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Abstract
OBJECTIVES The literature on Alzheimer's disease (AD) provides little data about long-term cognitive course trajectories. We identify global cognitive outcome trajectories and associated predictor variables that may inform clinical research and care. DESIGN Data derived from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set were used to examine the cognitive course of persons with possible or probable AD, a Mini-Mental State Examination (MMSE) of ≥10, and complete annual assessments for 5 years. SETTING Thirty-six Alzheimer's Disease Research Centers. PARTICIPANTS Four hundred and fourteen persons. MEASUREMENTS We used a hybrid approach comprising qualitative analysis of MMSE trajectory graphs that were operationalized empirically and binary logistic regression analyses to assess 19 variables' associations with each trajectory. MMSE scores of ±3 points or greater were considered clinically meaningful. RESULTS Five distinct cognitive trajectories were identified: fast decliners (32.6%), slow decliners (30.7%), zigzag stable (15.9%), stable (15.9%), and improvers (4.8%). The decliner groups had three subtypes: curvilinear, zigzag, and late decline. The fast decliners were associated with female gender, lower baseline MMSE scores, a shorter illness duration, or receiving a cognitive enhancer. An early MMSE decline of ≥3 points predicted a worse outcome. A higher rate of traumatic brain injury, the absence of an ApoE ϵ4 allele, and male gender were the strongest predictors of favorable outcomes. CONCLUSIONS Our hybrid approach revealed five distinct cognitive trajectories and a variegated pattern within the decliners and stable/improvers that was more consistent with real-world clinical experience than prior statistically modeled studies. Future investigations need to determine the consistency of the distribution of these categories across settings.
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Affiliation(s)
- Carl I Cohen
- Division of Geriatric Psychiatry & Center of Excellence for Alzheimer's Disease, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Barry Reisberg
- Emeritus, New York University Langone Health, New York, NY, USA
| | - Robert Yaffee
- Retired, Silver School of Social Work, New York University, New York, NY, USA
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Kauzor K, Drewel M, Gonzalez H, Rattinger GB, Hammond AG, Wengreen H, Lyketsos CG, Tschanz JT. Malnutrition and neuropsychiatric symptoms in dementia: the Cache County Dementia Progression Study. Int Psychogeriatr 2023; 35:653-663. [PMID: 37246509 PMCID: PMC10592578 DOI: 10.1017/s1041610223000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Among people with dementia, poor nutritional status has been associated with worse cognitive and functional decline, but few studies have examined its association with neuropsychiatric symptoms (NPS). We examined this topic in a population-based sample of persons with dementia. DESIGN Longitudinal, observational cohort study. SETTING Community. PARTICIPANTS Two hundred ninety-two persons with dementia (71.9% Alzheimer's disease, 56.2% women) were followed up to 6 years. MEASUREMENTS We used a modified Mini-Nutritional Assessment (mMNA) and the Neuropsychiatric Inventory (NPI) to evaluate nutritional status and NPS, respectively. Individual linear mixed effects models examined the associations between time-varying mMNA total score or clinical categories (malnourishment, risk for malnourishment, or well-nourished) and NPI total score (excluding appetite domain) or NPI individual domain or cluster (e.g. psychosis) scores. Covariates tested were dementia onset age, type, and duration, medical comorbidities, sex, apolipoprotein E (APOE) genotype, and education. RESULTS Compared to the well-nourished, those at risk for malnourishment and those malnourished had higher total NPI scores [b (95% CI) = 1.76 (0.04, 3.48) or 3.20 (0.62, 5.78), respectively], controlling for significant covariates. Higher mMNA total score (better nutritional status) was associated with lower total NPI [b (95% CI) = -0.58 (-0.86, -0.29)] and lower domain scores for psychosis [b (95% CI) = -0.08 (-0.16, .004)], depression [b (95% CI = -0.11 (-0.16, -0.05], and apathy [b (95% CI = -0.19 (-0.28, -0.11)]. CONCLUSIONS Worse nutritional status is associated with more severe NPS. Dietary or behavioral interventions to prevent malnutrition may be beneficial for persons with dementia.
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Affiliation(s)
- Kaitlyn Kauzor
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Mikaela Drewel
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Hector Gonzalez
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Gail B Rattinger
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, P.O. Box 6000. Binghamton, NY 13902-6000, USA
| | - Alexandra G Hammond
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Heidi Wengreen
- Nutrition Dietetics and Food Sciences, Utah State University, 8710 Old Main Hill, Logan, UT 84322-8710, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Drive, 4th Floor, Baltimore, MD 21224, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
- Alzheimer's Disease and Dementia Research Center, Utah State University, 6405 Old Main Hill, Logan, UT, 84322-6405, USA
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Manso-Calderón R, Cacabelos-Pérez P, Sevillano-García MD, Herrero-Prieto ME, González-Sarmiento R. Analysis of endothelial gene polymorphisms in Spanish patients with vascular dementia and Alzheimer´s disease. Sci Rep 2023; 13:13441. [PMID: 37596325 PMCID: PMC10439194 DOI: 10.1038/s41598-023-39576-7] [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: 09/30/2019] [Accepted: 10/14/2020] [Indexed: 08/20/2023] Open
Abstract
There is increasing evidence for the involvement of blood-brain barrier (BBB) in vascular dementia (VaD) and Alzheimer´s disease (AD) pathogenesis. However, the role of endothelial function-related genes in these disorders remains unclear. We evaluated the association of four single-nucleotide polymorphisms (VEGF, VEGFR2 and NOS3) with diagnosis and rate of cognitive decline in AD and VaD in a Spanish case-control cohort (150 VaD, 147 AD and 150 controls). Participants carrying -604AA genotype in VEGFR2 (rs2071559) were less susceptible to VaD after multiple testing. Further analysis for VaD subtype revealed a significant difference between small-vessel VaD patients and controls, but not for large-vessel VaD patients. In addition, -2578A and -460C alleles in VEGF (rs699947 and rs833061) showed to decrease the risk of AD, whereas NOS3 (rs1799983) influenced disease progression. Our study supports previous findings of a deleterious effect of VEGFR2 reduced expression on small-vessel disease, but not on large-vessel disease; as well as a detrimental effect of down-regulating VEGF and eNOS in AD, affecting vascular permeability and neuronal survival. These data highlight the relevance of endothelial function and, therefore, BBB in both VaD and AD.
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Affiliation(s)
- Raquel Manso-Calderón
- Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, 37007, Salamanca, Spain.
- Division of Neurology, Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain.
- Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.
| | - Purificación Cacabelos-Pérez
- Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, 37007, Salamanca, Spain
- Department of Neurology, Hospital Clínico Universitario de Santiago (CHUS), A Coruña, Spain
| | - M Dolores Sevillano-García
- Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - M Elisa Herrero-Prieto
- Division of Neurology, Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain
- Division of Neurology, Department of Internal Medicine, Hospital El Bierzo de Ponferrada, León, Spain
| | - Rogelio González-Sarmiento
- Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
- Molecular Medicine Unit, Department of Medicine, University of Salamanca, Salamanca, Spain
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Hautecloque-Raysz G, Sellal F, Bousiges O, Phillipi N, Blanc F, Cretin B. Epileptic Prodromal Alzheimer's Disease Treated with Antiseizure Medications: Medium-Term Outcome of Seizures and Cognition. J Alzheimers Dis 2023:JAD221197. [PMID: 37355889 DOI: 10.3233/jad-221197] [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: 06/26/2023]
Abstract
BACKGROUND The medium term outcome (over more than one year) of epileptic prodromal AD (epAD) patients treated with antiseizure medications (ASMs) is unknown in terms of seizure response, treatment tolerability, and cognitive and functional progression. OBJECTIVE To describe such medium term outcome over a mean of 5.1±2.1 years. METHODS We retrospectively compared 19 epAD patients with 16 non-epileptic prodromal AD (nepAD) patients: 1) at baseline for demographics, medical history, cognitive fluctuations (CFs), psychotropic medications, MMSE scores, visually rated hippocampal atrophy, CSF neurodegenerative biomarkers, and standard EEG recordings; 2) during follow-up (FU) for psychotropic medications, MMSE progression, and conversion to dementia. In the epAD group, we analyzed baseline and FU types of seizures as well as each line of ASM with the corresponding efficacy and tolerability. RESULTS At baseline, the epAD group had more CFs than the nepAD group (58% versus 20%, p = 0.03); focal impaired awareness seizures were the most common type (n = 12, 63.1%), occurring at a monthly to quarterly frequency (89.5%), and were well controlled with monotherapy in 89.5% of cases (including 63.1% seizure-free individuals). During FU, treated epAD patients did not differ significantly from nepAD patients in MMSE progression or in conversion to dementia. CONCLUSION Epilepsy is commonly controlled with ASMs over the medium term in epAD patients, with similar functional and cognitive outcomes to nepAD patients. Pathophysiologically, epilepsy is likely to be an ASM-modifiable cognitive aggravating factor at this stage of AD.
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Affiliation(s)
- Geoffroy Hautecloque-Raysz
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France
- Service de Neurologie, Hospices Civils de Colmar, France
| | - François Sellal
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France
- Service de Neurologie, Hospices Civils de Colmar, France
- Unité INSERM U-1118, Faculté de Médecine de Strasbourg, France
| | - Olivier Bousiges
- Service de Neurologie, Hospices Civils de Colmar, France
- University Hospital of Strasbourg, Laboratory of Biochemistry and Molecular Biology, and CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR7364, Strasbourg, France
| | - Nathalie Phillipi
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France
- Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Frédéric Blanc
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France
- Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Cretin
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), France
- Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Watson R, Sanson-Fisher R, Bryant J, Mansfield E. Dementia is the second most feared condition among Australian health service consumers: results of a cross-sectional survey. BMC Public Health 2023; 23:876. [PMID: 37173717 PMCID: PMC10176813 DOI: 10.1186/s12889-023-15772-y] [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: 09/23/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Fear of disease may act as a barrier to screening or early diagnosis. This cross-sectional survey of 355 people attending outpatient clinics at one Australian hospital found that cancer (34%) and dementia (29%) were the most feared diseases. Participants aged 65 years and over feared dementia the most.
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Affiliation(s)
- Rochelle Watson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, W4, HMRI Building, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, W4, HMRI Building, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, W4, HMRI Building, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, W4, HMRI Building, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Sarcopenic Obesity Tendency and Nutritional Status Is Related to the Risk of Sarcopenia, Frailty, Depression and Quality of Life in Patients with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052492. [PMID: 35270185 PMCID: PMC8908993 DOI: 10.3390/ijerph19052492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to investigate the nutritional status of dementia patients and examine the correlation with sarcopenia, frailty, depression, and quality of life. We enrolled patients aged 60 years and over with Mini Mental State Examination (MMSE) scores ≤ 26 (Taiwan), and dementia diagnosed by a neurologist or psychiatrist. Nutritional status was assessed with the Mini Nutritional Assessment (MNA). Muscle mass was measured by dual-energy X-ray absorptiometry. Muscle strength and endurance were evaluated by handgrip, leg-back strength, dumbbell curls, sit to stand test, and gait speed. Quality of life, frailty, and depression status were measured by questionnaires. Patients with moderate dementia (MMSE ≤ 20) had a significantly lower MNA score, muscle function, and quality of life than patients with mild dementia (p < 0.01). A lower MNA score was significantly associated with the risk of frailty (odds ratio: 4.76, p < 0.01), depression (odds ratio: 3.17, p = 0.03), and poor quality of life (odds ratio: 2.73, p < 0.05), and sarcopenia (odds ratio: 3.97, p = 0.03) after adjusting for potential confounders. In conclusion, patients with dementia were at risk of malnutrition, and nutritional status was associated to the risk of sarcopenia, frailty, depression, and quality of life.
