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Shahouzaie N, Farzadfar MT, Jamali J, Sobhani-Rad D. The impact of subcortical stroke-related aphasia on executive functions and working memory. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 36745708 DOI: 10.1080/23279095.2023.2174437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aphasia is a common post-stroke disorder characterized by impairments in speaking, listening, reading, and writing. Although cognitive impairments have been well studied in cortical aphasia, deficits associated with subcortical aphasia remain to be elucidated. The current study aimed to assess executive functions (EF) and working memory (WM) in patients with subcortical aphasia, and investigate the relationship between language abilities and cognition deficits. Participants of this research included patients with thalamus lesions (n = 9; mean age = 53.89 years) and healthy individuals (n = 9; mean age = 54.33 years). Assessment materials were the Mini-Mental State Examination (MMSE), Persian Western Aphasia Battery (P-WAB-1), digit span subtest of Adult Wechsler Test (WAIS-R), and Wisconsin Card Sorting Test (WCST). Obtained results revealed significant differences in all components of EF, as well as in WM forward and backward digit spans between patients and healthy individuals. However, investigating the relationship between MMSE and AQ scores and components of EF and WM revealed no significant difference. In conclusion, the findings of the present research indicated defects in cognitive functions, including WM and EF, in patients with subcortical stroke. Accordingly, it is crucial to provide optimal rehabilitation therapies for the improvement of language and cognitive problems upon subcortical aphasia.
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Affiliation(s)
- Nasrin Shahouzaie
- Department of Speech Therapy, School of Rehabilitation, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Taghi Farzadfar
- Department of Neurology, Mashhad University of Medical Sciences, Ghaem Medical Center, Mashhad, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davood Sobhani-Rad
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhu CW, Gu Y, Cosentino S, Kociolek AJ, Hernandez M, Stern Y. Racial/Ethnic Disparities in Misidentification of Dementia in Medicare Claims: Results from the Washington Heights-Inwood Columbia Aging Project. J Alzheimers Dis 2023; 96:359-368. [PMID: 37781805 PMCID: PMC10759149 DOI: 10.3233/jad-230584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Misidentification of dementia in Medicare claims is quite common. OBJECTIVE We examined potential race/ethnic disparities in misidentification of dementia in Medicare claims in a diverse cohort of older adults who underwent careful clinical assessment. METHODS Participants were enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging in which dementia status was assessed using a rigorous clinical protocol. ICD-9-CM and ICD-10-CM diagnosis codes in all available Medicare claims (1999-2019) were compared to clinical dementia diagnosis and categorized into three mutually exclusive groups: 1) congruent-, 2) over-, and 3) under- identification during the study period. Multinomial logistic regression model was used to examine the relationship between race (White, African American/Black, other) and ethnicity (Hispanic/Latinx, non-Hispanic/Latinx) and congruency of dementia identification after controlling for clinical (cognition, function, comorbidities) and demographic characteristics (age, sex, education), and inpatient and outpatient utilization. RESULTS Across all person-years, 88.4% had congruent identification of dementia compared to clinical diagnosis, in 4.1% of the times participants were over-identified with dementia, and 7.5% of the times the participants were under-identified. Rates of misidentification was higher in minority participants than in White, non-Hispanic participants. Multivariable estimation results showed that the probability of over-identification with dementia was 2.2% higher for African American/Black than White (p = 0.05) and 2.7% higher for Hispanic participants than non-Hispanics (p = 0.03) participants. Differences in under-identification by race/ethnicity were not statistically significant. CONCLUSIONS African American/Black and Hispanic participants were more likely over-identified with dementia in Medicare claims.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Anton J. Kociolek
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Michelle Hernandez
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
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Markus HS, van Der Flier WM, Smith EE, Bath P, Biessels GJ, Briceno E, Brodtman A, Chabriat H, Chen C, de Leeuw FE, Egle M, Ganesh A, Georgakis MK, Gottesman RF, Kwon S, Launer L, Mok V, O'Brien J, Ottenhoff L, Pendlebury S, Richard E, Sachdev P, Schmidt R, Springer M, Tiedt S, Wardlaw JM, Verdelho A, Webb A, Werring D, Duering M, Levine D, Dichgans M. Framework for Clinical Trials in Cerebral Small Vessel Disease (FINESSE): A Review. JAMA Neurol 2022; 79:1187-1198. [PMID: 35969390 PMCID: PMC11036410 DOI: 10.1001/jamaneurol.2022.2262] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cerebral small vessel disease (SVD) causes a quarter of strokes and is the most common pathology underlying vascular cognitive impairment and dementia. An important step to developing new treatments is better trial methodology. Disease mechanisms in SVD differ from other stroke etiologies; therefore, treatments need to be evaluated in cohorts in which SVD has been well characterized. Furthermore, SVD