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Makri M, Gkioka M, Moraitou D, Fidani L, Tegos T, Tsolaki M. Attitudes, Motivations, and Barriers to Pre-Symptomatic Alzheimer's Disease Screening: Development and Validation of the 'Perceptions regarding pRE-symptomatic Alzheimer's Disease Screening' (PRE-ADS) Questionnaire. J Alzheimers Dis 2023; 95:1163-1174. [PMID: 37661876 DOI: 10.3233/jad-220954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Pre-symptomatic screening methods for detecting a higher risk of Alzheimer's disease (AD) are gaining popularity; thus, more people are seeking these tests. However, to date, not much is known about the attitudes toward pre-symptomatic AD screening. OBJECTIVE The goal of this study is to examine the psychometric properties of a tool for assessing the attitudes, barriers, and motivations to pre-symptomatic AD screening. METHODS This is a cross-sectional study performed on 208 Greek participants (189 students and 19 caregivers) provided with an online questionnaire. Psychometric properties were assessed through the examination of its construct validity (principal component analysis) and internal consistency. RESULTS Exploratory factor analysis revealed the presence of four factors. The first factor is labeled as "Perceived harms of testing" (10 items), the second "Acceptance of testing" (5 items), the third "Perceived benefits of testing" (6 items), and the fourth factor "Need for knowledge" (4 items). The reliability (internal consistency) of each factor separately was acceptable to good (0.70-0.87) while the internal consistency of the overall questionnaire (25 items) was good (Cronbach's α=0.82). CONCLUSION PRE-ADS is a valid questionnaire that might help in the research of peoples' attitudes related to the pros and cons of pre-symptomatic screening for AD, and the development of effective counseling programs and prevention strategies. However, future research is required in the target population.
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Affiliation(s)
- Marina Makri
- Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Association of Alzheimer Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mara Gkioka
- Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Moraitou
- Department of Experimental and Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Liana Fidani
- Department of Medical Biology-Genetics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magdalini Tsolaki
- Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Association of Alzheimer Disease and Related Disorders, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mehrani I, Sachdev PS. The role of Memory Clinics in the assessment and management of dementia, now and into the future. Curr Opin Psychiatry 2022; 35:118-122. [PMID: 35026801 DOI: 10.1097/yco.0000000000000777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of dementia is often delayed and many individuals with the disorder go undiagnosed or receive an inadequate assessment. Specialist Memory Clinics have long been at the centre of such assessments. Recent developments in biomarkers and disease-modifying treatments are likely increase the need for specialist assessments. It is therefore timely to review the role of Memory Clinics internationally. RECENT FINDINGS The timely diagnosis of dementia and cognitive decline is the main responsibility of Memory Clinics. These clinics can diagnose dementia up to 4 years earlier than primary care services, but their low numbers and capacity of leads to long waiting times and a focus on complex cases. Few clinics are resourced to offer specific postdiagnostic support services, and their roles in clinical trials and research have not been realised. They are often well integrated with primary care and aged care services. SUMMARY Memory Clinics play an important role in bridging the gap between research and clinical practice and providing high-quality assessment and care. Additional Memory Clinic services and greater harmonisation of their responsibilities and procedures are needed to exploit their full potential.
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Affiliation(s)
- Inga Mehrani
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, The University of New South Wales
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, The University of New South Wales
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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Jan DL, Delfine D, Eileen VDP, Herlinde VE, Jan S, Birgitte S. The management of dementia by flemish GPs: it remains a difficult job. Acta Clin Belg 2021; 76:264-271. [PMID: 31996112 DOI: 10.1080/17843286.2020.1716462] [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: 10/25/2022]
Abstract
Objective: The following study examines how GPs in Flanders deal with dementia in terms of detection, diagnosis, care diagnosis and treatment.Methods: An online survey was sent out by mail to 5113 Flemish GP's. Data were collected in 2016. The results were processed in a univariate and multivariate analysis with SAS 9.4Results: 331 GPs completed the survey in full (response rate 6.47%). The results are representative of GPs of the Flemish Region in terms of distribution across the provinces and university of graduation. 82.78% use the MMSE and 5.44% the DSM criteria. A blood analysis was performed by 80.97%, aCT or MRI by 23.56% and 17,22% respectively. Nine out of 331 mapped out the full care planning. The Katz scale was used rarely or never by 25.38%. The physical condition of the caregivers was enquired about by 91.69% and their mental state by 96.92%. Acetylcholinesterase inhibitors were prescribed by 94.56%, memantine by 57.70%, ginkgo biloba by 49.85%. 89.73% prefers a medical approach for hallucinations and delusions, 65.26% for aggression, 50.78% for agitation, 71.30% for depression and 48.34% for sleep disorders. Older GPs felt their knowledge was insufficient and used more pharmacological treatments.Conclusion: GPs are unfamiliar with available detection and diagnostic possibilities. GPs include history taking of carers but underuse available support tools, biochemical analyses and imaging. Post diagnostic care is mapped out insufficiently, despite the fact that GPs focus adequately on their patients' caregivers. In the pharmacological treatment there is a notable discrepancy between what GPs think and do. Pharmacological policy in behavioural bymptoms is most common. GPs highly value the possibility of receiving support by reference physicians.