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Rodella C, Bernini S, Panzarasa S, Sinforiani E, Picascia M, Quaglini S, Cavallini E, Vecchi T, Tassorelli C, Bottiroli S. A double-blind randomized controlled trial combining cognitive training (CoRe) and neurostimulation (tDCS) in the early stages of cognitive impairment. Aging Clin Exp Res 2022; 34:73-83. [PMID: 34156651 DOI: 10.1007/s40520-021-01912-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of neurodegenerative diseases is expected to increase over the next years, therefore, new methods able to prevent and delay cognitive decline are needed. AIMS To evaluate the effectiveness of a combined treatment protocol associating a computerized cognitive training (CoRe) with anodal transcranial direct current stimulation (tDCS). METHODS In this randomized controlled trial, 33 patients in the early stage of cognitive impairment were assigned to the experimental group (CoRE + real tDCS) or control group (CoRE + sham tDCS). In each group, the intervention lasted 3 consecutive weeks (4 sessions/week). A neuropsychological assessment was administered at baseline (T0), post-intervention (T1) and 6-months later (T2). RESULTS The CoRE + real tDCS group only improved in working memory and attention/processing speed at both T1 and T2. It reported a stable MMSE score at T2, while the CoRE + sham tDCS group worsened. Age, mood, and T0 MMSE score resulted to play a role in predicting treatment effects. CONCLUSION Combined multi-domain interventions may contribute to preventing or delaying disease progression. TRIAL REGISTRATION Trial registration number (ClinicalTrials.gov): NCT04118686.
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Mouchet J, Betts KA, Georgieva MV, Ionescu-Ittu R, Butler LM, Teitsma X, Delmar P, Kulalert T, Zhu J, Lema N, Desai U. Classification, Prediction, and Concordance of Cognitive and Functional Progression in Patients with Mild Cognitive Impairment in the United States: A Latent Class Analysis. J Alzheimers Dis 2021; 82:1667-1682. [PMID: 34219723 PMCID: PMC8461667 DOI: 10.3233/jad-210305] [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] [Indexed: 12/03/2022]
Abstract
Background: Progression trajectories of patients with mild cognitive impairment (MCI) are currently not well understood. Objective: To classify patients with incident MCI into different latent classes of progression and identify predictors of progression class. Methods: Participants with incident MCI were identified from the US National Alzheimer’s Coordinating Center Uniform Data Set (09/2005-02/2019). Clinical Dementia Rating (CDR®) Dementia Staging Instrument-Sum of Boxes (CDR-SB), Functional Activities Questionnaire (FAQ), and Mini-Mental State Examination (MMSE) score longitudinal trajectories from MCI diagnosis were fitted using growth mixture models. Predictors of progression class were identified using multivariate multinomial logistic regression models; odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: In total, 21%, 22%, and 57% of participants (N = 830) experienced fast, slow, and no progression on CDR-SB, respectively; for FAQ, these figures were 14%, 23%, and 64%, respectively. CDR-SB and FAQ class membership was concordant for most participants (77%). Older age (≥86 versus≤70 years, OR [95% CI] = 5.26 [1.78–15.54]), one copy of APOE ɛ4 (1.94 [1.08–3.47]), higher baseline CDR-SB (2.46 [1.56–3.88]), lower baseline MMSE (0.85 [0.75–0.97]), and higher baseline FAQ (1.13 [1.02–1.26]) scores were significant predictors of fast progression versus no progression based on CDR-SB (all p < 0.05). Predictors of FAQ class membership were largely similar. Conclusion: Approximately a third of participants experienced progression based on CDR-SB or FAQ during the 4-year follow-up period. CDR-SB and FAQ class assignment were concordant for the vast majority of participants. Identified predictors may help the selection of patients at higher risk of progression in future trials.
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Affiliation(s)
| | | | | | | | | | | | - Paul Delmar
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Levine SZ, Goldberg Y, Yoshida K, Samara M, Cipriani A, Iwatsubo T, Leucht S, Furawaka TA. Quantifying the heterogeneity of cognitive functioning in Alzheimer's disease to extend the placebo-treatment dichotomy: Latent class analysis of individual-participant data from five pivotal randomized clinical trials of donepezil. Eur Psychiatry 2021; 64:e16. [PMID: 33583479 PMCID: PMC8057455 DOI: 10.1192/j.eurpsy.2021.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The extent and profiles of heterogeneity in cognitive functioning among participants in clinical trials of antidementia medication are unknown. We aimed to quantify and identify profiles of heterogeneity of cognition in Alzheimer's disease. METHODS Individual-level participant data were analyzed from five pivotal clinical trials of donepezil for Alzheimer's disease (N = 2,919). Based on Alzheimer's Disease Assessment Scale-Cognitive Subscale total scores from baseline up to week 12, a latent class model was used to identify heterogeneous groups. A logistic regression model was used to examine factors associated with group membership. Sensitivity analysis was conducted, restricted to the donepezil, and then the placebo arm. RESULTS The latent class model identified three classes labeled as low scorers (i.e., least cognitive impairment; N = 1,666, 76.04%), improvers (N = 27, 1.23%), and high scorers (N = 498, 22.73%). Logistic modeling showed that donepezil compared to placebo was significantly (p < 0.05) positively associated with membership in the improvers class (OR = 6.88, 95% CI = 2.03, 42.95), and negatively with high scorers (OR = 0.79, 95% CI = 0.64, 0.98). Sensitivity analysis restricted to the placebo, then donepezil arms replicated similar heterogeneity patterns. CONCLUSIONS Our results inform clinicians regarding the extent of heterogeneity in cognitive functioning during treatment and contribute to trial design considerations.
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Affiliation(s)
- Stephen Z Levine
- Department of Community Mental Health, University of Haifa, Haifa3498838, Israel
| | - Yair Goldberg
- Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Myrto Samara
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany.,3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Toshiaki A Furawaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
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Katzourou I, Leonenko G, Ivanov D, Meggy A, Marshall R, Sims R, Williams J, Holmans P, Escott-Price V. Cognitive Decline in Alzheimer's Disease Is Not Associated with APOE. J Alzheimers Dis 2021; 84:141-149. [PMID: 34487047 DOI: 10.3233/jad-210685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The rate of cognitive decline in Alzheimer's disease (AD) has been found to vary widely between individuals, with numerous factors driving this heterogeneity. OBJECTIVE This study aimed to compute a measure of cognitive decline in patients with AD based on clinical information and to utilize this measure to explore the genetic architecture of cognitive decline in AD. METHODS An in-house cohort of 616 individuals, hereby termed the Cardiff Genetic Resource for AD, as well as a subset of 577 individuals from the publicly available ADNI dataset, that have been assessed at multiple timepoints, were used in this study. Measures of cognitive decline were computed using various mixed effect linear models of Mini-Mental State Examination (MMSE). After an optimal model was selected, a metric of cognitive decline for each individual was estimated as the random slope derived from this model. This metric was subsequently used for testing the association of cognitive decline with apolipoprotein E (APOE) genotype. RESULTS No association was found between the number of APOEɛ2 or ɛ4 alleles and the rate of cognitive decline in either of the datasets examined. CONCLUSION Further exploration is required to uncover possible genetic variants that affect the rate of decline in patients with AD.
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Affiliation(s)
| | - Ganna Leonenko
- UK Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Dobril Ivanov
- UK Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Alun Meggy
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Rachel Marshall
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Rebecca Sims
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Julie Williams
- UK Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Peter Holmans
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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Functional Decline and Body Composition Change in Older Adults With Alzheimer Disease: A Retrospective Cohort Study at a Japanese Memory Clinic. Alzheimer Dis Assoc Disord 2020; 35:36-43. [PMID: 33323780 DOI: 10.1097/wad.0000000000000426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is a dearth of longitudinal data on body composition, function, and physical performance in persons with Alzheimer's disease (AD). OBJECTIVES The aim was to describe the trajectories of function, body composition, and physical performance in older adults with AD. METHODS In this retrospective cohort study, data were collected from older adults (n=1402) diagnosed with AD (mean age: 78.1 y old, women: 69.3%). Cognitive function was assessed using the mini-mental state examination. Proxy-reported instrumental and basic activities of daily living were assessed using the Lawton and Barthel indexes. Body composition was assessed using bioelectrical impedance analysis. Physical performance was assessed using the timed up and go test and grip strength. RESULTS Median (interquartile range) of follow-up time was 2.2 (1.2 to 3.6) years. Participants' mini-mental state examination score, Barthel index, and Lawton index declined over time. Skeletal muscle mass index and physical performance (timed up and go test and grip strength) decreased, while fat mass index increased with time. No significant changes or slight decline in weight and body mass index was observed. CONCLUSIONS Muscle mass and physical performance are likely to decline in older adults with AD. Clinicians should assess muscle mass and physical performance trajectories regularly in these patients and intervene appropriately.
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Ydstebø AE, Benth JŠ, Bergh S, Selbæk G, Vossius C. Informal and formal care among persons with dementia immediately before nursing home admission. BMC Geriatr 2020; 20:296. [PMID: 32811440 PMCID: PMC7436969 DOI: 10.1186/s12877-020-01703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
Background Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network. Methods In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients’ files. Results A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver’s working situation. Good/excellent general health was associated with less formal care. Conclusion Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services.
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Affiliation(s)
- Arnt Egil Ydstebø
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway. .,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway. .,Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.
| | - Jurate Šaltytė Benth
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Akershus, Norway
| | - Sverre Bergh
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Corinna Vossius
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway
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13
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Rausch C, Hoffmann F. Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany. Eur J Clin Pharmacol 2020; 76:877-885. [PMID: 32219538 PMCID: PMC7239800 DOI: 10.1007/s00228-020-02859-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/11/2020] [Indexed: 12/04/2022]
Abstract
Purpose We studied the prevalence of medications of questionable benefit in the last 6 months of life among older nursing home residents with and without dementia in Germany. Methods A retrospective cohort study was conducted on claims data from 67,328 deceased nursing home residents aged 65+ years who were admitted between 2010 and 2014. We analyzed prescription regimens of medications of questionable benefit in the 180–91-day period and the 90-day period prior to death for residents with dementia (n = 29,052) and without dementia (n = 38,276). Factors associated with new prescriptions of medications of questionable benefit prior to death were analyzed using logistic regression models among all nursing home residents and stratified by dementia. Results A higher proportion of nursing home residents with dementia were prescribed at least one medication of questionable benefit in the 180–91-day (29.6%) and 90-day (26.8%) periods prior to death, compared with residents without dementia (180–91 days, 22.8%; 90 days, 20.1%). Lipid-lowering agents were the most commonly prescribed medications. New prescriptions of medications of questionable benefit were more common among residents with dementia (9.8% vs. 8.7%). When excluding anti-dementia medication, new prescriptions of these medications were more common among residents without dementia (6.4% vs. 8.0%). The presence of dementia (odds ratio [OR] 1.40, 95% confidence interval [95%CI] 1.32–1.48) and excessive polypharmacy were associated with new prescriptions of medications of questionable benefit prior to death (OR 4.74, 95%CI 4.15–5.42). Conclusion Even when accounting for anti-dementia prescriptions, the prevalence of nursing home residents with dementia receiving medications of questionable benefit is considerable and may require further attention. Electronic supplementary material The online version of this article (10.1007/s00228-020-02859-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Rausch
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany.