itself can be caused by a number of different pathologies, the most common of which are arteriosclerosis and cerebral amyloid angiopathy. To date, there have been few sufficiently powered high-quality randomized clinical trials in SVD, and inconsistent trial methodology has made interpretation of some findings difficult. Observations To address these issues and develop guidelines for optimizing design of clinical trials in SVD, the Framework for Clinical Trials in Cerebral Small Vessel Disease (FINESSE) was created under the auspices of the International Society of Vascular Behavioral and Cognitive Disorders. Experts in relevant aspects of SVD trial methodology were convened, and a structured Delphi consensus process was used to develop recommendations. Areas in which recommendations were developed included optimal choice of study populations, choice of clinical end points, use of brain imaging as a surrogate outcome measure, use of circulating biomarkers for participant selection and as surrogate markers, novel trial designs, and prioritization of therapeutic agents using genetic data via Mendelian randomization. Conclusions and Relevance The FINESSE provides recommendations for trial design in SVD for which there are currently few effective treatments. However, new insights into understanding disease pathogenesis, particularly from recent genetic studies, provide novel pathways that could be therapeutically targeted. In addition, whether other currently available cardiovascular interventions are specifically effective in SVD, as opposed to other subtypes of stroke, remains uncertain. FINESSE provides a framework for design of trials examining such therapeutic approaches.
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Affiliation(s)
- Hugh S Markus
- Alzheimer Center Amsterdam, Department of Neurology, Epidemiology and Data Science, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van Der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Epidemiology and Data Science, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Philip Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emily Briceno
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor
| | - Amy Brodtman
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Hugues Chabriat
- Department of Neurology, FHU NeuroVasc, APHP, University of Paris, Paris, France
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijimegen, the Netherlands
| | - Marco Egle
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Aravind Ganesh
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Munich, Germany
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Rebecca F Gottesman
- Now with National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sun Kwon
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Lenore Launer
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Vincent Mok
- Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - John O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Lois Ottenhoff
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam and the Netherlands and Brain Research Center Amsterdam, the Netherlands
| | - Sarah Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, NIHR Oxford Biomedical Research Centre, Departments of General (internal) Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijimegen, the Netherlands
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, New South Wales, Australia
| | - Reinhold Schmidt
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
| | | | - Stefan Tiedt
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, Edinburgh, United Kingdom
| | - Ana Verdelho
- Faculdade de Medicina, Department of Neurosciences and Mental Health, CHULN-Hospital de Santa Maria Instituto de Medicina Molecular (IMM) e Instituto de Saúde Ambiental (ISAMB), University of Lisbon, Lisbon, Portugal
| | - Alastair Webb
- Wolfson Centre for Prevention of Stroke and Dementia, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - David Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Medical Image Analysis Center (MIAC AG) and Quantitative Biomedical Imaging Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Deborah Levine
- Departments of Internal Medicine and Neurology, University of Michigan, Ann Arbor
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Pa J, Aslanyan V, Casaletto KB, Rentería MA, Harrati A, Tom SE, Armstrong N, Rajan K, Avila-Rieger J, Gu Y, Schupf N, Manly JJ, Brickman A, Zahodne L. Effects of Sex, APOE4, and Lifestyle Activities on Cognitive Reserve in Older Adults. Neurology 2022; 99:e789-e798. [PMID: 35858818 PMCID: PMC9484731 DOI: 10.1212/wnl.0000000000200675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/18/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Lifestyle activities, such as physical activity and cognitive stimulation, may mitigate age-associated cognitive decline, delay dementia onset, and increase cognitive reserve. Whether the association between lifestyle activities and cognitive reserve differs by sex and APOE4 status is an understudied yet critical component for informing targeted prevention strategies. The current study examined interactions between sex and physical or cognitive activities on cognitive reserve for speed and memory in older adults. METHODS Research participants with unimpaired cognition, mild cognitive impairment, or dementia from the Washington Heights-Inwood Columbia Aging Cohort were included in this study. Cognitive reserve scores for speed and memory were calculated by regressing out hippocampal volume, total gray matter volume, and white matter hyperintensity volume from composite cognitive scores for speed and