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Affiliation(s)
- De Lepeleire Jan
- Department General Practice, University Leuven, Belgium
- University Psychiatric Hospital KU Leuven (UPC), Belgium
| | - Despriet Delfine
- Department General Practice, Master Education Program, University Leuven, Belgium
| | - Van De Putte Eileen
- Department General Practice, Master Education Program, University Leuven, Belgium
| | - Van Eecke Herlinde
- Department General Practice, Master Education Program, University Leuven, Belgium
| | - Steyaert Jan
- Department of Sociology, Expertisecentrum Dementie, Antwerp, Belgium
- University Antwerp
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He J, Han J, Xin C. WITHDRAWN: Research on the "integration of physical activity and medicine" prevention scheme of chronic disease population based on health risk assessment. Work 2021:WOR205363. [PMID: 34308881 DOI: 10.3233/wor-205363] [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: 11/15/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
- Jiali He
- Sports Science College of Lingnan Normal University, Zhangjiang, China
| | - Jinyong Han
- Sports Science College of Lingnan Normal University, Zhangjiang, China
| | - Changcheng Xin
- Graduate School, Jose Rizal University, Mandaluyong City, Metro Manila, Philippines
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2020 update on the clinical validity of cerebrospinal fluid amyloid, tau, and phospho-tau as biomarkers for Alzheimer's disease in the context of a structured 5-phase development framework. Eur J Nucl Med Mol Imaging 2021; 48:2121-2139. [PMID: 33674895 PMCID: PMC8175301 DOI: 10.1007/s00259-021-05258-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Purpose In the last decade, the research community has focused on defining reliable biomarkers for the early detection of Alzheimer’s disease (AD) pathology. In 2017, the Geneva AD Biomarker Roadmap Initiative adapted a framework for the systematic validation of oncological biomarkers to cerebrospinal fluid (CSF) AD biomarkers—encompassing the 42 amino-acid isoform of amyloid-β (Aβ42), phosphorylated-tau (P-tau), and Total-tau (T-tau)—with the aim to accelerate their development and clinical implementation. The aim of this work is to update the current validation status of CSF AD biomarkers based on the Biomarker Roadmap methodology. Methods A panel of experts in AD biomarkers convened in November 2019 at a 2-day workshop in Geneva. The level of maturity (fully achieved, partly achieved, preliminary evidence, not achieved, unsuccessful) of CSF AD biomarkers was assessed based on the Biomarker Roadmap methodology before the meeting and presented and discussed during the workshop. Results By comparison to the previous 2017 Geneva Roadmap meeting, the primary advances in CSF AD biomarkers have been in the area of a unified protocol for CSF sampling, handling and storage, the introduction of certified reference methods and materials for Aβ42, and the introduction of fully automated assays. Additional advances have occurred in the form of defining thresholds for biomarker positivity and assessing the impact of covariates on their discriminatory ability. Conclusions Though much has been achieved for phases one through three, much work remains in phases four (real world performance) and five (assessment of impact/cost). To a large degree, this will depend on the availability of disease-modifying treatments for AD, given these will make accurate and generally available diagnostic tools key to initiate therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05258-7.
