Between July 2023 and January 2025, 169 patients were screened and 86 initiated lecanemab treatment. By January 2025, 53 patients had reached the 6-month follow-up date. In the intention-to-treat (ITT) population, MMSE scores declined significantly over 6 months (F(1, 45.13) = 7.41, p =.009). Subgroup analysis revealed a significant decline in younger patients (n = 31; F(1, 24.67) = 8.06, p =.009), but not in older patients (n = 22; F(1, 19.25) = 0.67, p =.424). At 12 months, 31 patients had reached follow-up, with no significant change in MMSE scores observed (F(1, 17.18) = 2.49, p =.133). Age subgroup analysis was not performed at 12 months due to limited sample size. No significant correlations were found between baseline biomarkers and cognitive change. ARIA occurred in 18.6% of patients, mostly asymptomatic. One patient experienced symptomatic ARIA, required hospitalization with intravenous treatment, and discontinued therapy. A mixed-effects model showed no significant effect of ARIA on MMSE change (p =.264) and no interaction with time (p =.433). Infusion-related reactions occurred in 22.1%, all mild and transient. Treatment was discontinued in 19.8% of patients due to ARIA, financial barriers, comorbidities, or personal preference. CONCLUSIONS This real-world analysis demonstrates the feasibility and safety of Lecanemab administration for early-stage AD within a tertiary hospital setting. Establishing dedicated infrastructure enabled streamlined patient evaluations and treatment. The findings suggest a differential response across age groups, consistent with clinical trial data. Continued longitudinal follow-up is needed to assess long-term efficacy and safety.
Collapse
Affiliation(s)
- Noa Bregman
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.
- Faculty of Medical & Health Sciences, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel.
- Sagol School of Neuroscience, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel.
| | - Talya Nathan
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Dror Shir
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Nurit Omer
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
- Faculty of Medical & Health Sciences, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
| | - Mori Hai Levy
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Aya Bar David
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Orna Aizenstien
- Faculty of Medical & Health Sciences, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
- Department of Diagnostic Imaging, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Eyal Lotan
- Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY, 10016, USA
| | - Yifat Alcalay
- Division of Clinical Laboratories, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Anan Abu Awad
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Avi Gadoth
- Faculty of Medical & Health Sciences, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
- Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
| | - Elissa Ash
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
- Faculty of Medical & Health Sciences, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
| | - Tamara Shiner
- Cognitive Neurology Unit, Neurological Institute, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel
- Faculty of Medical & Health Sciences, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 6997801, Israel
| |
Collapse
|
25
|
Summanwar D, Fowler NR, Hammers DB, Perkins AJ, Brosch JR, Willis DR. Agile Implementation of a Digital Cognitive Assessment for Dementia in Primary Care. Ann Fam Med 2025; 23:199-206. [PMID: 40300819 PMCID: PMC12120161 DOI: 10.1370/afm.240294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 01/14/2025] [Accepted: 02/04/2025] [Indexed: 05/01/2025] Open
Abstract
PURPOSE This study aimed to assess how agile implementation-driven iterative processes and tailored workflows can facilitate the implementation of a digital cognitive assessment (DCA) tool for patients aged 65 years or older into primary care practices. METHODS We used agile implementation principles to integrate a DCA tool into routine workflows across 7 primary care clinics. The intervention involved a structured selection process for identifying an appropriate DCA tool, stakeholder engagement through iterative sprints (structured, time-bound cycles), and development of tailored workflows to meet clinic-specific needs. A brain health navigator role was established to support patients with positive or borderline screenings, and assist primary care clinicians with follow-up assessment. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate the intervention's performance over a 12-month period. RESULTS The intervention engaged 69 (63.8%) of 108 clinicians across the 7 clinics. DCA screening was completed in 1,808 (10.8%) of 16,708 eligible visits. We selected the Linus Health Core Cognitive Evaluation tool as our DCA tool based on stakeholder evaluations. Screening workflows were tailored to each clinic. The brain health navigator received 447 referrals for further assessment of a positive or borderline screening result. Four clinics fully adopted the intervention, achieving a DCA completion rate of at least 20%, and 5 clinics were still routinely using the DCA tool at 12 months. CONCLUSIONS Agile implementation effectively helped integrate the DCA tool into primary care workflows. Customized workflows, stakeholder engagement, and iterative improvements were crucial for adoption and sustainability. These insights can guide future efforts for early detection and management of cognitive impairment in primary care, ultimately improving patient outcomes and easing the burden on health care professionals.
Collapse
Affiliation(s)
- Diana Summanwar
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
| | - Dustin B Hammers
- Department of Statistics and Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anthony J Perkins
- Department of Statistics and Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Deanna R Willis
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
26
|
Guzmán-Vélez E, Aguillón D, Rivera-Hernández A, Baena AY, Londoño-Sotomayor N, Picard G, Kramer AF, Arnold SE, Caraballo-Gracia DI, Taylor JA, Quiroz YT. Association among cardiorespiratory fitness, plasma biomarkers of pathology and astrocyte reactivity, and cognition in autosomal-dominant Alzheimer's disease. J Alzheimers Dis 2025:13872877251344327. [PMID: 40420671 DOI: 10.1177/13872877251344327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2025]
Abstract
BackgroundHigh cardiorespiratory fitness has been associated with greater neuroplasticity, and slower neurodegeneration and cognitive decline in healthy adults. Yet, less is known about whether low-to-intermediate cardiorespiratory fitness is associated with lower markers of disease progression in the preclinical stage of Alzheimer's disease (AD).ObjectiveWe investigated whether cardiorespiratory fitness was associated with plasma biomarkers for AD-related pathology, neural injury and astrocyte reactivity, and episodic memory in Presenilin-1 E280A carriers without dementia from the world's largest kindred with autosomal-dominant AD.MethodsTwenty-seven mutation carriers (25 cognitively unimpaired, 2 with mild cognitive impairment; ages: μ=30.22 years, SD = 5.24; 74% female) participated in the study. Participants underwent a graded aerobic fitness test to assess cardiorespiratory fitness, measured in maximum metabolic equivalent of task (MET). Plasma biomarkers included amyloid 42/40, phosphorylated tau-181, neurofilament light chain, and glial fibrillary acidic protein. Participants completed the Consortium to Establish a Registry for AD word list learning and delayed recall. We conducted multiple linear regressions controlling for age, sex, and years of education.ResultsFourteen participants' MET values were indicative of low cardiorespiratory fitness (<9 MET), and 13 participants' MET values of intermediate cardiorespiratory fitness (9-14 MET). METs were not associated with age, biomarkers, or episodic memory.ConclusionsOur findings suggest that low-to-intermediate cardiorespiratory fitness may not be associated with biomarkers for AD-related pathology, neural injury and astrocyte reactivity, or memory in people at genetic risk for dementia. Longitudinal studies and randomized-controlled trials are needed to better understand the relationships among cardiorespiratory fitness and AD progression.