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FA10, 9713 AV, Groningen, The Netherlands.
- Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, SE, 17177, Stockholm, Sweden.
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany
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14
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Haaksma ML, Rizzuto D, Leoutsakos JMS, Marengoni A, Tan EC, Olde Rikkert MG, Fratiglioni L, Melis RJ, Calderón-Larrañaga A. Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia: 2 Population-Based Studies. J Am Med Dir Assoc 2019; 20:1444-1450. [DOI: 10.1016/j.jamda.2019.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
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15
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Wang Y, Haaksma ML, Ramakers IH, Verhey FR, van de Flier WM, Scheltens P, van Maurik I, Olde Rikkert MG, Leoutsakos JS, Melis RJ. Cognitive and functional progression of dementia in two longitudinal studies. Int J Geriatr Psychiatry 2019; 34:1623-1632. [PMID: 31318090 PMCID: PMC6803041 DOI: 10.1002/gps.5175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Previous studies have identified several subgroups (ie, latent trajectories) with distinct disease progression among people with dementia. However, the methods and results were not always consistent. This study aims to perform a coordinated analysis of latent trajectories of cognitive and functional progression in dementia across two datasets. METHODS Included and analyzed using the same statistical approach were 1628 participants with dementia from the US National Alzheimer's Coordinating Center (NACC) and 331 participants with dementia from the Dutch Clinical Course of Cognition and Comorbidity study (4C-Study). Trajectories of cognition and instrumental activities of daily living (IADL) were modeled jointly in a parallel-process growth mixture model. RESULTS Cognition and IADL tended to decline in unison across the two samples. Slow decline in both domains was observed in 26% of the US sample and 74% of the Dutch sample. Rapid decline in cognition and IADL was observed in 7% of the US sample and 26% of the Dutch sample. The majority (67%) of the US sample showed moderate cognitive decline and rapid IADL decline. CONCLUSIONS Trajectories of slow and rapid dementia progression were identified in both samples. Despite using the same statistical methods, the number of latent trajectories was not replicated and the relative class sizes differed considerably across datasets. These results call for careful consideration when comparing progression estimates in the literature. In addition, the observed discrepancy between cognitive and functional decline stresses the need to monitor dementia progression across multiple domains.
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Affiliation(s)
- Yuwei Wang
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Miriam L. Haaksma
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Inez H.G.B. Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Wiesje M. van de Flier
- Alzheimer Center Amsterdam, Department of Neurology, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ingrid van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamThe Netherlands
| | - Marcel G.M. Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Jeannie‐Marie S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and NeuropsychiatryJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - René J.F. Melis
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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Kawaharada R, Sugimoto T, Matsuda N, Tsuboi Y, Sakurai T, Ono R. Impact of loss of independence in basic activities of daily living on caregiver burden in patients with Alzheimer's disease: A retrospective cohort study. Geriatr Gerontol Int 2019; 19:1243-1247. [DOI: 10.1111/ggi.13803] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/10/2019] [Accepted: 09/30/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Rika Kawaharada
- Department of Public HealthKobe University Graduate School of Health Sciences Kobe Japan
| | - Taiki Sugimoto
- Department of Public HealthKobe University Graduate School of Health Sciences Kobe Japan
- Center for Comprehensive Care and Research on Memory DisordersNational Center for Geriatrics and Gerontology Obu Japan
- Medical Genome CenterNational Center for Geriatrics and Gerontology Obu Japan
| | - Naoka Matsuda
- Department of Public HealthKobe University Graduate School of Health Sciences Kobe Japan
| | - Yamato Tsuboi
- Department of Public HealthKobe University Graduate School of Health Sciences Kobe Japan
- Japan Society for the Promotion of Science Tokyo Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory DisordersNational Center for Geriatrics and Gerontology Obu Japan
- Department of Cognitive and Behavioral ScienceNagoya University Graduate School of Medicine Nagoya Japan
| | - Rei Ono
- Department of Public HealthKobe University Graduate School of Health Sciences Kobe Japan
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17
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Shepherd H, Livingston G, Chan J, Sommerlad A. Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC Med 2019; 17:130. [PMID: 31303173 PMCID: PMC6628507 DOI: 10.1186/s12916-019-1369-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/14/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. However, no intervention has yet reduced admissions of community-dwelling people with dementia. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia and to identify socio-demographic and clinical predictors of hospitalisation. METHODS We searched MEDLINE, Embase, and PsycINFO from inception to 9 May 2019. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. non-psychiatric) hospital admissions. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. Three authors graded evidence strength using Cochrane's GRADE approach, including assessing for evidence of publication bias using Begg's test. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia. RESULTS We included 34 studies of 277,432 people with dementia: 17 from the USA, 15 from Europe, and 2 from Asia. The pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. Hospitalisation rates in people with dementia were between 0.37 and 1.26/person-year in high-quality studies. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. There was strong evidence that dementia severity alone is not associated. CONCLUSIONS People with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. Future interventions to reduce unnecessary hospitalisations should target potentially modifiable factors, such as polypharmacy and functional ability, in high-risk populations.
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Affiliation(s)
- Hilary Shepherd
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, 4 St Pancras Way, London, NW1 0PE, UK
| | - Justin Chan
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, 4 St Pancras Way, London, NW1 0PE, UK.
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18
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Fast food consumption and its associations with heart rate, blood pressure, cognitive function and quality of life. Pilot study. Heliyon 2019; 5:e01566. [PMID: 31193345 PMCID: PMC6526229 DOI: 10.1016/j.heliyon.2019.e01566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/28/2019] [Accepted: 04/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background To investigate the relationship of fast food consumption with cognitive and metabolic function of adults (18-25 years old) in Riyadh, Kingdom of Saudi Arabia. Materials and Method This cross-sectional study was conducted at the College of Medicine at King Khalid University Hospital, Riyadh, Saudi Arabia. The conventionally recruited subjects underwent an evaluation that included demographic data, quality of life (wellness, stress, sleepiness, and physical activity), mini-mental status examination, and the frequency of fast food consumption. To investigate metabolic function, blood was drawn to evaluate serum HDL, LDL, cholesterol, and triglyceride levels. Cognitive function was assessed by the Cambridge neuropsychological test automated battery. The participants were divided into 2 groups based on fast food consumption: those who consumed fast food 3 times per week or less (Group 1) and those who consumed fast food more than 3 times per week (Group 2). Results The mean diastolic blood pressure in Group 1 and Group 2 was 72 mmHg and 77 mmHg, respectively, a significant difference (p = 0.04). There was no significant difference for cognitive function and quality of life between the two groups. There was significant correlation of HDL with AST correct mean latency and the AST correct mean latency congruent (p = 0.02, p = 0.01, respectively) and TC with diastolic blood pressure (p = 0.003). Conclusions We concluded that fast food consumption has an effect on blood pressure but has no direct effect on cognition or quality of life.
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19
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Suh J, Park YH, Kim HR, Jang JW, Kang MJ, Yang J, Baek MJ, Kim S. The usefulness of visual rating of posterior atrophy in predicting rapid cognitive decline in Alzheimer disease: A preliminary study. Int J Geriatr Psychiatry 2019; 34:625-632. [PMID: 30714196 DOI: 10.1002/gps.5072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/28/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Approximately 10% to 30% of Alzheimer disease (AD) patients progress rapidly in severity and become more dependent on caregivers. Although several studies have investigated whether imaging biomarkers such as medial temporal atrophy (MTA) and posterior atrophy (PA) are useful for predicting the rapid progression of AD, their results have been inconsistent. OBJECTIVE The study aims to investigate the association of visually rated MTA and PA with rapid disease progression in AD. METHODS This was a retrospective cohort study of 159 AD patients who were initially diagnosed with mild AD and were followed for 1 year to determine whether they progressed rapidly (a decrease of three points or more on the Mini-Mental State Examination over 1 year). We used 5-point and 4-point visual rating scales to assess MTA and PA, respectively. MTA and PA scores for each patient were dichotomized as normal (without atrophy) or abnormal (atrophy). We performed a logistic regression analysis to determine the odds ratios (ORs) of MTA and PA for rapid disease progression with adjustment for covariates. RESULTS Within the study population, 47 (29.6%) patients progressed rapidly. Visual assessment of the magnetic resonance imaging (MRI) scans revealed that 112 patients (70.4%) showed MTA, whereas 80 patients (50.3%) showed PA. The ORs with 95% confidence intervals for MTA and PA were 1.825 (0.819-4.070) and 2.844 (1.378-5.835), respectively. The association of visually assessed PA, but not MTA, with rapid progression was significant after adjustment for covariates. CONCLUSION In patients with mild AD, visual assessment of PA exhibits independent predictive value for rapid disease progression.
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Affiliation(s)
- Jeewon Suh
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hang-Rai Kim
- Graduate School of Medical Science and Engineering, Korean Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Min Ju Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jimin Yang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Jae Baek
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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20
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Eldholm RS, Barca ML, Persson K, Knapskog AB, Kersten H, Engedal K, Selbæk G, Brækhus A, Skovlund E, Saltvedt I. Progression of Alzheimer's Disease: A Longitudinal Study in Norwegian Memory Clinics. J Alzheimers Dis 2019; 61:1221-1232. [PMID: 29254085 DOI: 10.3233/jad-170436] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The course of Alzheimer's disease (AD) varies considerably between individuals. There is limited evidence on factors important for disease progression. OBJECTIVE The primary aim was to study the progression of AD, as measured by the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB). Secondary aims were to investigate whether baseline characteristics are important for differences in progression, and to examine the correlation between progression assessed using three different instruments: CDR-SB (0-18), the cognitive test Mini-Mental State Examination (MMSE, 0-30), and the functional measure Instrumental Activities of Daily Living (IADL, 0-1). METHODS The Progression of AD and Resource use (PADR) study is a longitudinal observational study in three Norwegian memory clinics. RESULTS In total, 282 AD patients (mean age 73.3 years, 54% female) were followed for mean 24 (16-37) months. The mean annual increase in CDR-SB was 1.6 (SD 1.8), the mean decrease in MMSE score 1.9 (SD 2.6), and the mean decrease in IADL score 0.13 (SD 0.14). Of the 282 patients, 132 (46.8%) progressed slowly, with less than 1 point yearly increase in CDR-SB. Cognitive test results at baseline predicted progression rate, and together with age, ApoE, history of hypertension, and drug use could explain 17% of the variance in progression rate. The strongest correlation of change was found between CDR-SB and IADL scores, the weakest between MMSE and IADL scores. CONCLUSION Progression rate varied considerably among AD patients; about half of the patients progressed slowly. Cognitive test results at baseline were predictors of progression rate.