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An integrative review of system-level factors influencing dementia detection in primary care. J Am Assoc Nurse Pract 2020; 32:299-305. [PMID: 31274678 DOI: 10.1097/jxx.0000000000000230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of Alzheimer disease (AD) is increasing in the United States, yet more than half of the people with AD are diagnosed late in the course of the disease. Most are identified outside primary care. New approaches to prevention and treatment mean that early detection of AD may improve the quality of life of those affected by the disease. Nurse practitioners (NPs) have an important role in increasing early diagnosis of AD.The purpose of this systematic literature review is to identify health care system factors that contribute to missed or delayed diagnosis of dementia by primary care providers. METHODS Articles were identified through a systematic electronic search of the following databases: MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Results indicate considerable variation in the diagnostic accuracy of dementia by primary care providers. Missed or underdiagnosis of dementia results from organizational, provider, and patient factors. New treatments are under investigation that may slow the progression of AD much better than current therapy, emphasizing the need to improve early detection by clinicians, especially primary care NPs.
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Rosenberg A, Coley N, Soulier A, Kulmala J, Soininen H, Andrieu S, Kivipelto M, Barbera M. Experiences of dementia and attitude towards prevention: a qualitative study among older adults participating in a prevention trial. BMC Geriatr 2020; 20:99. [PMID: 32164544 PMCID: PMC7068959 DOI: 10.1186/s12877-020-1493-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A better insight into older adults' understanding of and attitude towards cognitive disorders and their prevention, as well as expectations and reasons for participation in prevention trials, would help design, conduct, and implement effective preventive interventions. This qualitative study aimed at exploring the knowledge and perceptions of cognitive disorders and their prevention among participants in a prevention trial. METHODS Semi-structured interviews were conducted among the participants of a multinational randomised controlled trial testing the efficacy of a lifestyle-based eHealth intervention in preventing cardiovascular disease or cognitive decline in community dwellers aged 65+. Participants were probed on their reasons for participation in the trial and their views on general health, cardiovascular disease, ageing, and prevention. The subset of data focusing on cognitive disorders (15 interviewees; all in Finland) was considered for this study. Data were analysed using content analysis. RESULTS Participants' knowledge of the cause and risk factors of cognitive disorders and prevention was limited and superficial, and a need for up-to-date, reliable, and practical information and advice was expressed. Cognitive disorders evoked fear and concern, and feelings of hopelessness and misery were frequently expressed, indicating a stigma. Strong heredity of cognitive disorders was a commonly held belief, and opinions on the possibility of prevention were doubtful, particularly in relation to primary prevention. Family history and/or indirect experiences of cognitive disorders was a recurrent theme and it showed to be linked to both the knowledge of and feelings associated with cognitive disorders, as well as attitude towards prevention. Indirect experiences were linked to increased awareness and knowledge, but also uncertainty about risk factors and possibility of prevention. Distinct fear and concerns, particularly over one's own cognition/risk, and high motivation towards engaging in prevention and participating in a prevention trial were also identified in connection to this theme. CONCLUSIONS Family history and/or indirect experiences of cognitive disorders were linked to sensitivity and receptiveness to brain health and prevention potential. Our findings may be helpful in addressing older adults' expectations in future prevention trials to improve recruitment, maximise adherence, and facilitate the successful implementation of interventions.
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Affiliation(s)
- Anna Rosenberg
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Nicola Coley
- LEASP, UMR 1027, INSERM/Université Toulouse III Paul Sabatier, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Alexandra Soulier
- LEASP, UMR 1027, INSERM/Université Toulouse III Paul Sabatier, University of Toulouse, Toulouse, France
| | - Jenni Kulmala
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurocenter Finland, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Sandrine Andrieu
- LEASP, UMR 1027, INSERM/Université Toulouse III Paul Sabatier, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
| | - Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Watson R, Bryant J, Sanson-Fisher R, Mansfield E, Evans TJ. What is a 'timely' diagnosis? Exploring the preferences of Australian health service consumers regarding when a diagnosis of dementia should be disclosed. BMC Health Serv Res 2018; 18:612. [PMID: 30081889 PMCID: PMC6080387 DOI: 10.1186/s12913-018-3409-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently the dementia field has shifted focus away from the early diagnosis debate in favour of 'timely' diagnosis. 'Timely' diagnosis disclosure takes into consideration the preferences and unique circumstances of the individual. Determining when diagnosis disclosure is 'timely' may be particularly complex if there are differing views between the individual, their family, and their health care providers regarding disclosure. This study explores the preferences of consumers regarding when a diagnosis of dementia should be communicated. METHODS A cross-sectional survey was conducted with English-speaking adults attending outpatient clinics at an Australian hospital. Participants were recruited by a research assistant in the clinic waiting room and invited to complete the survey on a web-connected iPad. The survey included questions examining socio-demographics and experience with dementia. Two scenarios were used to explore preferences for timing of diagnosis disclosure. RESULTS Of 446 participants, 92% preferred a diagnosis of dementia to be disclosed as soon as possible. Preferences were not associated with socio-demographics or previous dementia experience. Most participants also preferred disclosure to occur as soon as possible if their spouse or partner was diagnosed with dementia (88%). There was strong correlation between preferences for self and preferences for spouse (0.91). CONCLUSIONS These findings provide guidance to health care providers about preferences for disclosure of a dementia diagnosis, and may help to overcome potential barriers to timely diagnosis. As the prevalence of dementia increases, consumers' preference for diagnosis to occur as soon as possible has important implications for the health system.