Collapse
Affiliation(s)
- Edmarie Guzmán-Vélez
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Aguillón
- Grupo de Neurociencias, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Ana Y Baena
- Grupo de Neurociencias, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Glen Picard
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Cambridge, MA, USA
| | - Arthur F Kramer
- Center for Cognitive and Brain Health, Northeastern University, Boston, MA, USA
- Beckman Institute, University of Illinois, Urbana, IL, USA
| | - Steven E Arnold
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - J Andrew Taylor
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Cambridge, MA, USA
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Grupo de Neurociencias, Universidad de Antioquia, Medellín, Antioquia, Colombia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
27
|
Zhang Z, Wang W, Yang X, Yang Y, Yang B, Ding Y, Zhang Y, Lin X, Gu P, Li F, Shao J. Spontaneous brain activity in patients with type 2 diabetes: linking serum neuroproteins to cognitive ability. Diabetol Metab Syndr 2025; 17:174. [PMID: 40426217 PMCID: PMC12117735 DOI: 10.1186/s13098-025-01727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 05/03/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Cognitive impairment is a complication of type 2 diabetes with high prevalence and serious harm. This study aims to identify serum and imaging biomarkers of type 2 diabetes with mild cognitive impairment (MCI) and to study whether spontaneous brain activities evaluated by functional MRI mediate the relationships between these serum neuroprotein biomarkers and cognitive ability. METHODS According to Montreal Cognitive Assessment (MoCA) scores, 38 patients with MCI and 32 patients with normal cognition in type 2 diabetes were recruited. Serum neuroproteins were determined with Olink Proteomics. Brain activities were evaluated by functional MRI. Logistic regression were performed to determine the biomarkers of type 2 diabetes with MCI. Mediation analysis were performed to examine the potential causal chain between the neuroproteins and cognitive ability. RESULTS The levels of Epiregulin (EREG), Abhydrolase domain containing 14B (ABHD14B) and Inositol monophosphatase 1 (IMPA1) decreased, while the level of Cysteine-rich intestinal protein 2 (CRIP2) increased in type 2 diabetic patients with MCI (FDR p < 0.05). Combination of EREG and CRIP2, a ROC curve was generated with an AUC of 0.85 and an accuracy of 70.0%, and a sensitivity of 86.7% for diagnosing type 2 diabetes with MCI. Brain activities in bilateral superior parietal gyrus, bilateral postcentral gyrus, left inferior frontal gyrus, right cerebellum 6, left cerebellum crus1 decreased, while increased in right hippocampus and left middle frontal gyrus in type 2 diabetic patients with MCI (FDR p < 0.05). The mALFF values in the left cerebellum crus-1 mediated 29.1% of the association between the EREG and MoCA scores (p < 0.001). The mALFF values in the right cerebellum-6, left cerebellum crus-1, right hippocampus, right superior parietal gyrus and right postcentral gyrus all significantly and partially mediated the association between ABHD14B levels and MoCA scores, with mediating effects of 21.7%, 27.1%, 25.8%, 20.7% and 19.2%, respectively (all p values < 0.001). CONCLUSIONS Type 2 diabetic patients with MCI exhibit specific serum neuroprotein and functional MRI characteristics. The relationships between these neuroproteins and cognitive ability were mediated by spontaneous brain activities.
Collapse
Affiliation(s)
- Zhen Zhang
- Department of Endocrinology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
- Department of Endocrinology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wei Wang
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xinyi Yang
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yuting Yang
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Bingjie Yang
- Department of Endocrinology, Jinling Clinical College, General Hospital of Eastern Theater Command, Nanjing Medical University, Nanjing, China
| | - Yunchuan Ding
- Department of Endocrinology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yunxiao Zhang
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiang Lin
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Ping Gu
- Department of Endocrinology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - Fangping Li
- Department of Endocrinology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Jiaqing Shao
- Department of Endocrinology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
| |
Collapse
|
28
|
Fowler NR, Hammers DB, Perkins AJ, Summanwar D, Higbie A, Swartzell K, Brosch JR, Willis DR. Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care. Ann Fam Med 2025; 23:191-198. [PMID: 40300815 PMCID: PMC12120163 DOI: 10.1370/afm.240293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 01/14/2025] [Accepted: 01/20/2025] [Indexed: 05/01/2025] Open
Abstract
PURPOSE We assessed the feasibility and acceptability of implementing a digital cognitive assessment (DCA) for Alzheimer disease and related dementias (ADRD) screening into primary care. We also assessed the prevalence of positive screens and measured diagnostic and care outcomes after a positive DCA result. METHODS We conducted a single-arm pragmatic clinical demonstration project in 7 diverse primary care clinics to test implementation of the Linus Health Core Cognitive Evaluation and Digital Clock and Recall DCAs (Linus Health, Inc). Eligible patients were aged ≥65 years. Patients were ineligible if unable to see or hear, not English or Spanish speaking, or if they had a DCA in the past 12 months with an unimpaired or impaired result. RESULTS There were 16,708 eligible encounters during the 12-month study period (June 2022-May 2023). A total of 1,808 DCAs (10.8%) were completed by 1,722 unique patients; 3,727 (22.3%) declined, and at 9,232 encounters (55.3%) the physicians declined to have the patient complete the DCA or the encounter was deemed out of scope. Among those who completed DCAs, results for 762 (44.3%) were categorized as unimpaired, 628 (36.5%) borderline, 236 (13.7%) impaired, and 96 (5.6%) inconclusive. Among the 236 patients who were categorized as impaired, 2.1% received a new diagnosis of ADRD, and 5.1% received a new diagnosis of mild cognitive impairment within 90 days after the DCA. CONCLUSIONS One-half of all patients scored impaired or borderline for cognitive impairment. Digital cognitive assessments can be implemented in primary care, have utility for early detection, and could represent the first step in identification of patients who could benefit from ADRD disease-modifying therapeutics, care management, or other interventions to improve patient and family caregiver outcomes.
Collapse
Affiliation(s)
- Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Regenstrief Institute Inc, Indianapolis, Indiana
| | - Dustin B Hammers
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Diana Summanwar
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anna Higbie
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Regenstrief Institute Inc, Indianapolis, Indiana
| | | | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Deanna R Willis
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
29
|
Liang J, Wang Q, Wang J, Shao Y, Zhu S, Wu N, Huo X, Zhang G, Lin H. Individual electric field in cortical white matter is correlated with cognitive improvement in patients with mild cognitive impairment due to Alzheimer's disease after repetitive transcranial magnetic stimulation treatment. J Alzheimers Dis 2025:13872877251344599. [PMID: 40420669 DOI: 10.1177/13872877251344599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2025]
Abstract
BackgroundRepetitive transcranial magnetic stimulation (rTMS) may be effective for Alzheimer's disease (AD) and mild cognitive impairment (MCI); however, the therapeutic efficacy varies significantly, highlighting the need for reliable biomarkers to predict treatment response. While rTMS may activates cortical white matter, the relationship between induced electric field (E-field) in this region and clinical outcomes remains unclear.ObjectiveThis study characterized the E-field in cortical gray matter (EFgm), cortical white matter (EFwm), and region-of-interest (EFROI) in the left dorsolateral prefrontal cortex (DLPFC), and explored their correlations with treatment efficacy in patients with MCI due to AD.MethodsThirty patients with MCI due to AD received 2-week rTMS treatment, with efficacy measured by Auditory Verbal Learning Test (AVLT) and a comprehensive neuropsychological battery. Responders were defined as those with >25% improvement in AVLT-immediate memory. Correlations between regional brain volumes and E-field magnitudes, and the correlations between E-field magnitudes and cognitive improvement, were analyzed. Predictive performance of E-fields for responder classification was evaluated.ResultsPronounced inter-individual variability in magnitudes of EFgm, EFwm and EFROI was observed, partially explained by differences in regional brain volumes of DLPFC targeted area. Treatment responders exhibited significantly higher EFwm magnitude. EFwm positively correlated with AVLT-immediate memory improvement (R2 = 0.37) and predicted responder groups, achieving an area under the curve (AUC) of 0.76.ConclusionsE-field within cortical white matter in the DLPFC correlates with rTMS efficacy and predicts therapeutic response in MCI due to AD. Personalized stimulation protocols incorporating EFwm modeling may optimize treatment parameters.Trial registrationThis study is registered in the Chinese Clinical Trial Registry, number ChiCTR2200062564, date of registration: 2022-08-11.