memory, respectively. Self-reported physical activity was assessed using the Godin Leisure Time Exercise Questionnaire, converted to metabolic equivalents (METS). Self-reported cognitive activity (COGACT) was calculated as the sum of 3 yes/no questions. Sex by activity interactions and sex-stratified analyses were conducted using multivariable linear regression models, including a secondary analysis with APOE4 as a moderating factor. RESULTS Seven hundred fifty-eight participants (mean age = 76.11 ± 6.31 years, 62% women) were included in this study. Higher METS was associated with greater speed reserve in women (β = 0.04, CI 0.0-08) but not in men (β = 0.004, CI -0.04 to 0.05). METS was not associated with memory reserve in women or men. More COGACT was associated with greater speed reserve in the cohort (β = 0.13, CI 0.05-0.21). More COGACT had a trend for greater memory reserve in women (β = 0.06, CI -0.02 to 0.14) but not in men (β = -0.04, CI -0.16 to 0.08). Only among women, APOE4 carrier status attenuated relationships between METS and speed reserve (β = -0.09, CI -0.22 to 0.04) and between COGACT and both speed (β = -0.26, CI -0.63 to 0.11) and memory reserves (β = -0.20, CI -0.50.0 to 093). DISCUSSION The associations of self-reported physical and cognitive activities with cognitive reserve are more pronounced in women, although APOE4 attenuates these associations. Future studies are needed to understand the causal relationship among sex, lifestyle activities, and genetic factors on cognitive reserve in older adults to best understand which lifestyle activities may be most beneficial and for whom.
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Affiliation(s)
- Judy Pa
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor.
| | - Vahan Aslanyan
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Kaitlin B Casaletto
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Miguel Arce Rentería
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Amal Harrati
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Sarah E Tom
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Nicole Armstrong
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Kumar Rajan
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Justina Avila-Rieger
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Yian Gu
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Nicole Schupf
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Jennifer J Manly
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Adam Brickman
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
| | - Laura Zahodne
- From the Alzheimer's Disease Cooperative Study (J.P.), Department of Neurosciences, School of Medicine, UCSD Health, San Diego, CA; Mark and Mary Stevens Neuroimaging and Informatics Institute (J.P., V.A.), USC Alzheimer Disease Research Center, Department of Neurology, University of Southern California, Los Angeles; Department of Population and Public Health Sciences (V.A.), Keck School of Medicine, University of Southern California, Los Angeles; Memory and Aging Center (K.B.C.), Department of Neurology, University of California, San Francisco; Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.A.R., J.A.-R., Y.G., N.S., J.J.M., A.B.), Department of Neurology, Columbia University, New York City; Center for Population Health Sciences (A.H.), Department of Primary Care and Population Health, Stanford University, CA; Department of Neurology (S.E.T.), Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City; Laboratory of Behavioral Neuroscience (N.A.), National Institute on Aging, Bethesda, MD; Department of Psychiatry and Human Behavior (N.A.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Public Health Sciences (K.R.), University of California, Davis; and Department of Psychology (L.Z.), University of Michigan, Ann Arbor
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5
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Zhu CW, Ornstein KA, Cosentino S, Gu Y, Andrews H, Stern Y. Medicaid Contributes Substantial Costs to Dementia Care in an Ethnically Diverse Community. J Gerontol B Psychol Sci Soc Sci 2020; 75:1527-1537. [PMID: 31425587 DOI: 10.1093/geronb/gbz108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The main objective of this study was to estimate effects of dementia on Medicaid expenditures in an ethnically diverse community. METHODS The sample included 1,211 Medicare beneficiaries who did not have any Medicaid coverage and 568 who additionally had full Medicaid coverage enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging in northern Manhattan (1999-2010). Individuals' dementia status was determined using a rigorous clinical protocol. Relationship between dementia and Medicaid coverage and expenditures were estimated using a two-part model. RESULTS In participants who had full Medicaid coverage, average annual Medicaid expenditures were substantially higher for those with dementia than those without dementia ($50,270 vs. $21,966, p < .001), but Medicare expenditures did not differ by dementia status ($8,458 vs. $9,324, p = .19). In participants who did not have any Medicaid coverage, average annual Medicare expenditures were substantially higher for those with dementia than those without dementia ($12,408 vs. $8,113, p = .02). In adjusted models, dementia was associated with a $6,278 increase in annual Medicaid spending per person after controlling for other characteristics. DISCUSSION Results highlight Medicaid's contribution to covering the cost of dementia care in addition to Medicare. Studies that do not include Medicaid are unlikely to accurately reflect the true cost of dementia.