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Affiliation(s)
- Rannveig Sakshaug Eldholm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Memory Clinic, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Karin Persson
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Memory Clinic, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Anne-Brita Knapskog
- Department of Geriatric Medicine, Memory Clinic, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Hege Kersten
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Pharmaceutical Bioscience, School of Pharmacy, University of Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Memory Clinic, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Brækhus
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Memory Clinic, Oslo University Hospital, Ullevaal, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway
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21
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Ferrari C, Lombardi G, Polito C, Lucidi G, Bagnoli S, Piaceri I, Nacmias B, Berti V, Rizzuto D, Fratiglioni L, Sorbi S. Alzheimer's Disease Progression: Factors Influencing Cognitive Decline. J Alzheimers Dis 2019; 61:785-791. [PMID: 29226870 DOI: 10.3233/jad-170665] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) patients present high variability in the rate of cognitive decline. Despite the wide knowledge on factors influencing dementia risk, little is known on what accounts for AD progression. Previous studies on this topic have mainly analyzed each factor separately without taking into account the interaction between genetic and non-genetic factors. OBJECTIVE The aim of the present study is to evaluate the role of demographic, clinical, therapeutic, and genetic factors and their interaction on cognitive decline among newly diagnosed AD patients. METHODS We retrospectively selected 160 AD patients diagnosed at the Neurology Unit of Careggi University Hospital of Florence. We evaluated the occurrence of rapid cognitive changes defined as the worsening of more than four points at the Mini-Mental State Examination after 2-year follow up period. RESULTS Among the 160 AD patients, 50% presented rapid disease progression. Extrapyramidal signs at disease onset were predictors of worse outcome (OR 2.2), especially among Apolipoprotein E (APOE) ɛ4 allele carriers, while the presence of family history for dementia decreased the risk of rapid progression by about 50%. Higher educated ɛ4-carriers showed a slower AD progression. We identified the chronic use of aspirin as potential secondary preventative strategy for the non ɛ4-carriers. CONCLUSION At dementia onset, some clinical and demographic data can be predictors of future progression. The outcomes of the present study support the already hypothesized interaction between genetic and non-genetic factors during disease course and suggest genetic-based approaches.
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Affiliation(s)
| | - Gemma Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Cristina Polito
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Italy
| | - Giulia Lucidi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Irene Piaceri
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Valentina Berti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Italy
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Centrum, Stockholm, Sweden
| | - Sandro Sorbi
- IRCCS Don Gnocchi, Florence, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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22
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Hsu YH, Chou MY, Chu CS, Liao MC, Wang YC, Lin YT, Chen LK, Liang CK. Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study. J Nutr Health Aging 2019; 23:876-882. [PMID: 31641739 DOI: 10.1007/s12603-019-1246-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults. DESIGN Prospectively longitudinal cohort study. SETTING AND PARTICIPANTS The study recruited 354 men aged 65 years and older in the veteran's retirement community. MEASURES Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality. RESULTS According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006). CONCLUSIONS Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.
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Affiliation(s)
- Y-H Hsu
- Chih-Kuang Liang, Address: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (R.O.C.), Phone: 886-7-3422526, E-mail:
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Facilitators and barriers to optimizing eating performance among cognitively impaired older adults: A qualitative study of nursing assistants’ perspectives. DEMENTIA 2018; 19:2090-2113. [DOI: 10.1177/1471301218815053] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and Objectives Cognitively impaired individuals are at increased risk for functional and behavioral difficulties at mealtimes, leading to compromised eating performance, low food and fluid intake, and negative functional and nutritional outcomes. Nursing assistants are the most critical front-line care staff and best positioned to manage the personal and environmental factors that influence resident eating performance. Identifying nursing assistants’ perceptions of barriers and facilitators to engaging residents in eating will provide important experientially based foundation for developing and testing evidence-driven interventions to promote mealtime care. Methods A qualitative descriptive study was conducted in three sites: two nursing homes and one hospital gero-psychiatric inpatient unit. Six focus groups were conducted with a purposive sample of 23 nursing assistants who regularly provided mealtime care to residents with cognitive impairment. Interview questions addressed barriers and facilitators at resident, caregiver, environmental (facility), and policy levels in optimizing mealtime care. Audio recordings of focus groups were transcribed and analyzed using qualitative descriptive content analysis. Both barriers and facilitators were organized into a hierarchical taxonomy based on similarities and differences framed by the Social Ecological Model. Results The majority of barriers and facilitators were at the caregiver level. Caregiver-level barriers included lack of preparation and training, competing work demands, time pressure, and frustration. Caregiver-level facilitators included caregiver preparation and motivational, technical, informational, and instrumental assistance. Environmental-level barriers and facilitators related to the physical, social, and cultural environment and facility practices. Only barriers to optimizing mealtime care were identified at resident and policy levels. Conclusions Nursing assistants identified multilevel barriers as well as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice.
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Hsiao HT, Lee JJ, Chen HH, Wu MK, Huang CW, Chang YT, Lien CY, Wang JJ, Chang HI, Chang CC. Adequacy of nutrition and body weight in patients with early stage dementia: The cognition and aging study. Clin Nutr 2018; 38:2187-2194. [PMID: 30316533 DOI: 10.1016/j.clnu.2018.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. METHODS A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. RESULTS There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24% mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (β = -.06, P < 0.001) and MNA (β = -.1, P < 0.001). A BMI of 22-23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. CONCLUSIONS In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.
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Affiliation(s)
- Hua-Tsen Hsiao
- Department of Nursing, National Tainan Junior College of Nursing, Taiwan
| | - Jun-Jun Lee
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Hui Chen
- Department of Physical Education, National Kaohsiung University of Science and Technology, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Wei Huang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Ting Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Yi Lien
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Hsin-I Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute of Human Resource Management, National Sun Yat-Sen University, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Haaksma ML, Calderón-Larrañaga A, Olde Rikkert MG, Melis RJ, Leoutsakos JS. Cognitive and functional progression in Alzheimer disease: A prediction model of latent classes. Int J Geriatr Psychiatry 2018; 33:1057-1064. [PMID: 29761569 PMCID: PMC6039270 DOI: 10.1002/gps.4893] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/13/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We sought to replicate a previously published prediction model for progression, developed in the Cache County Dementia Progression Study, using a clinical cohort from the National Alzheimer's Coordinating Center. METHODS We included 1120 incident Alzheimer disease (AD) cases with at least one assessment after diagnosis, originating from 31 AD centres from the United States. Trajectories of the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum of boxes (CDR-sb) were modelled jointly over time using parallel-process growth mixture models in order to identify latent classes of trajectories. Bias-corrected multinomial logistic regression was used to identify baseline predictors of class membership and compare these with the predictors found in the Cache County Dementia Progression Study. RESULTS The best-fitting model contained 3 classes: Class 1 was the largest (63%) and showed the slowest progression on both MMSE and CDR-sb; classes 2 (22%) and 3 (15%) showed moderate and rapid worsening, respectively. Significant predictors of membership in classes 2 and 3, relative to class 1, were worse baseline MMSE and CDR-sb, higher education, and lack of hypertension. Combining all previously mentioned predictors yielded areas under the receiver operating characteristic curve of 0.70 and 0.75 for classes 2 and 3, respectively, relative to class 1. CONCLUSIONS Our replication study confirmed that it is possible to predict trajectories of progression in AD with relatively good accuracy. The class distribution was comparable with that of the original study, with most individuals being members of a class with stable or slow progression. This is important for informing newly diagnosed AD patients and their caregivers.
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Affiliation(s)
- Miriam L. Haaksma
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm UniversityStockholmSweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm UniversityStockholmSweden
| | - Marcel G.M. Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - René J.F. Melis
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Jeannie‐Marie S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and NeuropsychiatryJohns Hopkins University School of MedicineBaltimoreMDUSA
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Impact of diabetes on caregiver stress in patients with Alzheimer's disease: data from the ICTUS study. Int Psychogeriatr 2018; 30:1109-1117. [PMID: 29380719 DOI: 10.1017/s1041610217002460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED ABSTRACTBackground:To estimate the impact of comorbid diabetes on caregiver stress in Alzheimer's disease (AD) patients from the Impact of Cholinergic Treatment Use (ICTUS) study. METHODS Using the Data from the ICTUS study, diabetes mellitus (DM) was recorded at baseline and caregiver burden was assessed twice per year using the Zarit Burden Interview (ZBI) scale. The three-factorial model of ZBI (the effect on the social and personal life of caregivers, the psychological burden and the feelings of guilt) was adopted. Linear mixed models were used to examine the relation between DM and the scores of ZBI. RESULTS The present analyses were conducted on 1,264 AD subjects. A total of 156 patients (12.3%) had DM with taking antidiabetic medication and/or self-report of a history. At baseline, the caregivers of patients with or without DM had similar ZBI global scores and similar scores of three different factors of ZBI. Unadjusted and adjusted models both indicated that ZBI global score increased over a 24-month follow-up without significant effect of DM. Similarly, unadjusted model showed that DM was not determining any significant difference in the score of any factor. However, adjusted model indicated that in diabetic patients, the scores of the social and personal life of caregivers and the psychological burden increased more slowly than those in non-diabetic patients (p = 0.04 and 0.01, respectively). CONCLUSIONS DM may affect the caregivers' daily social and personal life and psychological burden in AD patients. It is necessary for further research.
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Ávila A, De-Rosende-Celeiro I, Torres G, Vizcaíno M, Peralbo M, Durán M. Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:734-743. [PMID: 29998539 DOI: 10.1111/hsc.12594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 05/08/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
Nonpharmacologic therapies such as occupational therapy (OT) are promising for people with Alzheimer's disease (AD). However, more research is needed to better understand the effectiveness of home-based OT programs. This pilot study aimed to assess the effects of a home-based, high-intensity and multicomponent OT intervention on the activities of daily living of people with AD in Spain. The secondary objective was to examine its impact on the cognitive functions. A multiple-baseline intrasubject design was used. Twenty-one community-dwelling older adults with mild AD (mean age 78.6 years) and their primary caregivers participated in a 12-week home-based OT program. This intervention was replicated for 8 weeks after a 1.5-month intervention withdrawal period. The intervention followed a holistic, biopsychosocial and client-centred approach and consisted of the following components: meaningful activities/tasks, cognitive stimulation, activation of psychomotor and sensory skills, home modification, caregiver counselling and training in daily living skills. Functional independence was the primary outcome (Barthel Index). The cognitive functions were assessed by the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G). Data were analysed using nonparametric tests. Main results showed that after completing the OT program, 6.5 months after the moment of inclusion, the level of functional independence improved significantly and the effect size was large. Moreover, there was a significant moderate-to-substantial improvement in several cognitive functions after each of the two intervention periods: place orientation, time orientation and attention/concentration. In summary, the findings give a great deal of information as a basis for further research. This study provides evidence that an intensive home-based OT intervention has a positive influence on daily activities and some cognitive functions, suggesting that this program may be beneficial as a nonpharmacological supplementary tool in health and social care for people with AD living in the community.