Collapse
Affiliation(s)
- Junhua Liang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qianqian Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiahao Wang
- Beijing Key Laboratory of Bioelectromagnetism, Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Yuxuan Shao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shuxiang Zhu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Nianshuang Wu
- Beijing Key Laboratory of Bioelectromagnetism, Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Xiaolin Huo
- Beijing Key Laboratory of Bioelectromagnetism, Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Guanghao Zhang
- Beijing Key Laboratory of Bioelectromagnetism, Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Hua Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
30
|
Fowler NR, Partrick KA, Taylor J, Hornbecker M, Kelleher K, Boustani M, Cummings JL, MacLeod T, Mielke MM, Brosch JR, Lee J, Shobin E, Galvin JE, Fillit H, Udeh-Momoh C, Willis DR. Implementing early detection of cognitive impairment in primary care to improve care for older adults. J Intern Med 2025. [PMID: 40410933 DOI: 10.1111/joim.20098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2025]
Abstract
Primary care is the ideal setting for early detection of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD), as it serves as the primary point of care for most older adults. With the growing aging population, reliance on specialists for detection and diagnosis is unsustainable, highlighting the need for primary care-led assessment. Recent research findings on successful brain health prevention strategies, AD diagnostic tools, and anti-amyloid treatments empower primary care to play a central role in early detection and intervention. Primary care-focused resources are being developed, including tools for cognitive assessments and materials designed to educate patients about brain health and initiate discussions on lifestyle modifications, thereby making early detection more feasible and efficient. Identifying risk factors early enables providers to implement interventions that can slow cognitive decline and improve outcomes for patients and caregivers. If left undetected and unmanaged, MCI and ADRD can lead to worse outcomes, including increased falls, hospitalizations, financial vulnerability, and caregiver stress. Early detection enables the identification of reversible causes of cognitive impairment, supports the management of comorbidities worsened by cognitive decline, mitigates safety risks, and can preserve quality of life. Importantly, primary care is essential for addressing ADRD-related health disparities that disproportionately affect racial minorities, rural populations, and those of lower socioeconomic status. With a focus on the United States healthcare system, this perspective addresses how implementing early detection practices into primary care can improve outcomes for patients and caregivers, reduce societal burdens, and promote health equity in ADRD care.
Collapse
Affiliation(s)
- Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | | | | | | | | | - Malaz Boustani
- Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada at Las Vegas, Las Vegas, Nevada, USA
| | - Tim MacLeod
- Davos Alzheimer's Collaborative, Wayne, Pennsylvania, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jared R Brosch
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Janice Lee
- Voices of Alzheimer's, New York, New York, USA
| | - Eli Shobin
- Alzheimer's Drug Discovery Foundation, New York, New York, USA
| | - James E Galvin
- Departments of Neurology and Psychiatry, Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Boca Raton, Florida, USA
| | - Howard Fillit
- Alzheimer's Drug Discovery Foundation, New York, New York, USA
| | - Chinedu Udeh-Momoh
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Deanna R Willis
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
31
|
Taddei RN, Duff KE. Synapse vulnerability and resilience across the clinical spectrum of dementias. Nat Rev Neurol 2025:10.1038/s41582-025-01094-7. [PMID: 40404832 DOI: 10.1038/s41582-025-01094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2025] [Indexed: 05/24/2025]
Abstract
Preservation of synapses is crucial for healthy cognitive ageing, and synapse loss is one of the closest anatomical correlates of cognitive decline in Alzheimer disease, dementia with Lewy bodies and frontotemporal dementia. In these conditions, some synapses seem particularly vulnerable to degeneration whereas others are resilient and remain preserved. Evidence has highlighted that vulnerability and resilience are intrinsically distinct phenomena linked to specific brain structural and/or functional signatures, yet the key features of vulnerable and resilient synapses in the dementias remain incompletely understood. Defining the characteristics of vulnerable and resilient synapses in each form of dementia could offer novel insight into the mechanisms of synapse preservation and of synapse loss that underlies cognitive decline, thereby facilitating the discovery of targeted biomarkers and disease-modifying therapies. In this Review, we consider the concepts of synapse vulnerability and resilience, and provide an overview of our current understanding of the associations between synaptic protein changes, neuropathology and cognitive decline. We also consider how understanding of the underlying mechanisms could identify novel strategies to mitigate the cognitive dysfunction associated with dementias.
Collapse
Affiliation(s)
- Raquel N Taddei
- Neurology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- UK Dementia Research Institute at UCL, Institute of Neurology, University College London, London, UK.
| | - Karen E Duff
- UK Dementia Research Institute at UCL, Institute of Neurology, University College London, London, UK
| |
Collapse
|
32
|
Chen D, Yang H, Li H, He X, Mu H. MRI-based diagnostic model for Alzheimer's disease using 3D-ResNet. Biomed Phys Eng Express 2025; 11:035031. [PMID: 40354785 DOI: 10.1088/2057-1976/add73d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 05/12/2025] [Indexed: 05/14/2025]
Abstract
Alzheimer's disease (AD), a progressive neurodegenerative disorder, is the leading cause of dementia worldwide and remains incurable once it begins. Therefore, early and accurate diagnosis is essential for effective intervention. Leveraging recent advances in deep learning, this study proposes a novel diagnostic model based on the 3D-ResNet architecture to classify three cognitive states: AD, mild cognitive impairment (MCI), and cognitively normal (CN) individuals, using MRI data. The model integrates the strengths of ResNet and 3D convolutional neural networks (3D-CNN), and incorporates a special attention mechanism(SAM) within the residual structure to enhance feature representation. The study utilized the ADNI dataset, comprising 800 brain MRI scans. The dataset was split in a 7:3 ratio for training and testing, and the network was trained using data augmentation and cross-validation strategies. The proposed model achieved 92.33% accuracy in the three-class classification task, and 97.61%, 95.83%, and 93.42% accuracy in binary classifications of AD versus CN, AD versus MCI, and CN versus MCI, respectively, outperforming existing state-of-the-art methods. Furthermore, Grad-CAM heatmaps and 3D MRI reconstructions revealed that the cerebral cortex and hippocampus are critical regions for AD classification. These findings demonstrate a robust and interpretable AI-based diagnostic framework for AD, providing valuable technical support for its timely detection and clinical intervention.
Collapse
Affiliation(s)
- Dongkui Chen
- College of Science, Northeast Forestry University, Harbin, 150040, People's Republic of China
| | - Hong Yang
- Research Institute of Intelligent Control and Systems, Harbin Institute of Technology, Harbin, 150001, People's Republic of China
| | - Hao Li
- College of Science, Northeast Forestry University, Harbin, 150040, People's Republic of China
| | - Xuanlong He
- College of Science, Northeast Forestry University, Harbin, 150040, People's Republic of China
| | - Hongbo Mu
- College of Science, Northeast Forestry University, Harbin, 150040, People's Republic of China
| |
Collapse
|
33
|
Scheffer JA, Levan DT, Wells JL, Gallagher-Thompson D, Grimm KJ, Chen KH, Brown CK, Bullard BM, Yee CI, Newton SL, Chen EY, Merrilees JJ, Moss D, Wang G, Levenson RW. In-Home Assistive Technology May Help Protect Dementia Caregivers from Declining Sleep Efficiency: A Randomized Control Trial. Clin Gerontol 2025:1-14. [PMID: 40400304 DOI: 10.1080/07317115.2025.2499812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2025]
Abstract
OBJECTIVES Caregivers for people with dementia (PWDs) often experience sleep problems due to stressors associated with their role (e.g. concern about PWDs' nighttime wandering). We investigated whether a technology system, People Power Caregiver (PPCg), that helps monitor the caregiver's home would benefit caregivers' sleep. METHODS Primary caregivers of PWDs (Study 1: N = 70, Age M = 64.54, SD = 11.82, range = 35-84; Study 2: N = 92, Age M = 62.73, SD = 11.10, range = 32-89) were assigned to a fully activated PPCg condition or control condition (Study 1: partially active PPCg; Study 2: waitlist control). Caregivers completed the Pittsburgh Sleep Quality Index at baseline, three-months, and six-months. RESULTS Caregivers in the control conditions reported significantly worsening sleep efficiency whereas in comparison, those in the active conditions reported improving sleep efficiency. CONCLUSIONS Given how critical sleep is both for caregivers' health and the care they provide, these findings underscore potential benefits of in-home technologies for protecting caregivers' sleep. CLINICAL IMPLICATIONS Technology-based interventions that help monitor the home may support caregivers' sleep. Protecting caregivers' sleep may also preserve their ability to provide high-quality care as their loved one's disease and associated functional decline progresses.