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Affiliation(s)
- Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,James J Peters VA Medical Center, Bronx, New York
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York
| | - Yian Gu
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York
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6
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Prediction of Alzheimer's disease diagnosis within 14 years through Aβ misfolding in blood plasma compared to
APOE4
status, and other risk factors. Alzheimers Dement 2020; 16:283-291. [DOI: 10.1016/j.jalz.2019.08.189] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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7
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Wei K, Tran T, Chu K, Borzage MT, Braskie MN, Harrington MG, King KS. White matter hypointensities and hyperintensities have equivalent correlations with age and CSF β-amyloid in the nondemented elderly. Brain Behav 2019; 9:e01457. [PMID: 31692294 PMCID: PMC6908861 DOI: 10.1002/brb3.1457] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION T1- and T2-weighted sequences from MRI often provide useful complementary information about tissue properties. Leukoaraiosis results in signal abnormalities on T1-weighted images, which are automatically quantified by FreeSurfer, but this marker is poorly characterized and is rarely used. We evaluated associations between white matter hyperintensity (WM-hyper) volume from FLAIR and white matter hypointensity (WM-hypo) volume from T1-weighted images and compared their associations with age and cerebrospinal fluid (CSF) β-amyloid and tau. METHODS A total of 56 nondemented participants (68-94 years) were recruited and gave informed consent. All participants went through MR imaging on a GE 1.5T scanner and of these 47 underwent lumbar puncture for CSF analysis. WM-hypo was calculated using FreeSurfer analysis of T1 FSPGR 3D, and WM-hyper was calculated with the Lesion Segmentation Toolbox in the SPM software package using T2-FLAIR. RESULTS WM-hyper and WM-hypo were strongly correlated (r = .81; parameter estimate (p.e.): 1.53 ± 0.15; p < .0001). Age was significantly associated with both WM-hyper (r = .31, p.e. 0.078 ± 0.030, p = .013) and WM-hypo (r = .42, p.e. 0.055 ± 0.015, p < .001). CSF β-amyloid levels were predicted by WM-hyper (r = .33, p.e. -0.11 ± 0.044, p = .013) and WM-hypo (r = .42, p.e. -0.24 ± 0.073, p = .002). CSF tau levels were not correlated with either WM-hyper (p = .9) or WM-hypo (p = .99). CONCLUSIONS Strong correlations between WM-hyper and WM-hypo, and similar associations with age, abnormal β-amyloid, and tau suggest a general equivalence between these two imaging markers. Our work supports the equivalence of white matter hypointensity volumes derived from FreeSurfer for evaluating leukoaraiosis. This may have particular utility when T2-FLAIR is low in quality or absent, enabling analysis of older imaging data sets.
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Affiliation(s)
- Ke Wei
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Thao Tran
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Karen Chu
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Matthew T Borzage
- Fetal and Neonatal Institute, Division of Neonatology Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Meredith N Braskie
- Department of Neurology, Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael G Harrington
- Neuroscience Department, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Kevin S King
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA, USA
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8
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Mohajeri M, Behnam B, Barreto GE, Sahebkar A. Carbon nanomaterials and amyloid-beta interactions: potentials for the detection and treatment of Alzheimer's disease? Pharmacol Res 2019; 143:186-203. [DOI: 10.1016/j.phrs.2019.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 01/24/2023]
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9
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Avila JF, Verney SP, Kauzor K, Flowers A, Mehradfar M, Razani J. Normative data for Farsi-speaking Iranians in the United States on measures of executive functioning. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:229-235. [PMID: 29313722 DOI: 10.1080/23279095.2017.1392963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As the Farsi-speaking Iranian population continues to grow in the United States, examination of their cognitive performance is an imperative first step to providing this group with culturally competent services. Thirty-six healthy primarily Farsi-speaking Iranian adults completed Farsi-translated and adapted versions of three frequently used measures of executive/subcortical functioning: Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), and Color Trails Test (CTT). Participants' performance on each measure was compared to published normative data resulting in 0-85% of cognitively and medically healthy individuals being classified as impaired depending on the executive/subcortical test score examined, with the highest impairment rates for specific WCST outcome scores. These findings raise questions for the use of published norms with Farsi-speaking Iranians residing in the US. The present study provided normative data from this group of Farsi-speaking Iranians on the Farsi-translated and adapted versions of the WCST, TMT, and CTT.