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Affiliation(s)
- Rochelle Watson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, W4 HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | - Tiffany-Jane Evans
- Hunter Medical Research Institute, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
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Liu XQ, Peng DH, Wang YP, Xie R, Chen XL, Yu CQ, Li XT. Diagnostic Accuracy of Chinese Medicine Diagnosis Scale of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: A Study Protocol. Chin J Integr Med 2018; 25:515-520. [PMID: 29721788 DOI: 10.1007/s11655-018-2793-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Phlegm and blood stasis syndrome (PBSS) is one of the main syndromes in coronary heart disease (CHD). Syndromes of Chinese medicine (CM) are lack of quantitative and easy-implementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. OBJECTIVE To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. METHODS Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic (ROC) curve. DISCUSSION This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study. (No. ChiCTR-OOC-15006599).
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Affiliation(s)
- Xiao-Qi Liu
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Dan-Hong Peng
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Yan-Ping Wang
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Rong Xie
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xin-Lin Chen
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Chun-Quan Yu
- Journal Editorial Board, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Xian-Tao Li
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
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Lawrence E, Vegvari C, Ower A, Hadjichrysanthou C, De Wolf F, Anderson RM. A Systematic Review of Longitudinal Studies Which Measure Alzheimer's Disease Biomarkers. J Alzheimers Dis 2018; 59:1359-1379. [PMID: 28759968 PMCID: PMC5611893 DOI: 10.3233/jad-170261] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Alzheimer’s disease (AD) is a progressive and fatal neurodegenerative disease, with no effective treatment or cure. A gold standard therapy would be treatment to slow or halt disease progression; however, knowledge of causation in the early stages of AD is very limited. In order to determine effective endpoints for possible therapies, a number of quantitative surrogate markers of disease progression have been suggested, including biochemical and imaging biomarkers. The dynamics of these various surrogate markers over time, particularly in relation to disease development, are, however, not well characterized. We reviewed the literature for studies that measured cerebrospinal fluid or plasma amyloid-β and tau, or took magnetic resonance image or fluorodeoxyglucose/Pittsburgh compound B-positron electron tomography scans, in longitudinal cohort studies. We summarized the properties of the major cohort studies in various countries, commonly used diagnosis methods and study designs. We have concluded that additional studies with repeat measures over time in a representative population cohort are needed to address the gap in knowledge of AD progression. Based on our analysis, we suggest directions in which research could move in order to advance our understanding of this complex disease, including repeat biomarker measurements, standardization and increased sample sizes.