Collapse
Affiliation(s)
- Julian A Scheffer
- Department of Psychology, University of California, Berkeley, California, USA
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Darius T Levan
- Department of Psychology, University of California, Berkeley, California, USA
| | - Jenna L Wells
- Department of Psychology, Cornell University, Ithaca, New York, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences and School of Medicine, Stanford University, Stanford, California, USA
| | - Kevin J Grimm
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Kuan-Hua Chen
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Casey K Brown
- Department of Psychology, Georgetown University, Washington, DC, USA
| | - Breanna M Bullard
- Department of Psychology, University of California, Berkeley, California, USA
| | - Claire I Yee
- Department of Quantitative and Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Scott L Newton
- Department of Psychology, University of California, Berkeley, California, USA
| | - Enna Y Chen
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Jennifer J Merrilees
- Department of Neurology, Memory and Aging Center, San Francisco, California, USA
| | - David Moss
- People Power Company dba Care Daily Company
| | - Gene Wang
- People Power Company dba Care Daily Company
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, California, USA
| |
Collapse
|
34
|
Levenson RW, Merrilees J, Henry ML, Dronkers NF. Associations between dementia symptoms and caregiver and relationship health: A prominent role for speech and language. J Alzheimers Dis 2025:13872877251340578. [PMID: 40397128 DOI: 10.1177/13872877251340578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
BackgroundDementia is a significant public health issue globally. People with dementia (PWD) exhibit symptoms in multiple domains (e.g., cognition, emotion, motor, speech/language) that can vary in their impact on the caregiver and the PWD-caregiver relationship.ObjectiveWe assessed the relative impact of various dementia symptoms on caregiver health and well-being and on the PWD-caregiver relationship using a broad sampling of PWD symptoms and caregiver/relationship outcome measures.MethodsData were analyzed from 54 primary caregivers of PWDs who completed seven questionnaires assessing caregiver health and well-being and PWD-caregiver relationship quality. An exploratory factor analysis of these questionnaires revealed two primary factors: (a) General Distress (anxiety, burden, depression, general health, loneliness), and (b) Relationship Quality (interpersonal closeness, relationship satisfaction). Caregivers also rated nine categories of PWD symptoms (memory, executive functions, speech/language, visual/spatial, motor, changes in behavior, sleep, medical/sensory, activities of daily living).ResultsGreater caregiver General Distress was associated with greater PWD speech/language and sleep symptoms. Lower caregiver Relationship Quality was associated (at trend, p < 0.10, levels) with greater PWD speech/language and activities of daily living symptoms. Correlations with the seven individual caregiver outcome measures revealed that speech/language symptoms were the most robust predictors (correlated with five measures), followed by sleep and activities of daily living symptoms (correlated with two measures), and memory, visual/spatial, and motor symptoms (correlated with one measure).ConclusionsFindings highlight the profound adverse effects that PWD speech and language deficits may have on caregivers and underscore the importance of addressing these deficits in dementia care.
Collapse
Affiliation(s)
- Robert W Levenson
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Jennifer Merrilees
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, Austin, TX, USA
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, CA, USA
| |
Collapse
|
35
|
Luchsinger JA, Teresi JA, Valdez L, Rosario D, de Miguel M, Taylor D, Singer J, Chang N, Fuller WS, Boquín C, Silver S, Eimicke JP, Kong J, Goldberg TE, Devanand DP. Performance of a smell identification test versus the Mini-Mental Status Exam for the detection of dementia and cognitive impairment among persons with cognitive concerns in primary care. J Alzheimers Dis 2025:13872877251345083. [PMID: 40397401 DOI: 10.1177/13872877251345083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
BackgroundOdor identification deficits predict Alzheimer's disease (AD) in epidemiological studies.ObjectiveTo compare the accuracy of a short odor identification test with a short cognitive screening test for the detection of dementia and cognitive impairment in elderly persons with cognitive concerns.MethodsThis was a cross-sectional study of 600 participants 65 years and older, without known mild cognitive impairment (MCI) or dementia, with cognitive concerns, attending primary care practices in New York City. The odor identification test was the Brief Smell Identification Test (BSIT). The comparator test was the Mini Mental Status Exam II (MMSE). Cognitive diagnoses were made using the National Alzheimer's Coordinating Center Uniform Data set (NACC-UDS) version 3 forms with slight modifications. Test performance was compared using Receiver Operating Characteristic analyses.ResultsThe mean age was 72.65 ± 6.31 years, 73.3% were female, 63.3% were Hispanic, 13.5% non-Hispanic Black, and 20.8% non-Hispanic White; 23.5% were classified as normal cognition, 27.7% as cognitive impairment-not mild cognitive impairment (MCI), 31.2% as amnestic MCI, 5.7% as non-amnestic MCI, and 12% as dementia. The MMSE was superior to the BSIT in detecting dementia and any cognitive impairment. Combining abnormal scores in the BSIT (≤8) to MMSE (≤24) improved the MMSE's specificity and positive predictive value (PPV) in detecting cognitive impairment.ConclusionsThe MMSE was superior to the BSIT in detecting dementia and cognitive impairment in primary care but using both tests improved specificity and PPV for identifying persons with subjective complaints needing further cognitive and biomarker evaluation.
Collapse
Affiliation(s)
- José A Luchsinger
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Joseph P. Mailman School of Public Health, CUIMC, New York, NY, USA
| | - Jeanne A Teresi
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Columbia University Stroud Center at the New York State Psychiatric Institute, New York, NY, USA
| | - Lenfis Valdez
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Dahiana Rosario
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria de Miguel
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Ambulatory Care Network, New York Presbyterian Hospital, New York, NY, USA
| | - Delphine Taylor
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Ambulatory Care Network, New York Presbyterian Hospital, New York, NY, USA
| | - Jessica Singer
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Ambulatory Care Network, New York Presbyterian Hospital, New York, NY, USA
| | - Nancy Chang
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Ambulatory Care Network, New York Presbyterian Hospital, New York, NY, USA
| | - William S Fuller
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Ambulatory Care Network, New York Presbyterian Hospital, New York, NY, USA
| | - Cyrus Boquín
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Ambulatory Care Network, New York Presbyterian Hospital, New York, NY, USA
| | - Stephanie Silver
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph P Eimicke
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Jian Kong
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Terry E Goldberg
- Department of Psychiatry, College of Physicians and Surgeons, CUIMC, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Davangere P Devanand
- Department of Psychiatry, College of Physicians and Surgeons, CUIMC, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
36
|
Zueva I, Belyaev G, Petrov K. Disease-modifying effect of donepezil on APP/PS1 mice at different stages of Alzheimer's disease. Mol Cell Biochem 2025:10.1007/s11010-025-05310-2. [PMID: 40399637 DOI: 10.1007/s11010-025-05310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 05/09/2025] [Indexed: 05/23/2025]
Abstract
Despite Alzheimer's disease (AD) representing a significant global health concern, disease-modifying therapeutic options remain elusive. The use of animal models of the disease to develop drugs intended for the treatment of AD does not always predict their efficacy in clinical trials. Our research demonstrates the benefits of a drug-withdrawal approach to screening AD-modifying compounds, focussing on β-amyloid (Aβ)-related pathological changes in APP/PS1 transgenic mice at different stages of the disease. To assess the efficacy of this approach, we examined the AD-modifying effect of donepezil as a reference drug. A significant cognitive decline exhibited by APP/PS1 transgenic mice from 8.4 months of age was accompanied by progressive accumulation of Aβ plaques, decreased synaptophysin and vesicular acetylcholine transporter immunoexpression. Donepezil had a disease-modifying effect, slowing the deterioration of all the pathological markers studied when treatment was started in a pre-symptomatic stage of AD. However, in the group of mice with advanced stage of AD, such disease-modifying effects were not evident.