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Affiliation(s)
- Justina F Avila
- a Department of Psychology , University of New Mexico , Albuquerque , New Mexico , USA
| | - Steven P Verney
- a Department of Psychology , University of New Mexico , Albuquerque , New Mexico , USA
| | - Kaitlyn Kauzor
- b Department of Psychology , California State University , Northridge , California , USA
| | - Amina Flowers
- b Department of Psychology , California State University , Northridge , California , USA
| | - Maryam Mehradfar
- b Department of Psychology , California State University , Northridge , California , USA
| | - Jill Razani
- b Department of Psychology , California State University , Northridge , California , USA
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10
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Kimchi EY, Hshieh TT, Guo R, Wong B, O'Connor M, Marcantonio ER, Metzger ED, Strauss J, Arnold SE, Inouye SK, Fong TG. Consensus Approaches to Identify Incident Dementia in Cohort Studies: Systematic Review and Approach in the Successful Aging after Elective Surgery Study. J Am Med Dir Assoc 2017; 18:1010-1018.e1. [PMID: 28927945 PMCID: PMC5701828 DOI: 10.1016/j.jamda.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To survey the current methods used to ascertain dementia and mild cognitive impairment (MCI) in longitudinal cohort studies, to categorize differences in approaches and to identify key components of expert panel methodology in current use. METHODS We searched PubMed for the past 10 years, from March 6, 2007 to March 6, 2017 using a combination of controlled vocabulary and keyword terms to identify expert panel consensus methods used to diagnose MCI or dementia in large cohort studies written in English. From these results, we identified a framework for reporting standards and describe as an exemplar the clinical consensus procedure used in an ongoing study of elective surgery patients (the Successful Aging after Elective Surgery study). RESULTS Thirty-one articles representing unique cohorts were included. Among published methods, membership of experts panel varied significantly. There was more similarity in what types of information was use to ascertain disease status. However, information describing the diagnostic decision process and resolution of disagreements was often lacking. CONCLUSIONS Methods used for expert panel diagnosis of MCI and dementia in large cohort studies are widely variable, and there is a need for more standardized reporting of these approaches. By describing the procedure in which our expert panel achieved consensus diagnoses, we hope to encourage the development and publication of well-founded and reproducible methods for diagnosis of MCI and dementia in longitudinal studies.
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Affiliation(s)
- Eyal Y Kimchi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tammy T Hshieh
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ray Guo
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Bonnie Wong
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Margaret O'Connor
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Edward R Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eran D Metzger
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason Strauss
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Steven E Arnold
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sharon K Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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11
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Abstract
Aggregation of the amyloid-β (Aβ) peptide is strongly correlated with Alzheimer's disease (AD). Recent research has improved our understanding of the kinetics of amyloid fibril assembly and revealed new details regarding different stages in plaque formation. Presently, interest is turning toward studying this process in a holistic context, focusing on cellular components which interact with the Aβ peptide at various junctures during aggregation, from monomer to cross-β amyloid fibrils. However, even in isolation, a multitude of factors including protein purity, pH, salt content, and agitation affect Aβ fibril formation and deposition, often producing complicated and conflicting results. The failure of numerous inhibitors in clinical trials for AD suggests that a detailed examination of the complex interactions that occur during plaque formation, including binding of carbohydrates, lipids, nucleic acids, and metal ions, is important for understanding the diversity of manifestations of the disease. Unraveling how a variety of key macromolecular modulators interact with the Aβ peptide and change its aggregation properties may provide opportunities for developing therapies. Since no protein acts in isolation, the interplay of these diverse molecules may differentiate disease onset, progression, and severity, and thus are worth careful consideration.
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Affiliation(s)
- Katie L Stewart
- Astbury Centre for Structural Molecular Biology, School of Molecular and Cellular Biology, University of Leeds, Leeds, LS2 9JT, UK.
| | - Sheena E Radford
- Astbury Centre for Structural Molecular Biology, School of Molecular and Cellular Biology, University of Leeds, Leeds, LS2 9JT, UK.