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Affiliation(s)
- Emma Lawrence
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Carolin Vegvari
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Alison Ower
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | | | - Frank De Wolf
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,Janssen Prevention Center, Leiden, The Netherlands
| | - Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Mate KE, Magin PJ, Brodaty H, Stocks NP, Gunn J, Disler PB, Marley JE, Pond CD. An evaluation of the additional benefit of population screening for dementia beyond a passive case-finding approach. Int J Geriatr Psychiatry 2017; 32:316-323. [PMID: 26988976 DOI: 10.1002/gps.4466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE General practitioners (GPs) fail to identify more than 50% of dementia cases using the existing passive case-finding approach. Using data from the "Ageing in General Practice" study, we sought to establish the additional benefit of screening all patients over the age of 75 for dementia beyond those patients already identified by passive case-finding. METHOD Patients were classified as "case-finding" (n = 425) or "screening" (n = 1006) based on their answers to four subjective memory related questions or their GP's clinical judgement of their dementia status. Cognitive status of each patient was formally assessed by a research nurse using the Cambridge Cognition Examination (CAMCOG-R). Patients then attended their usual GP for administration of the GP assessment of Cognition (GPCOG) dementia screening instrument, and follow-up care and/or referral as necessary in light of the outcome. RESULTS The prevalence of dementia was significantly higher in the case-finding group (13.6%) compared to the screening group (4.6%; p < 0.01). The GPCOG had a positive predictive value (PPV) of 61% in the case-finding group and 39% in the screening group; negative predictive value was >95% in both groups. GPs and their patients both found the GPCOG to be an acceptable cognitive assessment tool. The dementia cases missed via case-finding were younger (p = 0.024) and less cognitively impaired (p = 0.020) than those detected. CONCLUSION There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening.
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Affiliation(s)
- Karen E Mate
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | - Parker J Magin
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Australia
| | - Nigel P Stocks
- Discipline of General Practice, School of Population Health, The University of Adelaide, SA, Australia
| | - Jane Gunn
- Department of General Practice The University of Melbourne, VIC, Australia
| | - Peter B Disler
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | - John E Marley
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | - C Dimity Pond
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
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12
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Tsvetkova DZ, Bergquist SH, Parker MW, Jarrett TL, Howell JC, Watts KD, Kollhoff A, Roberts DL, Hu WT. Fear and Uncertainty Do Not Influence Reported Willingness to Undergo Lumbar Punctures in a U.S. Multi-Cultural Cohort. Front Aging Neurosci 2017; 9:22. [PMID: 28239349 PMCID: PMC5300987 DOI: 10.3389/fnagi.2017.00022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/27/2017] [Indexed: 12/03/2022] Open
Abstract
Cerebrospinal fluid (CSF) biomarkers for Alzheimer’s disease and related disorders can provide early and accurate prediction of underlying neuropathology even when the clinical symptoms are mild, but lumbar punctures (LP) to obtain CSF can be perceived as frightening and invasive. We previously demonstrated that this negative perception of the LP is strongly associated with a negative LP experience in terms of discomfort and complications, but it is not known what factors can lead to a negative perception of the LP. It has also been proposed that LP is less well-perceived by adults in the U.S. compared to Europe and elsewhere, although there is a paucity of primary data to support this. To address these knowledge gaps, we conducted a survey of 237 younger and older adults in the Atlanta area including a significant number born outside of the U.S. (n = 82, 34%) to determine demographic, medical, and experiential factors associated with the perception of LP as well as the willingness to undergo LP for medical or research purposes. Our results show that one in four respondents in this cohort with limited first-hand LP experience viewed the LP as a frightening invasive procedure, but the majority (89%) were willing to undergo LP for medical reasons. General awareness of the LP was associated with both standard and negative views of the LP, but perception did not influence willingness to undergo the procedure. Multi-variate models showed that higher annual household income, not place of birth or past experience, was associated with greater willingness to undergo LPs. We conclude that Americans (born in the U.S. or abroad) are not resistant to LPs if there is useful information to improve their health, although there is limited enthusiasm to undergo LPs solely for research purposes. At the same time, we failed to find modifiable factors to improve the perception of LP among those who already perceive it as frightening and invasive. Future recruitment effort should target adults with no preconceived notion of the LP with emphasis on data related to safety and tolerability.
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Affiliation(s)
- Dobromira Z Tsvetkova
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA
| | - Sharon H Bergquist
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta GA, USA
| | - Monica W Parker
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - Thomas L Jarrett
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta GA, USA
| | - Jennifer C Howell
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - Kelly D Watts
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - Alexander Kollhoff
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
| | - David L Roberts
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta GA, USA
| | - William T Hu
- Department of Neurology, Emory University School of Medicine, AtlantaGA, USA; Center for Neurodegenerative Diseases Research, Emory University School of Medicine, AtlantaGA, USA; Alzheimer's Disease Research Center, Emory University School of Medicine, AtlantaGA, USA
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