Collapse
Affiliation(s)
- Irina Zueva
- Arbuzov Institute of Organic and Physical Chemistry, Federal Research Center "Kazan Scientific Center of the Russian Academy of Sciences", Kazan, Russia.
| | - Grigory Belyaev
- Arbuzov Institute of Organic and Physical Chemistry, Federal Research Center "Kazan Scientific Center of the Russian Academy of Sciences", Kazan, Russia
| | - Konstantin Petrov
- Arbuzov Institute of Organic and Physical Chemistry, Federal Research Center "Kazan Scientific Center of the Russian Academy of Sciences", Kazan, Russia
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| |
Collapse
|
37
|
Mitrovic M, Selakovic D, Jovicic N, Ljujic B, Rosic G. BDNF/proBDNF Interplay in the Mediation of Neuronal Apoptotic Mechanisms in Neurodegenerative Diseases. Int J Mol Sci 2025; 26:4926. [PMID: 40430064 PMCID: PMC12112594 DOI: 10.3390/ijms26104926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2025] [Revised: 05/12/2025] [Accepted: 05/20/2025] [Indexed: 05/29/2025] Open
Abstract
The neurotrophic system includes neurotrophins, such as brain-derived neurotrophic factor (BDNF) and its precursor proBDNF, which play conflicting roles in neuronal survival and apoptosis, with their balance having a significant impact on neurodegenerative outcomes. While BDNF is widely acknowledged as a potent neurotrophin that promotes neuronal survival and differentiation, its precursor, proBDNF, has the opposite effect, promoting apoptosis and neuronal death. This review highlights the new and unique aspects of BDNF/proBDNF interaction in the modulation of neuronal apoptotic pathways in neurodegenerative disorders. It systematically discusses the cross-talk in apoptotic signaling at the molecular level, whereby BDNF activates survival pathways such as PI3K/Akt and MAPK/ERK, whereas proBDNF activates p75NTR and sortilin to induce neuronal apoptosis via JNK, RhoA, NFkB, and Rac-GTPase pathways such as caspase activation and mitochondrial injury. Moreover, this review emphasizes the factors that affect the balance between proBDNF and BDNF levels within the context of neurodegeneration, including proteolytic processing, the expression of TrkB and p75NTR receptors, and extrinsic gene transcription regulators. Cellular injury, stress, or signaling pathway alterations can disrupt the balance of BDNF/proBDNF, which may be involved in apoptotic-related neurodegenerative diseases like Alzheimer's, Parkinson's, and Huntington's diseases. This review provides a comprehensive framework for targeting neurotrophin signaling in the development of innovative therapies for neuronal survival and managing apoptotic-related neurodegenerative disorders, addressing the mechanistic complexity and clinical feasibility of BDNF/proBDNF interaction.
Collapse
Affiliation(s)
- Marina Mitrovic
- Department of Medical Biochemistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Dragica Selakovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Nemanja Jovicic
- Department of Histology and Embryology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Biljana Ljujic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Gvozden Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| |
Collapse
|
38
|
Heo G, Xu Y, Wang E, Ali M, Oh HSH, Moran-Losada P, Anastasi F, González Escalante A, Puerta R, Song S, Timsina J, Liu M, Western D, Gong K, Chen Y, Kohlfeld P, Flynn A, Thomas AG, Lowery J, Morris JC, Holtzman DM, Perlmutter JS, Schindler SE, Vilor-Tejedor N, Suárez-Calvet M, García-González P, Marquié M, Fernández MV, Boada M, Cano A, Ruiz A, Zhang B, Bennett DA, Benzinger T, Wyss-Coray T, Ibanez L, Sung YJ, Cruchaga C. Large-scale plasma proteomic profiling unveils diagnostic biomarkers and pathways for Alzheimer's disease. NATURE AGING 2025:10.1038/s43587-025-00872-8. [PMID: 40394224 DOI: 10.1038/s43587-025-00872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 04/09/2025] [Indexed: 05/22/2025]
Abstract
Proteomic studies have been instrumental in identifying brain, cerebrospinal fluid and plasma proteins associated with Alzheimer's disease (AD). Here, we comprehensively examined 6,905 aptamers corresponding to 6,106 unique proteins in plasma in more than 3,300 well-characterized individuals to identify new proteins, pathways and predictive models for AD. We identified 416 proteins (294 new) associated with clinical AD status and validated the findings in two external datasets representing more than 7,000 samples. AD-related proteins reflected blood-brain barrier disruption and other processes implicated in AD, such as lipid dysregulation or immune responses. A machine learning model was used to identify a set of seven proteins that were highly predictive of both clinical AD (area under the curve (AUC) of >0.72) and biomarker-defined AD status (AUC of >0.88), which were replicated in multiple external cohorts and orthogonal platforms. These findings underscore the potential of using plasma proteins as biomarkers for the early detection and monitoring of AD and for guiding treatment decisions.
Collapse
Affiliation(s)
- Gyujin Heo
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Ying Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Erming Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Hamilton Se-Hwee Oh
- Graduate Program in Stem Cell and Regenerative Medicine, Stanford University, Stanford, CA, USA
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Patricia Moran-Losada
- The Phil and Penny Knight Initiative for Brain Resilience, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Federica Anastasi
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Armand González Escalante
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Raquel Puerta
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- PhD Program in Biotechnology, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Soomin Song
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Jigyasha Timsina
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Menghan Liu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Daniel Western
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Katherine Gong
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Yike Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Pat Kohlfeld
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Allison Flynn
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Alvin G Thomas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - Joseph Lowery
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - David M Holtzman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Hope Center for Neurologic Diseases, Washington University, St. Louis, MO, USA
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO, USA
| | - Joel S Perlmutter
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Suzanne E Schindler
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Natalia Vilor-Tejedor
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- Department of Genetics, Radboud UMC, Nijmegen, Netherlands
| | - Marc Suárez-Calvet
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | - Pablo García-González
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Madrid, Spain
| | - Marta Marquié
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Madrid, Spain
| | - Maria Victoria Fernández
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Madrid, Spain
| | - Mercè Boada
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Madrid, Spain
| | - Amanda Cano
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Madrid, Spain
| | - Agustín Ruiz
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Madrid, Spain
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
| | - Bin Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Tammie Benzinger
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tony Wyss-Coray
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Laura Ibanez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yun Ju Sung
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
- NeuroGenomics and Informatics Center, Washington University, St. Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
- Hope Center for Neurologic Diseases, Washington University, St. Louis, MO, USA.
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO, USA.
| |
Collapse
|
39
|
Zhao K, Xue Y, Li B. Self-assembled cysteine-copper chiral nanoparticles for inhibiting aggregation of amyloid β peptides. J Mater Chem B 2025. [PMID: 40387858 DOI: 10.1039/d5tb00356c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
Inhibiting the aggregation of amyloid β (Aβ) peptides is a promising strategy for the treatment of Alzheimer's disease (AD). However, there have been very limited reports of highly effective inhibitors of Aβ aggregation in the past few decades. Herein, two types of nanoparticles (NPs) with opposite chirality were prepared through one-step assembly of L-cysteine (L-Cys) or D-cysteine (D-Cys) and Cu2+ at room temperature. L-Cys-Cu NPs and D-Cys-Cu NPs were able to inhibit the aggregation of Aβ42. Compared to their enantiomer L-Cys-Cu NPs, D-Cys-Cu NPs showed a larger binding affinity to Aβ42, leading to stronger inhibition of Aβ42 fibrillation. Moreover, D-Cys-Cu NPs were found to cause the disaggregation of Aβ42 fibrils. Due to their simple preparation, good biocompatibility and significant effects, these chiral Cys-Cu NPs have great potential in inhibiting protein aggregation.
Collapse
Affiliation(s)
- Kairen Zhao
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province, School of Chemistry & Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China.
| | - Yuanyuan Xue
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, National Engineering Laboratory for Resource Developing of Endangered Chinese Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an, 710119, China
| | - Baoxin Li
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province, School of Chemistry & Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China.
| |
Collapse
|
40
|
Du X, Gao B, Zhang J, Guo J. Dietary patterns and transition from normal cognition to mild cognitive impairment and its reversion: A longitudinal study of older adults. Clin Nutr 2025; 50:137-145. [PMID: 40414051 DOI: 10.1016/j.clnu.2025.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2025] [Revised: 05/07/2025] [Accepted: 05/13/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND The reversion from mild cognitive impairment (MCI) to normal cognition (NC) has received less attention than the progression to dementia. We aimed to estimate the MCI-to-NC reversion rate and examine dietary patterns associated with the cognitive transition among older adults. METHODS Longitudinal data from 11,211 adults aged 65 years and older were analyzed. Four dietary patterns including plant-based diet index (PDI), simplified healthy eating index (SHEI), dietary diversity score (DDS), and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) were assessed with the food frequency questionnaire. Cognitive function was quantified with the Mini-Mental State Examination. The multi-state Markov models were applied to estimate associations between each dietary pattern and transition of cognitive status with four states: NC, MCI, dementia, and death. RESULTS Participants (mean [SD] age, 85.80 [11.13] years; 6211 women [55.40 %] and 5000 men [44.60 %]) were followed over a mean time of 4.76 (SD = 3.14) years. The rate of reversion from MCI to NC was 9.4 %. Hazard ratios (HRs, 95 % confidence interval [CI]) for the progression from NC to MCI were 0.87 (0.77-0.97), 0.81 (0.73-0.91), 0.95 (0.92-0.99), and 0.95 (0.92-0.99) for dietary patterns of healthful PDI (hPDI), SHEI, DDS, and MIND, respectively. Besides, a better adherence to hPDI (HR = 1.21, 95 % CI = 1.03 to 1.43) and SHEI (HR = 1.20, 95 % CI = 1.02 to 1.41) was associated with increased likelihoods to revert from MCI to NC. CONCLUSIONS Dietary patterns of hPDI, SHEI, DDS, and MIND were linked to decreased risks of NC-to-MCI progression, and hPDI and SHEI were associated with higher likelihoods of MCI-to-NC reversion in older adults. Interventional studies with dietary patterns were warranted to confirm our findings.