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12
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Huang H, Zheng T, Liu F, Wu Z, Liang H, Wang S. Orthostatic Hypotension Predicts Cognitive Impairment in the Elderly: Findings from a Cohort Study. Front Neurol 2017; 8:121. [PMID: 28421033 PMCID: PMC5377264 DOI: 10.3389/fneur.2017.00121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/15/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is a known risk factor for cerebral ischemia, but its correlation with cognitive impairment (CI) is not well established. OBJECTIVE The aim of this study is to explore the relationship between OH and CI in the elderly. METHODS The study group consisted of 44 OH patients who presented with drowsiness, vertigo, and fatigue between January 2009 and December 2011 (OH group). Eighty-eight healthy elderly were paired with those in the OH group in a 1:2 based on their education levels (NOH group). Baseline sociodemographic information and cognition-related measures were collected for both groups. Cognitive function was assessed 4 years later using MMSE. RESULTS The overall incidence of CI was 14.0% among the 114 subjects who completed the follow-up assessment. There was a significant difference in the incidence of CI between the OH group (23.7%) and the NOH group (9.2%) (χ2 = 4.399, P = 0.036). After excluding the influence of age (OR = 1.199, 95% CI: 1.072-1.340, P = 0.001) and education years (OR = 0.568, 95% CI: 0.371-0.869, P = 0.009), OH (OR = 4.047, 95% CI: 1.144-14.313, P = 0.030) became an independent risk factor for CI. CONCLUSION OH can lead to CI. We suggest that future studies, with a larger sample size, use OH exposure time instead of OH exposure population to verify the conclusion of this study.
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Affiliation(s)
- Haixia Huang
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
| | - Tianheng Zheng
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
| | - Fang Liu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhuoli Wu
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
| | - Huazheng Liang
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Shaoshi Wang
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
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13
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Humphreys GW, Duta MD, Montana L, Demeyere N, McCrory C, Rohr J, Kahn K, Tollman S, Berkman L. Cognitive Function in Low-Income and Low-Literacy Settings: Validation of the Tablet-Based Oxford Cognitive Screen in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). J Gerontol B Psychol Sci Soc Sci 2016; 72:38-50. [PMID: 27974474 DOI: 10.1093/geronb/gbw139] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/05/2016] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES 1. Assess validity of the Oxford Cognitive Screen (OCS-Plus), a domain-specific cognitive assessment designed for low-literacy settings, especially in low- and middle-income countries (LMIC); 2. Advance theoretical contributions in cognitive neuroscience in domain-specific cognitive function and cognitive reserve, especially related to dementia. METHOD In a cross-sectional study of a sample of 1,402 men and women aged 40-79 in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we administered OCS-Plus along with health and sociodemographic assessments. HAALSI is a representative sample of older adults in Agincourt, South Africa contributing to normative understanding of cognition in LMIC. We report measure distributions, construct and external validity of the OCS-Plus. RESULTS OCS-Plus has excellent construct and external validity. Intra-class correlations between similar basic measures of orientation in OCS-Plus and in HAALSI assessments was 0.79, and groups of people performing well on the OCS-Plus verbal memory also showed superior performance on HAALSI verbal memory. The OCS-Plus scores showed consistent associations with age and education and domain-specific associations with alcohol and depression. Younger respondents and the more educated did better on all assessments. DISCUSSION The OCS-Plus represents a major methodological advance in dementia studies in LMICs, and enhances understanding of cognitive aging.
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Affiliation(s)
| | - Mihaela D Duta
- Department of Experimental Psychology, University of Oxford.