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Affiliation(s)
- Adriana Ávila
- Departamento de Ciencias da Saúde, Unidade de Investigación de Terapia Ocupacional en intervencións non farmacolóxicas, Universidade da Coruña, A Coruña, Spain
| | - Iván De-Rosende-Celeiro
- Departamento de Ciencias da Saúde, Unidade de Investigación de Terapia Ocupacional en intervencións non farmacolóxicas, Universidade da Coruña, A Coruña, Spain
| | - Gabriel Torres
- Departamento de Educación Física e Deportiva, Universidade da Coruña, A Coruña, Spain
| | - Mirian Vizcaíno
- Departamento de Ciencias da Saúde, Unidade de Investigación de Terapia Ocupacional en intervencións non farmacolóxicas, Universidade da Coruña, A Coruña, Spain
| | - Manuel Peralbo
- Departamento de Psicoloxía, Universidade da Coruña, A Coruña, Spain
| | - Montserrat Durán
- Departamento de Psicoloxía, Universidade da Coruña, A Coruña, Spain
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Henneges C, Reed C, Chen YF, Dell'Agnello G, Lebrec J. Describing the Sequence of Cognitive Decline in Alzheimer's Disease Patients: Results from an Observational Study. J Alzheimers Dis 2017; 52:1065-80. [PMID: 27079700 PMCID: PMC4927893 DOI: 10.3233/jad-150852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Improved understanding of the pattern of cognitive decline in Alzheimer’s disease (AD) would be useful to assist primary care physicians in explaining AD progression to patients and caregivers. Objective: To identify the sequence in which cognitive abilities decline in community-dwelling patients with AD. Methods: Baseline data were analyzed from 1,495 patients diagnosed with probable AD and a Mini-Mental State Examination (MMSE) score ≤ 26 enrolled in the 18-month observational GERAS study. Proportional odds logistic regression models were applied to model MMSE subscores (orientation, registration, attention and concentration, recall, language, and drawing) and the corresponding subscores of the cognitive subscale of the Alzheimer’s Disease Assessment Scale (ADAS-cog), using MMSE total score as the index of disease progression. Probabilities of impairment start and full impairment were estimated at each MMSE total score level. Results: From the estimated probabilities for each MMSE subscore as a function of the MMSE total score, the first aspect of cognition to start being impaired was recall, followed by orientation in time, attention and concentration, orientation in place, language, drawing, and registration. For full impairment in subscores, the sequence was recall, drawing, attention and concentration, orientation in time, orientation in place, registration, and language. The sequence of cognitive decline for the corresponding ADAS-cog subscores was remarkably consistent with this pattern. Conclusion: The sequence of cognitive decline in AD can be visualized in an animation using probability estimates for key aspects of cognition. This might be useful for clinicians to set expectations on disease progression for patients and caregivers.
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Affiliation(s)
| | - Catherine Reed
- Eli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
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Liu W, Jao YL, Williams K. The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: A secondary analysis. Int J Nurs Stud 2017; 71:70-79. [PMID: 28340390 PMCID: PMC5495475 DOI: 10.1016/j.ijnurstu.2017.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nursing home residents with dementia experience increased risk for compromised eating performance due to intrapersonal, interpersonal, and environmental factors. Environmental stimulation is physical, social, and/or sensory stimulation present in the environment that can potentially trigger individuals' emotion or motivate physical reactions. Beyond the personal factors, there is a lack of evidence on how environmental stimulation influences individuals' eating performance at mealtimes. OBJECTIVES This study examined the association between environmental stimulation and eating performance among nursing home residents with dementia. DESIGN This study was a secondary analysis using baseline videos selected from a communication intervention study, where videos were recorded to capture staff-resident interactions during care activities for nursing home residents with dementia. Videos were included in this study only if residents demonstrated eating activities at mealtimes. SAMPLE AND SETTING A total of 36 videos were selected (mean length=4min). The sample included 15 residents with dementia (mean age=86), and 19 certified nursing assistants (mean age=36) in 8 nursing homes. METHODS The dependent variable was eating performance as measured by the Level of Eating Independence scale (range: 15-36, with higher scores indicating better eating performance). The independent variables were characteristics of environmental stimulation measured by the Person-Environment Apathy Rating-Environment subscale (stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback). Each characteristic was rated on a 1-4 scale with higher scores indicating more desirable environmental stimulation. Multilevel models were used to examine the association between eating performance and environmental stimulation, adjusting for resident characteristics (i.e., age, gender, dementia stage, function, comorbidity, psychoactive medication use) and nesting effects of residents and staff. RESULTS Resident participants demonstrated moderate levels of eating performance (M=27.08, SD=5.16). Eating performance was significantly lower among older residents, those with more advanced dementia, and higher comorbidity. After controlling for resident characteristics, eating performance was significantly associated with stimulation specificity (how the stimulation is delivered and tailored to the resident), and was not associated with other environmental stimulation characteristics. For each 1 point increase in stimulation specificity, eating performance increased by 8.78 points (95% CI=0.59, 16.97). CONCLUSIONS Environmental stimulation that is personally tailored to a resident' needs and preferences and directly offered to a resident contributed to better eating performance among residents with dementia. The findings will direct future development and implementation of person-directed mealtime care programs and dining environment arrangements for residents with dementia in nursing homes.
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Affiliation(s)
- Wen Liu
- The University of Iowa, College of Nursing, 432 CNB, 50 Newton Road, Iowa City, IA, 52242, USA.
| | - Ying-Ling Jao
- Pennsylvania State University, College of Nursing, University Park, PA, USA
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Gallini A, Coley N, Andrieu S, Lapeyre-Mestre M, Gardette V. Effect of dementia on receipt of influenza vaccine: a cohort study in French older adults using administrative data: 2007-2012. Fundam Clin Pharmacol 2017; 31:471-480. [PMID: 28258589 DOI: 10.1111/fcp.12281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/30/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
Despite guidelines stating the vaccine benefit in this population, older adults with dementia may be less likely to receive influenza vaccine than cognitively intact older adults. But no study has yet reported on vaccine uptake in patients newly diagnosed with dementia or whether years since dementia diagnosis influences vaccine uptake. We conducted a cohort study in the French Health Insurance database (Echantillon Généraliste de Bénéficiaires) which contains hospital data and claims for a 1/97th random sample of the French population. Diseased subjects were ≥65 years and had a new record of dementia diagnosis between September 1, 2007, and August 31, 2008. Vaccine receipt was measured via influenza vaccine dispensing in community pharmacies. We described influenza vaccination rates up to 2011-2012 and estimated adjusted relative risks (aRR) for vaccine receipt each year using multivariate modified Poisson models controlling for sociodemographics, comorbidities, and health resources use. Four hundred and seven subjects with dementia (mean age 81.8 years, 69.3% females) and 4862 subjects (mean age 75.2 years, 61.3% females) without dementia were included. In 2008-2009, influenza vaccination prevalence was 70.0% (95% CI = [65.3-74.4]) and 70.2% (95% CI = [68.9-71.4]) in subjects with and without dementia, respectively (aRR = 0.93; 95% CI = [0.87-1.00]). In 2009-2010, the aRR was of the same magnitude (aRR = 0.96, 95% CI = [0.90-1.03]), but in 2010-2011 and 2011-2012, the aRR was 1.02 (95% CI = [0.94-1.11]) and 1.05 (95% CI = [0.96-1.14]), respectively. Subjects with dementia had a slightly nonsignificant lower receipt of influenza vaccine in the year following dementia diagnosis than subjects without dementia. In subsequent years, divergent trends were observed in vaccine uptake according to dementia status.
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Affiliation(s)
- Adeline Gallini
- UMR 1027, Epidémiologie et Analyses en Santé Publique: Risques, Maladies Chroniques et Handicaps, Inserm, Toulouse, F-31000, France.,Université de Toulouse III, Toulouse, F-31000, France.,Service d'Epidémiologie, CHU Toulouse, Toulouse, F-31000, France
| | - Nicola Coley
- UMR 1027, Epidémiologie et Analyses en Santé Publique: Risques, Maladies Chroniques et Handicaps, Inserm, Toulouse, F-31000, France.,Université de Toulouse III, Toulouse, F-31000, France.,Service d'Epidémiologie, CHU Toulouse, Toulouse, F-31000, France
| | - Sandrine Andrieu
- UMR 1027, Epidémiologie et Analyses en Santé Publique: Risques, Maladies Chroniques et Handicaps, Inserm, Toulouse, F-31000, France.,Université de Toulouse III, Toulouse, F-31000, France.,Service d'Epidémiologie, CHU Toulouse, Toulouse, F-31000, France
| | - Maryse Lapeyre-Mestre
- UMR 1027, Epidémiologie et Analyses en Santé Publique: Risques, Maladies Chroniques et Handicaps, Inserm, Toulouse, F-31000, France.,Université de Toulouse III, Toulouse, F-31000, France.,Service de Pharmacologie Clinique, CHU Toulouse, Toulouse, F-31000, France
| | - Virginie Gardette
- UMR 1027, Epidémiologie et Analyses en Santé Publique: Risques, Maladies Chroniques et Handicaps, Inserm, Toulouse, F-31000, France.,Université de Toulouse III, Toulouse, F-31000, France.,Service d'Epidémiologie, CHU Toulouse, Toulouse, F-31000, France
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Hornberger J, Bae J, Watson I, Johnston J, Happich M. Clinical and cost implications of amyloid beta detection with amyloid beta positron emission tomography imaging in early Alzheimer's disease - the case of florbetapir. Curr Med Res Opin 2017; 33:675-685. [PMID: 28035842 DOI: 10.1080/03007995.2016.1277197] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Amyloid beta (Aβ) positron emission tomography (PET) imaging helps estimate Aβ neuritic plaque density in patients with cognitive impairment who are under evaluation for Alzheimer's disease (AD). This study aims to evaluate the cost-effectiveness of the Aβ-PET scan as an adjunct to standard diagnostic assessment for diagnosis of AD in France, using florbetapir as an example. METHODS A state-transition probability analysis was developed adopting the French Health Technology Assessment (HTA) perspective per guidance. Parameters included test characteristics, rate of cognitive decline, treatment effect, costs, and quality of life. Additional scenarios assessed the validity of the analytical framework, including: (1) earlier evaluation/treatment; (2) cerebrospinal fluid (CSF) as a comparator; and (3) use of other diagnostic procedures. Outputs included differences in quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). All benefits and costs were discounted for time preferences. Sensitivity analyses were performed to assess the robustness of findings and key influencers of outcomes. RESULTS Aβ-PET used as an adjunct to standard diagnostic assessment increased QALYs by 0.021 years and 10 year costs by €470 per patient. The ICER was €21,888 per QALY gained compared to standard diagnostic assessment alone. When compared with CSF, Aβ-PET costs €24,084 per QALY gained. In other scenarios, Aβ-PET was consistently cost-effective relative to the commonly used affordability threshold (€40,000 per QALY). Over 95% of simulations in the sensitivity analysis were cost-effective. CONCLUSION Aβ-PET is projected to affordably increase QALYs from the French HTA perspective per guidance over a range of clinical scenarios, comparators, and input parameters.