Collapse
Affiliation(s)
- Xiaofu Du
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Bin Gao
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Jiangtao Zhang
- The Second Department of Geriatrics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Jing Guo
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China.
| |
Collapse
|
41
|
Wu S, Kan Y, Xiao P, Yang Y, Li H, Zhang W. Detection of donepezil concentration in serum by solid-phase extraction liquid chromatography-mass spectrometry based on magnetic molecularly imprinted polymer. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2025; 17:4027-4036. [PMID: 40326330 DOI: 10.1039/d5ay00267b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2025]
Abstract
Donepezil is a drug used to treat Alzheimer's disease, and its efficacy is closely related to the concentration of the drug in the serum. Therefore, monitoring the concentration of donepezil in the serum is crucial for evaluating the treatment effect and avoiding adverse reactions. In this study, a new method for determining the concentration of donepezil in serum was established by combining magnetic molecularly imprinted polymers (MMIPs) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology. The prepared magnetic molecularly imprinted polymers were characterized by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FT-IR), and transmission electron microscopy (TEM) to confirm that the polymer had effective imprinting and good magnetic responsivity. The adsorption experiment showed that the MMIPs had a saturated adsorption capacity of 15.4 mg g-1 for donepezil and the adsorption behavior followed the quasi-second-order kinetic model. The adsorption of donepezil by MMIPs was a chemical adsorption process. Finally, by combining LC-MS/MS technology, the method successfully achieved rapid, high selectivity, and high specificity separation and enrichment detection of donepezil in serum. The linear range of the method for donepezil in serum was 25-200 ng mL-1, the lowest detection limit was 0.33 ng mL-1, the recovery was 98.7-102.6%, and the relative standard deviation (RSD) was 1.2-4.5% (n = 3). The experiment confirmed that the method is simple and effective for detecting donepezil in serum.
Collapse
Affiliation(s)
- Shiwei Wu
- College of Materials and Chemistry, China Jiliang University, Hangzhou 310018, China
- Key Laboratory of Chemical Metrology and Applications on Nutrition, Health, State Administration for Market Regulation, Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China.
| | - Ying Kan
- Key Laboratory of Chemical Metrology and Applications on Nutrition, Health, State Administration for Market Regulation, Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China.
| | - Peng Xiao
- Key Laboratory of Chemical Metrology and Applications on Nutrition, Health, State Administration for Market Regulation, Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China.
| | - Yumeng Yang
- College of Materials and Chemistry, China Jiliang University, Hangzhou 310018, China
| | - Honemei Li
- Key Laboratory of Chemical Metrology and Applications on Nutrition, Health, State Administration for Market Regulation, Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China.
| | - Weifei Zhang
- Key Laboratory of Chemical Metrology and Applications on Nutrition, Health, State Administration for Market Regulation, Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China.
| |
Collapse
|
42
|
Liao X, Li Y, Zhang Z, Xiao Y, Yu X, Huang R, Zhong T. Associations of the body roundness index with cognitive function in US older adults and the mediating role of depression: a cross-sectional study from the NHANES 2011-2014. Sci Rep 2025; 15:16884. [PMID: 40374704 PMCID: PMC12081760 DOI: 10.1038/s41598-025-01383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 05/06/2025] [Indexed: 05/17/2025] Open
Abstract
The body roundness index (BRI) accurately assesses body composition and visceral fat distribution, but its independent associations with cognitive function and cognitive impairment remain unclear. This study, which is based on data from the 2011-2014 U.S. National Health and Nutrition Examination Survey (NHANES), explores the associations between the BRI and cognitive function as well as cognitive impairment in older adults. Weighted linear regression and weighted logistic regression models were used for data analysis. Restricted cubic spline (RCS) models, subgroup analysis, and mediation analysis were conducted to explore effect modification, nonlinear associations, and the mediating role of depression. The BRI score was negatively correlated with the cognitive function score (DSST score β = -0.63, P = 0.037; Sum Score β = -0.83, P = 0.042) and was not significantly associated with cognitive impairment. As the BRI score increases, both the DSST score (trend P = 0.013) and the Sum Score (trend P = 0.023) show a linear decrease. The mediation effect analysis revealed that depression mediated 39.4% of the association between the BRI score and cognitive function, suggesting that the effect may be indirectly mediated through mental health pathways. Subgroup analysis and RCS models did not reveal significant interaction effects or nonlinear associations.
Collapse
Affiliation(s)
- Xi Liao
- Faculty of Medicine, Macau University of Science and Technology, Taipa, 999078, Macao SAR, China
- School of Nursing, Xiangnan University, Chenzhou, 423000, China
| | - Yongwei Li
- Faculty of Medicine, Macau University of Science and Technology, Taipa, 999078, Macao SAR, China
| | - Zongyao Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, 232007, China
| | - Ying Xiao
- Faculty of Medicine, Macau University of Science and Technology, Taipa, 999078, Macao SAR, China
| | - Xi Yu
- Faculty of Medicine, Macau University of Science and Technology, Taipa, 999078, Macao SAR, China
| | - Ran Huang
- Yiwu Research Institute, Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China.
- Center for Innovation and Entrepreneurship, Taizhou Institute of Zhejiang University, Taizhou, 318000, Zhejiang, China.
| | - Tian Zhong
- Faculty of Medicine, Macau University of Science and Technology, Taipa, 999078, Macao SAR, China.
| |
Collapse
|
43
|
Poghosyan L, Dougherty M, Martsolf GR, Featherston K, Porat-Dahlerbruch J, Borson S, Sadak T, Wang S, O'Reilly-Jacob M. Dementia care management in primary care practices: a descriptive study among nurse practitioners. BMC PRIMARY CARE 2025; 26:164. [PMID: 40375125 PMCID: PMC12080150 DOI: 10.1186/s12875-025-02855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Accepted: 04/25/2025] [Indexed: 05/18/2025]
Abstract
BACKGROUND More than 55 million people worldwide have dementia, and every year, 10 million new cases are diagnosed. In the United States (U.S.) alone, 6.9 million Americans ages 65 and older have dementia. Health systems are searching for innovative solutions to expand the primary care system's capacity to care for these patients. Advanced practice nurses such as nurse practitioners (NPs) are vital to increasing primary care capacity to meet the need, yet primary care NPs often face structural, organizational, and workforce challenges. More specifically, little is known about NPs who care for dementia patients in primary care settings. This study explored the practice structural capabilities, organizational context, and job outcomes (i.e., burnout, job dissatisfaction, and intent to leave the practice) among NPs providing care for patients with dementia in U.S. primary care practices. METHODS We conducted a national cross-sectional survey of NPs using modified Dillman methods. Between 2021 and 2023, NPs working in primary care practices who cared for patients with dementia received a mail and online survey. Additional survey mailings, emails, postcard reminders, and phone calls encouraged non-respondents to participate. In total, 968 NPs responded across 847 practices. We estimated a response rate of 16.4-36.4%. RESULTS NPs reported that the quality of dementia care in their practices is poorer than the overall care provided. About 45% of NPs indicated that dementia care in their practices is less than "very good," while only 17% reported that the overall care delivered falls below that standard. Additionally, NPs reported significant deficits in practice structural capabilities for dementia care and challenges with administration within their organization. The findings show that over a third of NPs report burnout. CONCLUSIONS Given the projected growth in the number of patients with dementia and the growing workforce of NPs worldwide, policy and practice efforts should be directed toward strengthening primary care practices to provide quality care for dementia patients. Bolstering NP workforce capacity and supporting NP roles in dementia care could improve organizational capacity to provide dementia care. However, widespread burnout among NPs found in our study could undermine their contribution to the dementia care workforce.