| | - Livia Montana
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford
| | | | - Julia Rohr
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Kathleen Kahn
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts.,MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Lin PJ, Zhong Y, Fillit HM, Chen E, Neumann PJ. Medicare Expenditures of Individuals with Alzheimer's Disease and Related Dementias or Mild Cognitive Impairment Before and After Diagnosis. J Am Geriatr Soc 2016; 64:1549-57. [DOI: 10.1111/jgs.14227] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- 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 Massachusetts
| | - Yue Zhong
- Center for the Evaluation of Value and Risk in Health; Institute for Clinical Research and Health Policy Studies; Tufts Medical Center; Boston Massachusetts
| | - Howard M. Fillit
- The Alzheimer's Drug Discovery Foundation and the Icahn School of Medicine at Mount Sinai; New York New York
| | - Er Chen
- U.S. Medical Affairs; Genentech; South San Francisco California
| | - 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 Massachusetts
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15
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Grober E, Mowrey WB, Ehrlich AR, Mabie P, Hahn S, Lipton RB. Two-stage screening for early dementia in primary care. J Clin Exp Neuropsychol 2016; 38:1038-49. [PMID: 27270103 DOI: 10.1080/13803395.2016.1187117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective was to compare two screening strategies for dementia in an urban primary care clinic, serving a low-education, minority community composed largely of Latino and African American patients. METHOD Two hundred and fifty-seven patients underwent two-stage patient-based screening (PBS) and informant-based screening (IBS) followed by a diagnostic evaluation. In the first stage, PBS included brief tests of episodic memory (Memory Impairment Screen), semantic memory (Animal Fluency), and executive function (Reciting Months Backwards). For IBS, the first stage consisted of the short Informant Questionnaire on Cognitive Decline in the Elderly, administered to a family member or friend. Patients who screened positive in the first stage of either strategy underwent testing with the picture version of the Free and Cued Selective Reminding Test with Immediate Recall to identify memory impairment. Sensitivity, specificity, and positive and negative predictive values were computed for various cutoffs of each test and combination of tests. Dementia was diagnosed using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria without access to the screening test results. RESULTS We identified 66 patients (25.7%) with previously undiagnosed dementia. Sensitivity was the same (77%) for both strategies but specificity was higher for IBS than for PBS (92% versus 83%). IBS's higher specificity makes it the preferred strategy if a knowledgeable informant is available. CONCLUSION Unrecognized dementia is common in primary care. Case-finding can be improved using either PBS or IBS two-stage screening strategies.
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Affiliation(s)
- Ellen Grober
- a Department of Neurology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Wenzhu Bi Mowrey
- b Department of Epidemiology and Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Amy R Ehrlich
- c Division of Geriatrics of the Department of Medicine , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Peter Mabie
- a Department of Neurology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Steven Hahn
- d Department of Medicine , Albert Einstein College of Medicine and Jacobi Medical Center , Bronx , NY , USA
| | - Richard B Lipton
- a Department of Neurology , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.,b Department of Epidemiology and Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
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16
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Palm R, Jünger S, Reuther S, Schwab CGG, Dichter MN, Holle B, Halek M. People with dementia in nursing home research: a methodological review of the definition and identification of the study population. BMC Geriatr 2016; 16:78. [PMID: 27052960 PMCID: PMC4823911 DOI: 10.1186/s12877-016-0249-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background There are various definitions and diagnostic criteria for dementia, leading to discrepancies in case ascertainment in both clinical practice and research. We reviewed the different definitions, approaches and measurements used to operationalize dementia in health care studies in German nursing homes with the aim of discussing the implications of different approaches. Methods We conducted a systematic search of the MEDLINE and CINAHL databases to identify pre-2016 studies conducted in German nursing homes that focused on residents with dementia or cognitive impairment. In- or exclusion of studies were consented by all authors; data extraction was independently carried out by 2 authors (RP, SJ). The studies’ sampling methods were compared with respect to their inclusion criteria, assessment tools and methods used to identify the study population. Results We summarized case ascertainment methods from 64 studies. Study participants were identified based on a diagnosis that was evaluated during the study, or a recorded medical dementia diagnosis, or a recorded medical diagnosis either with additional cognitive screenings or using screening tests exclusively. The descriptions of the diagnostics that were applied to assess a diagnosis of dementia were not fully transparent in most of the studies with respect to either a clear reference definition of dementia or applied diagnostic criteria. If reported, various neuropsychological tests were used, mostly without a clear rationale for their selection. Conclusion Pragmatic considerations often determine the sampling strategy; they also may explain the variances we detected in the different studies. Variations in sampling methods impede the comparability of study results. There is a need to consent case ascertainment strategies in dementia studies in health service research in nursing homes. These strategies should consider resource constraints and ethical issues that are related to the vulnerable population of nursing home residents. Additionally, reporting about dementia studies in nursing homes need to be improved. If a diagnosis cannot be evaluated based on either ICD or DSM criteria, the study population may not be reported as having dementia. If a diagnosis is evaluated based on ICD or DSM criteria within the study, there is a need for more transparency of the diagnostic process. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0249-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Palm
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany. .,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany.