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Affiliation(s)
- John Hornberger
- a Cedar Associates , Menlo Park , CA USA
- b Stanford University , Stanford , CA USA
| | - Jay Bae
- c Eli Lilly and Company , Indianapolis , IN USA
| | - Ian Watson
- c Eli Lilly and Company , Indianapolis , IN USA
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Jones RW, Lebrec J, Kahle-Wrobleski K, Dell'Agnello G, Bruno G, Vellas B, Argimon JM, Dodel R, Haro JM, Wimo A, Reed C. Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes. Dement Geriatr Cogn Dis Extra 2017; 7:87-100. [PMID: 28611822 PMCID: PMC5465649 DOI: 10.1159/000461577] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/13/2016] [Indexed: 01/16/2023] Open
Abstract
Background/Aims We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Methods Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Results Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Conclusion Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.
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Affiliation(s)
- Roy W Jones
- aRICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
| | | | | | | | - Giuseppe Bruno
- eDepartment of Neurology and Psychiatry, Clinica della Memoria, University of Rome "Sapienza", Rome, Italy
| | - Bruno Vellas
- fGerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Josep M Argimon
- gDivisió d'Avaluació, Catalan Health Service, Barcelona, Spain
| | - Richard Dodel
- hDepartment of Neurology, Philipps University, Marburg, Germany
| | - Josep Maria Haro
- iParc Santari Saint Joan de Déu, CIBERSAM, University of Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Anders Wimo
- jDivision of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Catherine Reed
- kEli Lilly and Company Limited, Lilly Research Centre, Windlesham, UK
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Sanders C, Behrens S, Schwartz S, Wengreen H, Corcoran CD, Lyketsos CG, Tschanz JT. Nutritional Status is Associated with Faster Cognitive Decline and Worse Functional Impairment in the Progression of Dementia: The Cache County Dementia Progression Study1. J Alzheimers Dis 2017; 52:33-42. [PMID: 26967207 DOI: 10.3233/jad-150528] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nutritional status may be a modifiable factor in the progression of dementia. We examined the association of nutritional status and rate of cognitive and functional decline in a U.S. population-based sample. Study design was an observational longitudinal study with annual follow-ups up to 6 years of 292 persons with dementia (72% Alzheimer's disease, 56% female) in Cache County, UT using the Mini-Mental State Exam (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-sb), and modified Mini Nutritional Assessment (mMNA). mMNA scores declined by approximately 0.50 points/year, suggesting increasing risk for malnutrition. Lower mMNA score predicted faster rate of decline on the MMSE at earlier follow-up times, but slower decline at later follow-up times, whereas higher mMNA scores had the opposite pattern (mMNA by time β= 0.22, p = 0.017; mMNA by time2 β= -0.04, p = 0.04). Lower mMNA score was associated with greater impairment on the CDR-sb over the course of dementia (β= 0.35, p < 0.001). Assessment of malnutrition may be useful in predicting rates of progression in dementia and may provide a target for clinical intervention.
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Affiliation(s)
- Chelsea Sanders
- Department of Psychology, Utah State University, Logan, UT, USA
| | | | - Sarah Schwartz
- Department of Mathematics and Statistics, Utah State University, Logan, UT, USA
| | - Heidi Wengreen
- Department of Nutrition and Food Sciences, Utah State University, Logan, UT, USA
| | - Chris D Corcoran
- Department of Mathematics and Statistics, Utah State University, Logan, UT, USA.,Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA.,Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
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Barbe C, Morrone I, Novella JL, Dramé M, Wolak-Thierry A, Aquino JP, Ankri J, Jolly D, Mahmoudi R. Predictive Factors of Rapid Cognitive Decline in Patients with Alzheimer Disease. Dement Geriatr Cogn Dis Extra 2016; 6:549-558. [PMID: 28101101 PMCID: PMC5216188 DOI: 10.1159/000450975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
Aim To determine predictive factors associated with rapid cognitive decline (RCD) in elderly patients suffering from Alzheimer disease (AD). Methods Patients suffering from mild to moderate AD were included. RCD was defined as the loss of at least 3 points on the Mini-Mental State Examination (MMSE) over 12 months. Factors associated with RCD were identified by logistic regression. Results Among 123 patients included, 61 were followed up until 12 months. RCD occurred in 46% of patients (n = 28). Polymedication (p < 0.0001), the fact that the caregiver was the child or spouse of the patient (p < 0.0001) and autonomy for washing (p < 0.0001) were protective factors against RCD, while the presence of caregiver burden (p < 0.0001) was shown to be a risk factor for RCD. Conclusion Early detection of the RCD risk in AD patients could make it possible to anticipate the patient's medical needs and adjust the care plan for caregiver burden.
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Affiliation(s)
- Coralie Barbe
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | - Isabella Morrone
- Department of Geriatrics and Internal Medicine, Reims University Hospital, Reims, France
| | - J L Novella
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Geriatrics and Internal Medicine, Reims University Hospital, Reims, France
| | - Moustapha Dramé
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | - Aurore Wolak-Thierry
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | | | - Joël Ankri
- Centre of Gerontology, Public Assistance, Hospitals of Paris, Paris Cedex, France
| | - Damien Jolly
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | - Rachid Mahmoudi
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Geriatrics and Internal Medicine, Reims University Hospital, Reims, France
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Miranda LF, Gomes KB, Tito PA, Silveira JN, Pianetti GA, Byrro RM, Peles PR, Pereira FH, Santos TR, Assini AG, Ribeiro VV, Moraes EN, Caramelli P. Clinical Response to Donepezil in Mild and Moderate Dementia: Relationship to Drug Plasma Concentration and CYP2D6 and APOE Genetic Polymorphisms. J Alzheimers Dis 2016; 55:539-549. [DOI: 10.3233/jad-160164] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Luís F.J.R. Miranda
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Karina B. Gomes
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Pedro A.L. Tito
- Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Josianne N. Silveira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Gerson A. Pianetti
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Ricardo M.D. Byrro
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Patrícia R.H. Peles
- Serviço de Neurologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Fernando H. Pereira
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Thiago R. Santos
- Instituto de Ciências Exatas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Arthur G. Assini
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Valéria V. Ribeiro
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Edgar N. Moraes
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
- Serviço de Geriatria do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
| | - Paulo Caramelli
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
- Serviço de Neurologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil
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Joussain P, Bessy M, Fournel A, Ferdenzi C, Rouby C, Delphin-Combe F, Krolak-Salmon P, Bensafi M. Altered Affective Evaluations of Smells in Alzheimer's Disease. J Alzheimers Dis 2016; 49:433-41. [PMID: 26484905 DOI: 10.3233/jad-150332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies of olfaction in Alzheimer's disease (AD) mainly focused on deficits in odor detection and identification, with very few investigations of olfactory emotional changes and their consequences for hedonics. OBJECTIVE The aim of the present study was to characterize affective evaluations of odors in AD patients. METHODS To this end, 20 AD patients and 20 matched controls were tested. Participants were screened for odor detection and identification ability and then asked to rate the intensity, pleasantness, and edibility of 20 odorants. RESULTS Results showed that, overall, AD patients had lower detection ability and perceived all odors as weaker than controls. As expected, they had lower identification ability on both cued and non-cued tasks. In addition, when smelling pleasant odors, patients had significantly lower hedonic ratings than controls (p < 0.02), whereas no group difference was found for neutral or unpleasant odors (p > 0.05 in both cases). Moreover, an analysis combining both intensity and pleasantness ratings showed that whereas intensity increased as a function of pleasantness and unpleasantness in controls, this quadratic relationship was not observed in AD patients. CONCLUSIONS The study suggests that the simplest categorization criteria of odors (intensity and hedonic valence) are impaired in AD patients (especially for pleasant odors).
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Affiliation(s)
- Pauline Joussain
- CNRS UMR5292, INSERM U1028, Lyon Neuroscience Research Center, University Lyon, France
| | - Marion Bessy
- CNRS UMR5292, INSERM U1028, Lyon Neuroscience Research Center, University Lyon, France
| | - Arnaud Fournel
- CNRS UMR5292, INSERM U1028, Lyon Neuroscience Research Center, University Lyon, France
| | - Camille Ferdenzi
- CNRS UMR5292, INSERM U1028, Lyon Neuroscience Research Center, University Lyon, France
| | - Catherine Rouby
- CNRS UMR5292, INSERM U1028, Lyon Neuroscience Research Center, University Lyon, France
| | | | - Pierre Krolak-Salmon
- CNRS UMR5292, INSERM U1028, Lyon Neuroscience Research Center, University Lyon, France.,Hospices Civils de Lyon, France.,Clinical and Research Memory Center of Lyon, France
| | - Moustafa Bensafi
- CNRS UMR5292, INSERM U1028, Lyon Neuroscience Research Center, University Lyon, France
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Bucher CO, Dubuc N, von Gunten A, Morin D. Measuring change in clinical profiles between hospital admission and discharge and predicting living arrangements at discharge for aged patients presenting behavioral and psychological symptoms of dementia. Arch Gerontol Geriatr 2016; 65:161-7. [DOI: 10.1016/j.archger.2016.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 10/22/2022]
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Vidal JS, Hanon O, Funalot B, Brunel N, Viollet C, Rigaud AS, Seux ML, le-Bouc Y, Epelbaum J, Duron E. Low Serum Insulin-Like Growth Factor-I Predicts Cognitive Decline in Alzheimer’s Disease. J Alzheimers Dis 2016; 52:641-9. [DOI: 10.3233/jad-151162] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jean-Sébastien Vidal
- AP-HP, Hôpital Broca, Service de Gériatrie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Olivier Hanon
- AP-HP, Hôpital Broca, Service de Gériatrie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Benoît Funalot
- INSERM, UMR-S894, Centre de psychiatrie et neurosciences, Paris, France
| | | | - Cécile Viollet
- INSERM, UMR-S894, Centre de psychiatrie et neurosciences, Paris, France
| | - Anne-Sophie Rigaud
- AP-HP, Hôpital Broca, Service de Gériatrie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marie-Laure Seux
- AP-HP, Hôpital Broca, Service de Gériatrie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Yves le-Bouc
- INSERM/UPMC, Paris VI, UMRS 938, Centre de Recherche St-Antoine, Paris, France
| | - Jacques Epelbaum
- INSERM, UMR-S894, Centre de psychiatrie et neurosciences, Paris, France
| | - Emmanuelle Duron
- AP-HP, Hôpital Broca, Service de Gériatrie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, UMR-S894, Centre de psychiatrie et neurosciences, Paris, France
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Jutkowitz E, MacLehose RF, Gaugler JE, Dowd B, Kuntz KM, Kane RL. Risk Factors Associated With Cognitive, Functional, and Behavioral Trajectories of Newly Diagnosed Dementia Patients. J Gerontol A Biol Sci Med Sci 2016; 72:251-258. [PMID: 27129917 DOI: 10.1093/gerona/glw079] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/07/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dementia results in changes in cognition, function, and behavior. We examine the effect of sociodemographic and clinical risk factors on cognitive, functional, and behavioral declines in incident dementia patients. METHODS We used longitudinal data from the National Alzheimer's Coordinating Center to evaluate cognitive (Mini-Mental State Exam [MMSE]), functional (Functional Activities Questionnaire [FAQ]), and behavioral (Neuropsychiatric Inventory Questionnaire [NPI-Q] severity score) trajectories for incident dementia patients over an 8-year period. We evaluated trajectories of 457 patients with mixed effects linear regression models. RESULTS In the first year, cognition worsened by -1.518 (95% confidence interval [CI] -1.745, -1.291) MMSE points (0-30 scale). Education, race, and region of residence predicted cognition at diagnosis. Age of onset, geographic region of residence, and history of hypertension and congestive heart failure predicted cognitive changes. Function worsened by 3.464 (95% CI 3.131, 3.798) FAQ points in the first year (0-30 scale). Cognition, gender, race, region of residence and place of residence, and a history of stroke and hypercholesterolemia predicted function at diagnosis. Place of residence and a history of diabetes predicted functional changes. Behavioral symptoms worsened by 0.354 (95% CI 0.123, 0.585) NPI-Q points in the first year (0-36 scale). Age of onset, region of residence, and history of hypertension and psychiatric problems predicted behaviors at diagnosis. Cognition explained changes in behavior. CONCLUSIONS Sociodemographic characteristics and clinical comorbidities predict cognitive and functional changes. Only cognitive status explains behavioral decline. Results provide an understanding of the characteristics that impact cognitive, functional, and behavioral decline.