Collapse
Affiliation(s)
- Lusine Poghosyan
- Center for Healthcare Delivery Research and Innovation, Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA.
| | - Maura Dougherty
- Center for Healthcare Delivery Research and Innovation, Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA
| | - Grant R Martsolf
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, 315B Victoria Building, 3500 Victoria Building, Pittsburgh, PA, 15261, USA
| | - Kyle Featherston
- Center for Healthcare Delivery Research and Innovation, Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA
| | - Josh Porat-Dahlerbruch
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, 315B Victoria Building, 3500 Victoria Building, Pittsburgh, PA, 15261, USA
| | - Soo Borson
- Department of Family Medicine, Keck USC School of Medicine, 1000 S. Fremont Ave., Unit 22 Building A-6, 4th Floor Alhambra, Los Angeles, CA, 91803, USA
| | - Tatiana Sadak
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Siqing Wang
- Center for Healthcare Delivery Research and Innovation, Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA
| | - Monica O'Reilly-Jacob
- Center for Healthcare Delivery Research and Innovation, Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA
| |
Collapse
|
44
|
Papadopoulou M, Stefanou MI, Bakola E, Moschovos C, Athanasaki A, Tsigkaropoulou E, Michopoulos I, Paraskevas GP, Gournellis R, Tsivgoulis G. Dysautonomia in Alzheimer's Disease: A Systematic Review. Brain Sci 2025; 15:502. [PMID: 40426673 PMCID: PMC12109965 DOI: 10.3390/brainsci15050502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2025] [Revised: 05/06/2025] [Accepted: 05/13/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Alzheimer's disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from either cholinergic deficits or hypothalamic involvement. A wide range of tests has been used to investigate the role of the autonomic nervous system; however, the results have been inconsistent. Aim: To systematically review all published research investigating autonomic nervous system (ANS) involvement in patients with AD. A comprehensive literature search was conducted in December 2024 across the following databases: PubMed, Cochrane Library, ScienceDirect, and Scopus. Results: A total of 1422 records were identified, of which 30 studies fulfilled the inclusion criteria and were included in the review. Several autonomic tests were employed, with Heart Rate Variability (HRV) being the most frequently used. Other tests included assessments of orthostatic hypotension (OH), postprandial hypotension (PPH), sympathetic skin response (SSR), the tilt test, 123I-MIBG cardiac scintigraphy, norepinephrine (NE) measurements in serum and cerebrospinal fluid, and baroreflex sensitivity. In most studies, AD patients were compared to either healthy controls or patients with other types of dementia. Discussion: The primary finding of this review is that, although patients with AD rarely report dysautonomic symptoms, they frequently exhibit abnormal results on various autonomic tests. In some cases, these findings were sufficient to differentiate AD patients from healthy controls as well as from patients with Diffuse Lewy Body disease (DLB). The inconsistency in reporting symptoms, along with the variability in test results, suggests that autonomic dysfunction in AD may be under-recognized and warrants further investigation. Conclusions: The heterogeneity of the included studies limits the generalizability of the results. However, given the potential impact of dysautonomia on both quality of life and mortality, it is recommended that AD patients be systematically assessed for autonomic dysfunction. Even in the absence of overt symptoms, appropriate treatment should be considered where indicated to mitigate potential risks.
Collapse
Affiliation(s)
- Marianna Papadopoulou
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.-I.S.); (E.B.); (C.M.); (A.A.); (G.P.P.); (G.T.)
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.-I.S.); (E.B.); (C.M.); (A.A.); (G.P.P.); (G.T.)
| | - Eleni Bakola
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.-I.S.); (E.B.); (C.M.); (A.A.); (G.P.P.); (G.T.)
| | - Christos Moschovos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.-I.S.); (E.B.); (C.M.); (A.A.); (G.P.P.); (G.T.)
| | - Athanasia Athanasaki
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.-I.S.); (E.B.); (C.M.); (A.A.); (G.P.P.); (G.T.)
| | - Evdoxia Tsigkaropoulou
- First Department of Psychiatry, Eginition University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Ioannis Michopoulos
- Second Department of Psychiatry, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (I.M.); (R.G.)
| | - George P. Paraskevas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.-I.S.); (E.B.); (C.M.); (A.A.); (G.P.P.); (G.T.)
| | - Rossetos Gournellis
- Second Department of Psychiatry, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (I.M.); (R.G.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.-I.S.); (E.B.); (C.M.); (A.A.); (G.P.P.); (G.T.)
| |
Collapse
|
45
|
Bao R, Chang S, Liu R, Wang Y, Guan Y. Research status of visuospatial dysfunction and spatial navigation. Front Aging Neurosci 2025; 17:1609620. [PMID: 40438501 PMCID: PMC12116631 DOI: 10.3389/fnagi.2025.1609620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2025] [Accepted: 04/30/2025] [Indexed: 06/01/2025] Open
Abstract
Visuospatial function is a critical aspect of cognitive abilities, encompassing visual perception, attention, memory, and adaptive responses to spatial changes. This paper reviews studies on human visuospatial function, spatial navigation, and factors contributing to visuospatial impairments. After introducing fundamental concepts of visuospatial function and spatial navigation, classical methods for assessing visuospatial performance are summarized. By examining recent advances in spatial navigation studies, this paper discusses factors influencing spatial navigation capabilities and explores how spatial navigation paradigms can be used to investigate visuospatial cognitive impairments. Finally, current limitations in spatial navigation research are highlighted. Overall, the current research has not yet reached definitive conclusions regarding visuospatial aspects. However, this paper aims to enhance the understanding of visuospatial dysfunction and spatial navigation, providing valuable references for future research.
Collapse
Affiliation(s)
- Rui Bao
- School of Intelligent Medicine, China Medical University, Shenyang, China
| | - Shijie Chang
- School of Intelligent Medicine, China Medical University, Shenyang, China
| | - Ruixiang Liu
- School of Intelligent Medicine, China Medical University, Shenyang, China
| | - Yunning Wang
- School of Nursing, China Medical University, Shenyang, China
| | - Yifu Guan
- School of Intelligent Medicine, China Medical University, Shenyang, China
- Department of Biochemistry and Molecular Biology, China Medical University, Shenyang, China
| |
Collapse
|
46
|
Xing Y, Zhang L, Liu P, Pan Y, Tang Z, Ma L. Self-reported motoric cognitive risk syndrome predicts long-term mortality in older adults. J Nutr Health Aging 2025; 29:100578. [PMID: 40373390 DOI: 10.1016/j.jnha.2025.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 04/25/2025] [Accepted: 04/29/2025] [Indexed: 05/17/2025]
Abstract
OBJECTIVES Motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by slow gait and subjective cognitive decline, increasing the risk of adverse clinical events such as dementia and falls in older adults. However, whether self-reported MCR (sMCR) predicts long-term mortality in Chinese older adults remains unknown. This study aimed to explore the role of sMCR in 8-year mortality in community-dwelling older adults. DESIGN Longitudinal cohort study. SETTING Data were sourced from the Beijing Longitudinal Study of Aging. PARTICIPANTS A total of 1,683 community-dwelling individuals aged 65 years and older who were free from disability and dementia at baseline were included. MEASUREMENTS sMCR was defined based on the presence of subjective cognitive decline and self-reported slow gait. Mortality data were tracked over the 8-year follow-up period. Cox regression models were used to analyze the association between sMCR and 8-year mortality. RESULTS A total of 113 (6.71%) community-dwelling individuals had sMCR. sMCR was associated with female sex, older age, no spouse, living in rural areas, low education level, low monthly income, no work, no tea intake, poor sleep quality, inactivity, poor physical performance, chronic diseases, and frailty. Participants with sMCR had a higher 8-year mortality compared to those without (70.80% vs. 34.52%). Cox regression analysis showed that sMCR predicted 8-year mortality (hazard ratio [HR] = 2.859, 95% confidence interval [CI] 2.260-3.619). This association remained significant even after adjusting for sex, age, area, education level, marital status, chronic diseases, and lifestyle factors (HR = 1.540, 95% CI 1.169-2.028). CONCLUSIONS sMCR is a predictor of 8-year mortality in Chinese community-dwelling older adults, which highlights the importance of early identification and intervention for sMCR to reduce adverse clinical outcomes in the aging population.