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Affiliation(s)
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | | | - Bryan Dowd
- Division of Health Policy and Management and
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Delva F, Touraine C, Joly P, Edjolo A, Amieva H, Berr C, Rouaud O, Helmer C, Pérès K, Dartigues JF. ADL disability and death in dementia in a French population-based cohort: New insights with an illness-death model. Alzheimers Dement 2016; 12:909-16. [PMID: 27103260 DOI: 10.1016/j.jalz.2016.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/16/2016] [Accepted: 03/18/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Transition to bathing or dressing disability is a milestone in the evolution of dementia. We examined the transition to disability in these specific activities and considered death to be a competitive event and age and sex to be prognostic factors. METHODS From a large cohort of 570 incident dementia cases screened in two prospective population-based cohorts, the Paquid study, and the Three-City study, we estimated the probabilities of remaining nondisabled, becoming disabled in bathing or dressing, or dying after the diagnosis using an illness-death model. RESULTS On average, approximately half of the period (3 years) of living with dementia was free of disability. In women, a higher survival rate was associated with an average of 1 additional year with disability. DISCUSSION The joint prediction of death and disability in dementia by an illness-death model gives original and useful parameters for the prognosis and management of dementia.
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Affiliation(s)
- Fleur Delva
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France.
| | - Celia Touraine
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France
| | - Pierre Joly
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France
| | - Arlette Edjolo
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France
| | - Hélène Amieva
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France
| | - Claudine Berr
- Centre INSERM U1061, Université Montpellier 1, Hôpital La Colombière, Montpellier, France; CMRR Languedoc-Roussillon, CHU Montpellier, Hôpital Gui de Chauliac, Département de Neurologie, Montpellier, France
| | | | - Catherine Helmer
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France
| | - Karine Pérès
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France
| | - Jean-François Dartigues
- Centre INSERM U897, ISPED, Bordeaux, France; Université Bordeaux, Bordeaux, France; CMRR d'Aquitaine, CHU de Bordeaux, Bordeaux, France
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Function and clinical meaningfulness of treatments for mild Alzheimer's disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 2:105-12. [PMID: 27239541 PMCID: PMC4879645 DOI: 10.1016/j.dadm.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Effectiveness of Alzheimer's disease (AD) treatments is commonly evaluated with coprimary outcomes; cognition with function to ensure clinical meaningfulness of a cognitive effect. Methods We reviewed the literature for functional outcomes in mild AD or mild cognitive impairment (MCI) patients (distinct from combined mild-moderate/severe AD) treated with approved AD drugs. Cognitive and functional treatment differences in mild AD patients in solanezumab EXPEDITION/EXPEDITION2 studies were compared across time. Results Seven publications provided MCI/mild AD functional outcomes, one of which reported a significant functional treatment effect. Secondary analyses of EXPEDITION studies suggested a smaller functional effect of solanezumab relative to cognition. An increasing effect of solanezumab over 18 months was shown for cognition and function. Discussion Function as the sole measure to demonstrate clinical meaningfulness of cognitive effects in mild AD may have limitations. For disease-modifying treatments, point differences on cognitive and functional scales should be qualified with duration of treatment.
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Leoutsakos J, Forrester S, Corcoran C, Norton M, Rabins PV, Steinberg MI, Tschanz J, Lyketsos C. Latent classes of course in Alzheimer's disease and predictors: the Cache County Dementia Progression Study. Int J Geriatr Psychiatry 2015; 30:824-32. [PMID: 25363393 PMCID: PMC4632525 DOI: 10.1002/gps.4221] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/26/2014] [Accepted: 09/08/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Several longitudinal studies of Alzheimer's disease (AD) report heterogeneity in progression. We sought to identify groups (classes) of progression trajectories in the population-based Cache County Dementia Progression Study (N = 328) and to identify baseline predictors of membership for each group. METHODS We used parallel-process growth mixture models to identify latent classes of trajectories on the basis of Mini-Mental State Exam (MMSE) and Clinical Dementia Rating sum of boxes scores over time. We then used bias-corrected multinomial logistic regression to model baseline predictors of latent class membership. We constructed receiver operating characteristic curves to demonstrate relative predictive utility of successive sets of predictors. RESULTS We fit four latent classes; class 1 was the largest (72%) and had the slowest progression. Classes 2 (8%), 3 (11%), and 4 (8%) had more rapid worsening. In univariate analyses, longer dementia duration, presence of psychosis, and worse baseline MMSE and Clinical Dementia Rating sum of boxes were associated with membership in class 2, relative to class 1. Lower education was associated with membership in class 3. In the multivariate model, only MMSE remained a statistically significant predictor of class membership. Receiver operating characteristic areas under the curve were 0.98, 0.88, and 0.67, for classes 2, 3, and 4 relative to class 1. CONCLUSIONS Heterogeneity in AD course can be usefully characterized using growth mixture models. The majority belonged to a class characterized by slower decline than is typically reported in clinical samples. Class membership could be predicted using baseline covariates. Further study may advance our prediction of AD course at the population level and in turn shed light on the pathophysiology of progression.
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Affiliation(s)
- J.S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland USA,CORRESPONDING AUTHOR: Jeannie-Marie Leoutsakos, Ph.D., Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Bayview Alpha Commons Building, 4, Floor, Baltimore, MD 21224, Phone: 410-550-9884, Fax: 410-550-1407,
| | - S.N. Forrester
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - C.D. Corcoran
- Center for Epidemiologic Studies, Consumer and Human Development Utah State University, Logan, Utah, USA,Department of Mathematics and Statistics, Consumer and Human Development Utah State University, Logan, Utah, USA
| | - M.C. Norton
- Center for Epidemiologic Studies, Consumer and Human Development Utah State University, Logan, Utah, USA,Department of Psychology, Consumer and Human Development Utah State University, Logan, Utah, USA,Department of Family, Consumer and Human Development Utah State University, Logan, Utah, USA
| | - Peter V. Rabins
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Martin I. Steinberg
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - J.T. Tschanz
- Center for Epidemiologic Studies, Consumer and Human Development Utah State University, Logan, Utah, USA,Department of Psychology, Consumer and Human Development Utah State University, Logan, Utah, USA
| | - C.G. Lyketsos
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
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Liu W, Galik E, Boltz M, Nahm ES, Resnick B. Optimizing Eating Performance for Older Adults With Dementia Living in Long-term Care: A Systematic Review. Worldviews Evid Based Nurs 2015; 12:228-35. [DOI: 10.1111/wvn.12100] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Wen Liu
- Assistant Professor, University of Iowa College of Nursing; Iowa City IA
| | - Elizabeth Galik
- Associate Professor, University of Maryland School of Nursing, Department of Organizational Systems and Adult Health; Baltimore MD
| | - Marie Boltz
- Associate Professor, Boston College Connell School of Nursing; Chestnut Hill MA
| | - Eun-Shim Nahm
- Professor, University of Maryland School of Nursing, Department of Organizational Systems and Adult Health; Baltimore MD
| | - Barbara Resnick
- Professor, University of Maryland School of Nursing, Department of Organizational Systems and Adult Health; Baltimore MD
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Hallikainen I, Martikainen J, Lin PJ, Cohen JT, Lahoz R, Välimäki T, Hongisto K, Väätäinen S, Vanhanen M, Neumann PJ, Hänninen T, Koivisto AM. The Progression of Alzheimer's Disease Can Be Assessed with a Short Version of the CERAD Neuropsychological Battery: The Kuopio ALSOVA Study. Dement Geriatr Cogn Dis Extra 2014; 4:494-508. [PMID: 25685140 PMCID: PMC4296232 DOI: 10.1159/000369159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Measuring and predicting Alzheimer's disease (AD) progression is important in order to adjust treatment and allocate care resources. We aimed to identify a combination of subtests from the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) that best correlated with AD progression in follow-up as well as to predict AD progression. Method A total of 236 participants with very mild [Clinical Dementia Rating (CDR) = 0.5] or mild AD (CDR = 1.0) at baseline were followed up for 3 years. The CERAD-NB and Mini-Mental State Examination (MMSE) were used to assess cognition, and the CDR scale sum of boxes (CDR-sb) was employed to evaluate AD progression. Generalized estimating equations were used to develop models to predict and follow up disease progression. Results Performance declined on all CERAD-NB subtests. The ability of the separate subtests to distinguish between groups (baseline CDR = 0.5 or 1.0) diminished during follow-up. The best combination of subtests that explained 62% of CDR-sb variance in follow-up included verbal fluency, constructional praxis, the clock drawing test, and the MMSE. Baseline values of the same combination predicted 37% of the CDR-sb change. Conclusion A short version of the CERAD-NB subtests provides a promising and time-efficient alternative for measuring cognitive deterioration during AD follow-up. Although the initial signs of AD include memory difficulties, it may be useful to assess non-memory tasks in follow-up.
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Affiliation(s)
- Ilona Hallikainen
- School of Educational Sciences and Psychology, Kuopio, Finland ; Neurology, Institute of Clinical Medicine, Kuopio, Finland
| | - Janne Martikainen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | | | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland ; Development, Clinical Education and Research Unit of Nursing, Kuopio, Finland
| | | | - Saku Väätäinen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | | | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | - Tuomo Hänninen
- Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne Maria Koivisto
- Neurology, Institute of Clinical Medicine, Kuopio, Finland ; Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
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Troussière AC, Charley CM, Salleron J, Richard F, Delbeuck X, Derambure P, Pasquier F, Bombois S. Treatment of sleep apnoea syndrome decreases cognitive decline in patients with Alzheimer's disease. J Neurol Neurosurg Psychiatry 2014; 85:1405-8. [PMID: 24828897 DOI: 10.1136/jnnp-2013-307544] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is essential to detect and then treat factors that aggravate Alzheimer's disease (AD). Here, we sought to determine whether or not continuous positive airway pressure (CPAP) therapy for sleep apnoea syndrome (SAS) slows the rate of cognitive decline in mild-to-moderate AD patients. METHODS Between January 2003 and June 2011, we included consecutive, mild-to-moderate AD patients (a Mini Mental State Examination (MMSE) score at inclusion ≥15) with severe SAS as determined by video-polysomnography (an apnoea-hypopnoea index ≥30). In this single-blind, proof-of-concept trial, we analysed the mean decline in the annual MMSE score (the main outcome measure) according to whether or not the patients had received CPAP therapy. The decline was computed for each patient and for the first 3 years of follow-up. RESULTS Of the 23 included patients, 14 underwent CPAP treatment. The CPAP and non-CPAP groups did not differ significantly in terms of their demographic characteristics or MMSE score at baseline. The median annual MMSE decline was significantly slower in the CPAP group (-0.7 (-1.7; +0.8)) than in the non-CPAP group (-2.2 (-3.3; -1.9); p=0.013). CONCLUSIONS In this pilot study, CPAP treatment of severe SAS in mild-to-moderate AD patients was associated with significantly slower cognitive decline over a three-year follow-up period. Our results emphasise the importance of detecting and treating SAS in this population.
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Affiliation(s)
- Anne-Cécile Troussière
- University Lille North of France, CHU, Lille, France EA 1046, Lille, France Memory Clinic, Lille, France
| | - Christelle Monaca Charley
- University Lille North of France, CHU, Lille, France EA 1046, Lille, France Department of Neurophysiology and Sleep Unit, Lille, France
| | - Julia Salleron
- University Lille North of France, CHU, Lille, France Department of Public Health and Biostatistic Unit, Lille, France
| | - Florence Richard
- University Lille North of France, CHU, Lille, France Department of Public Health and Biostatistic Unit, Lille, France INSERM UMR 744, Institut Pasteur, Lille, France
| | - Xavier Delbeuck
- University Lille North of France, CHU, Lille, France EA 1046, Lille, France Memory Clinic, Lille, France
| | - Philippe Derambure
- University Lille North of France, CHU, Lille, France EA 1046, Lille, France Department of Neurophysiology and Sleep Unit, Lille, France
| | - Florence Pasquier
- University Lille North of France, CHU, Lille, France EA 1046, Lille, France Memory Clinic, Lille, France
| | - Stéphanie Bombois
- University Lille North of France, CHU, Lille, France EA 1046, Lille, France Memory Clinic, Lille, France
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Delva F, Edjolo A, Pérès K, Berr C, Barberger-Gateau P, Dartigues JF. Hierarchical structure of the activities of daily living scale in dementia. J Nutr Health Aging 2014; 18:698-704. [PMID: 25226109 DOI: 10.1007/s12603-014-0503-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the sequence of basic activities of daily living (ADL) loss to determine whether there is a hierarchical structure of ADL in dementia in two epidemiological prospective studies: the Paquid study and the Three City Study (3C). DESIGN Two prospective population-based cohort studies: Paquid (over 22 years of follow-up) and 3C (over 10 years of follow-up). SETTING Paquid Study, Gironde, Dordogne, France; The Three Cities Study, Bordeaux, Montpellier, Dijon, France. MAIN OUTCOMES MEASURES We analyzed four ADL of the Katz scale: bathing, dressing, transferring and feeding. The a priori hierarchical relationship of the 4 activities tested was 1) no ADL-disability at all four activities; 2) moderate ADL-disability, or disability at bathing and/or dressing (and no disability in transferring nor feeding); and 3) severe ADL-disability, or disability in bathing and/or dressing and transferring and/or feeding. We performed a Guttman scale analysis to establish the hierarchical properties scale. RESULTS In total, 845 incident cases of dementia were included, among which 838 cases (99.2%) were without any missing data for ADL. Upon diagnosis of dementia, 564 subjects (67.3%) had no ADL-disability, 236 (26.2%) had moderate ADL-disability, and 38 subjects (4.5%) had severe disability. The a priori hierarchy was respected with non-discordance. CONCLUSION We defined 3 simple relevant stages of ADL functional decline in dementia that would be easy to collect in clinical practice: stage 1, subjects with no major ADL disabilities; stage 2, subjects with complete disability in bathing and/or dressing; and stage 3, subjects with complete disability in all 4 tasks.
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Affiliation(s)
- F Delva
- F. Delva, ISPED, case 11, University Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux Cedex, Tel: 33557574538, Fax: 33557571486, E-mail:
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Maynard SD, Gelblum J. Retrospective cohort study of the efficacy of caprylic triglyceride in patients with mild-to-moderate alzheimer's disease. Neuropsychiatr Dis Treat 2013; 9:1619-27. [PMID: 24187497 PMCID: PMC3810439 DOI: 10.2147/ndt.s52331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effects of caprylic triglyceride (CT) in patients with mild-to-moderate Alzheimer's disease (AD) in routine clinical practice via review of medical records and caregiver questionnaires. METHODS Participants were outpatients aged ≥50 years with a diagnosis of probable mild-to-moderate AD who had received CT for ≥6 months. The primary outcome was change from baseline in the patient's condition as rated by the treating physician using a physician's overall assessment. RESULTS A total of 55 patients were included. The physician's overall assessment indicated that ~80% of patients who had CT added to ongoing pharmacotherapy were stable or improved. Mini-Mental State Examination scores also remained stable over 15 months of therapy (20.6 ± 3.0 at baseline and 20.1 ± 5.6 at follow-up, P = 0.5233, n = 27). Caregiver assessments indicated that most patients were stable or improved with respect to memory and ability to carry out activities of daily living. The most frequent adverse events with CT involved the gastrointestinal system. CONCLUSION Results from this chart review indicate that addition of CT to pharmacotherapy was associated with stable disease or improvement over a follow-up period of 18.8 months.
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Affiliation(s)
- Steven Douglas Maynard
- Union Associated Physicians Clinic, Terre Haute, IN, USA
- Indiana University School of Medicine, Terre Haute, IN, USA
| | - Jeff Gelblum
- Mt Sinai Medical Center of Miami, Aventura Hospital, Aventura, FL, USA
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Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study. Int Psychogeriatr 2013; 25:1335-44. [PMID: 23676340 DOI: 10.1017/s1041610213000653] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We studied the suitability of The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) total score for monitoring Alzheimer's disease (AD) progression in early-diagnosed medicated patients. We also investigated possible differences in progression between patients with very mild or mild baseline AD. METHODS In this three-year follow-up of 115 ALSOVA study patients with clinical dementia ratings (CDR) of very mild (0.5) or mild (1) AD, we analyzed total CERAD-NB, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), The Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory, and Clinical Dementia Rating Sum of Boxes scores. Correlations were identified with efficacy parameters. RESULTS Over three years, total CERAD-NB declined significantly in both groups. Annual change rates of total CERAD-NB were also significant. Total CERAD-NB revealed annual differences in cognition between study groups, while MMSE did not. Total CERAD-NB correlated well with other cognitive and global measures, but not with NPI. For almost two years, the CDR-0.5 group maintained a higher activities of daily living than the CDR-1 group exhibited at baseline. Furthermore, the CDR-0.5 group showed milder neuropsychiatric symptoms at the end of follow-up than the CDR-1 group showed at baseline. CONCLUSIONS The CERAD total score is a suitable and sensitive follow-up tool in longitudinal AD trials. Cognition progression rates did not significantly differ between study groups; however, patients with very mild AD at baseline had milder neuropsychiatric symptoms after long-term follow-up. This emphasizes the importance of early diagnosis and assessment of neuropsychiatric symptoms at the diagnostic visit and during follow-up.
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Schmidt C, Wolff M, von Ahsen N, Zerr I. Alzheimer's disease: genetic polymorphisms and rate of decline. Dement Geriatr Cogn Disord 2012; 33:84-9. [PMID: 22414550 DOI: 10.1159/000336790] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM To investigate the influence of established genetic risk factors for Alzheimer's disease on the speed of disease progression. METHODS Polymorphisms (in ACE, ApoE, BIN1, CLU, CR1, CST3, EXOC3L2, GWA14q32.13, IL8, LDLR, PICALM, TNK1) of 40 Alzheimer's disease patients from a longitudinal study were analyzed. A standardized loss of Mini-Mental State Examination points was used as the progression parameter. RESULTS Polymorphisms in CST3 and EXOC3L2 as well as the absence of APOE4 were associated with more aggressive disease courses. A trend was observed for BIN1. CONCLUSION In addition to being a risk factor for disease development, some of the polymorphisms investigated here are associated with higher rates of decline and disease progression and thus might act as prognostic disease markers. This effect needs to be considered in future treatment strategies.
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Affiliation(s)
- Christian Schmidt
- Department of Neurology, Georg August University Hospital, Robert-Koch-Strasse 40, Goettingen, Germany.
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Effects of general medical health on Alzheimer's progression: the Cache County Dementia Progression Study. Int Psychogeriatr 2012; 24:1561-70. [PMID: 22687143 PMCID: PMC3573852 DOI: 10.1017/s104161021200049x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several observational studies have suggested a link between health status and rate of decline among individuals with Alzheimer's disease (AD). We sought to quantify the relationship in a population-based study of incident AD, and to compare global comorbidity ratings to counts of comorbid conditions and medications as predictors of AD progression. METHODS This was a case-only cohort study arising from a population-based longitudinal study of memory and aging, in Cache County, Utah. Participants comprised 335 individuals with incident AD followed for up to 11 years. Patient descriptors included sex, age, education, dementia duration at baseline, and APOE genotype. Measures of health status made at each visit included the General Medical Health Rating (GMHR), number of comorbid medical conditions, and number of non-psychiatric medications. Dementia outcomes included the Mini-Mental State Examination (MMSE), Clinical Dementia Rating - sum of boxes (CDR-sb), and the Neuropsychiatric Inventory (NPI). RESULTS Health status tended to fluctuate over time within individuals. None of the baseline medical variables (GMHR, comorbidities, and non-psychiatric medications) was associated with differences in rates of decline in longitudinal linear mixed effects models. Over time, low GMHR ratings, but not comorbidities or medications, were associated with poorer outcomes (MMSE: β = -1.07 p = 0.01; CDR-sb: β = 1.79 p < 0.001; NPI: β = 4.57 p = 0.01). CONCLUSIONS Given that time-varying GMHR, but not baseline GMHR, was associated with the outcomes, it seems likely that there is a dynamic relationship between medical and cognitive health. GMHR is a more sensitive measure of health than simple counts of comorbidities or medications. Since health status is a potentially modifiable risk factor, further study is warranted.
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