Collapse
Affiliation(s)
- Yiwen Xing
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Medicine, Beijing 100053, China
| | - Li Zhang
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Medicine, Beijing 100053, China
| | - Pan Liu
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Medicine, Beijing 100053, China
| | - Yiming Pan
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Medicine, Beijing 100053, China
| | - Zhe Tang
- Beijing Geriatric Healthcare Center, Xuanwu Hospital Capital Medical University, Beijing Institute of Geriatrics, Beijing 100053, China
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Medicine, Beijing 100053, China.
| |
Collapse
|
47
|
Butovsky O, Rosenzweig N. Alzheimer's disease and age-related macular degeneration: Shared and distinct immune mechanisms. Immunity 2025; 58:1120-1139. [PMID: 40324382 DOI: 10.1016/j.immuni.2025.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 04/09/2025] [Accepted: 04/10/2025] [Indexed: 05/07/2025]
Abstract
Alzheimer's disease (AD) and age-related macular degeneration (AMD) represent the leading causes of dementia and vision impairment in the elderly, respectively. The retina is an extension of the brain, yet these two central nervous system (CNS) compartments are often studied separately. Despite affecting cognition vs. vision, AD and AMD share neuroinflammatory pathways. By comparing these diseases, we can identify converging immune mechanisms and potential cross-applicable therapies. Here, we review immune mechanisms highlighting the shared and distinct aspects of these two age-related neurodegenerative conditions, focusing on responses to hallmark disease manifestations, the opposite role of overlapping immune risk loci, and potential unified therapeutic approaches. We also discuss unique tissue requirements that may dictate different outcomes of conserved immune mechanisms and how we can reciprocally utilize lessons from AD therapeutics to AMD. Looking forward, we suggest promising directions for research, including the exploration of regenerative medicine, gene therapies, and innovative diagnostics.
Collapse
Affiliation(s)
- Oleg Butovsky
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Gene Lay Institute of Immunology and Inflammation, Brigham and Women's Hospital, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Neta Rosenzweig
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
48
|
Etnier JL, Wessinger CM, Herrera BM, Kayser KC. Chronic physical activity and the prevention of Alzheimer's disease. PSYCHOLOGY OF SPORT AND EXERCISE 2025; 80:102875. [PMID: 40374021 DOI: 10.1016/j.psychsport.2025.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Revised: 05/10/2025] [Accepted: 05/12/2025] [Indexed: 05/17/2025]
Abstract
The growing population of older adults and the lack of cure for Alzheimer's disease (AD) has resulted in researchers identifying modifiable lifestyle factors that might prevent or slow the progression of the disease. Prospective studies exploring the relationship between baseline physical activity (PA) and the subsequent risk of a diagnoses of AD and randomized controlled trials (RCTs) testing the effects of aerobic exercise (AE) and resistance exercise (RE) on cognitive performance, blood-based biomarkers of AD, and neuroimaging measures of brain health provide some intriguing results. Exemplars of these studies and results from meta-analytic reviews (when available) are presented to provide an overview of the state of the science. In general, results from prospective studies show that PA is protective, and results from RCTs show that AE improves cognitive performance by older adults who are cognitively normal and by those with mild cognitive impairment. Promising results have been observed for AE on measures of brain health, and studies exploring the effects on biomarkers have yielded some intriguing results but are less consistent to date. Studies testing the effects of RE also find benefits for cognitive performance by older adults and consistently show improvements in brain health. In conclusion, results from prospective studies and RCTs demonstrate the potential of exercise to improve cognition, brain health, and, to a lesser extent, blood-based biomarkers. Future research linking the magnitude of the findings from RCTs with evidence from prospective studies will advance our understanding of the potential of exercise to reduce the risk of AD.
Collapse
Affiliation(s)
- Jennifer L Etnier
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States.
| | - Chadsley M Wessinger
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States.
| | - Bryan Montero Herrera
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States.
| | - Kylie C Kayser
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States.
| |
Collapse
|
49
|
Scalzo P, Clevenger C, Cotter V. Knowledge, confidence, and behavioral changes after an Alzheimer's disease continuing education program for nurse practitioners. J Am Assoc Nurse Pract 2025:01741002-990000000-00294. [PMID: 40359180 DOI: 10.1097/jxx.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 03/26/2025] [Indexed: 05/15/2025]
Abstract
ABSTRACT Alzheimer's disease (AD) is a progressive, neurodegenerative disorder that currently affects an estimated 6.9 million people in the United States. Despite the growing prevalence of AD, management of this common condition remains suboptimal. To address knowledge and practice gaps related to cognitive evaluation and Alzheimer's diagnosis and treatment, the American Association of Nurse Practitioners (NPs) developed a 1.5-contact hour NP-focused continuing education (CE) program on AD. Changes in learner knowledge, competence, and confidence were assessed with preactivity and postactivity surveys; qualitative follow-up interviews were conducted to evaluate retention of CE material and behavior changes. In total, 4,793 learners (NPs, 93.6%) who completed the activity and self-reported providing patient care were included in the outcomes analysis. In the pre-activity assessment, notable knowledge and competence deficiencies were identified related to the diagnosis, classification, and pharmacotherapeutic management of AD. The CE activity was associated with significant improvements in knowledge and competence, with a 20-percentage point increase in correct response rate from the pre-activity to post-activity survey (p < .001). Learner confidence in their ability to perform key clinical tasks related to Alzheimer's management also improved. Twelve NPs participated in follow-up interviews; most reported that the CE activity reinforced their current practices. Despite improvements in knowledge and competence, certain knowledge gaps persisted, and learners identified several ongoing barriers to optimal management, including lack of access to specialists. Given the changing Alzheimer's landscape, ongoing educational interventions targeted to the NP workforce are needed to serve the growing population of adults at risk for AD.
Collapse
Affiliation(s)
- Patty Scalzo
- American Association of Nurse Practitioners, Austin, Texas
| | - Carolyn Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Valerie Cotter
- Johns Hopkins University School of Nursing and School of Medicine, Baltimore, Maryland
| |
Collapse
|
50
|
Xie Y, Wang S, Cha X, Li F, Xu Z, Wu J, Liu H, Ren W. Aging and chronic inflammation: impacts on olfactory dysfunction-a comprehensive review. Cell Mol Life Sci 2025; 82:199. [PMID: 40355677 PMCID: PMC12069206 DOI: 10.1007/s00018-025-05637-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Revised: 02/04/2025] [Accepted: 02/23/2025] [Indexed: 05/14/2025]
Abstract
Olfactory dysfunction (OD) is a common nasal disease, particularly prevalent among the elderly population, significantly impacting the affected individuals' quality of life. This review focuses on the influence of aging and chronic inflammation on olfactory dysfunction, presenting insights from both the peripheral and central olfactory systems. By exploring the molecular mechanisms and pathological changes underlying the occurrence of olfactory dysfunction in relation to age-related diseases and chronic inflammation conditions, we aim to provide a comprehensive theoretical foundation for further research and offer valuable insights for more effective treatment of olfactory dysfunction.
Collapse
Affiliation(s)
- Yingqi Xie
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China
| | - Shenglei Wang
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China
| | - Xudong Cha
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China
| | - Fengzhen Li
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China
| | - Zengyi Xu
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China
| | - Jian Wu
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China.
| | - Huanhai Liu
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China.
| | - Wenwen Ren
- Department of Otolaryngology, The Second Affiliated Hospital of the Naval Medical University, Shanghai Changzheng Hospital, Shanghai, China.
| |
Collapse
|