| | - Saskia Jünger
- Hannover Medical School, Institute of General Medicine, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sven Reuther
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Christian G G Schwab
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Martin N Dichter
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Margareta Halek
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
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A Genetics-based Biomarker Risk Algorithm for Predicting Risk of Alzheimer's Disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 2:30-44. [PMID: 27047990 PMCID: PMC4817110 DOI: 10.1016/j.trci.2015.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction A straightforward, reproducible blood-based test that predicts age-dependent risk of Alzheimer's disease (AD) could be used as an enrichment tool for clinical development of therapies. This study evaluated the prognostic performance of a genetics-based biomarker risk algorithm (GBRA) established on a combination of apolipoprotein E (APOE)/translocase of outer mitochondrial membrane 40 homolog (TOMM40) genotypes and age, then compare it to cerebrospinal fluid (CSF) biomarkers, neuroimaging, and neurocognitive tests using data from two independent AD cohorts. Methods The GBRA was developed using data from the prospective Joseph and Kathleen Bryan, Alzheimer's Disease Research Center study (n = 407; 86 conversion events [mild cognitive impairment {MCI} or late-onset Alzheimer's disease {LOAD}]). The performance of the algorithm was tested using data from the Alzheimer's Disease Neuroimaging Initiative study (n = 660; 457 individuals categorized as MCI or LOAD). Results The positive predictive values and negative predictive values of the GBRA are in the range of 70%–80%. The relatively high odds ratio (approximately 3–5) and significant net reclassification index scores comparing the GBRA to a version based on APOE and age alone support the value of the GBRA in risk prediction for MCI due to LOAD. Performance of the GBRA compares favorably with CSF and imaging (functional magnetic resonance imaging) biomarkers. In addition, the GBRA “high” and “low” AD-risk categorizations correlated well with pathologic CSF biomarker levels, positron emission tomography amyloid burden, and neurocognitive scores. Discussion Unlike dynamic markers (i.e., imaging, protein, or lipid markers) that may be influenced by factors unrelated to disease, genomic DNA is easily collected, stable, and the technical methods for measurement are robust, inexpensive, and widely available. The performance characteristics of the GBRA support its use as a pharmacogenetic enrichment tool for LOAD delay-of-onset clinical trials and merit further evaluation for its clinical utility in evaluating therapeutic efficacy.
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Normative data for 8 neuropsychological tests in older blacks and whites from the atherosclerosis risk in communities (ARIC) study. Alzheimer Dis Assoc Disord 2015; 29:32-44. [PMID: 24759546 DOI: 10.1097/wad.0000000000000042] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accurate assessment of cognitive impairment requires comparison of cognitive performance in individuals to performance in a comparable healthy normative population. Few prior studies have included a large number of black participants and few have excluded participants from the normative sample with subclinical/latent neurological disease or dementia. This study provides age, race, and education-specific normative data for 8 cognitive tests derived from 320 black and 392 white participants aged 61 to 82 years (mean 71 y) in the Atherosclerosis Risk in Communities (ARIC) study without clinical or subclinical/latent neurological disease. Normative data are provided for the Delayed Word Recall Test, Logical Memory Parts I and II, the Word Fluency Test, Animal Naming, the Trail Making Test Parts A and B and the Digit Symbol Substitution Test. Age, race, and education-specific mean and -1.5 SD scores are given in tabular form and graphically, as well as regression-based equations to derive adjusted score cut-points. These robust normative data should enhance comparison across studies of cognitive aging, where these measures are widely used, and improve interpretation of performance on these tests for the diagnosis of cognitive impairment not only within the ARIC cohort, but also among older blacks and whites with similar demographics.
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Bassi A, Bozzali M. Potential Interactions between the Autonomic Nervous System and Higher Level Functions in Neurological and Neuropsychiatric Conditions. Front Neurol 2015; 6:182. [PMID: 26388831 PMCID: PMC4559639 DOI: 10.3389/fneur.2015.00182] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/10/2015] [Indexed: 11/17/2022] Open
Abstract
The autonomic nervous system (ANS) maintains the internal homeostasis by continuously interacting with other brain structures. Its failure is commonly observed in many neurological and neuropsychiatric disorders, including neurodegenerative and vascular brain diseases, spinal cord injury, and peripheral neuropathies. Despite the different underlying pathophysiological mechanisms, ANS failure associates with various forms of higher level dysfunctions, and may also negatively impact on patients’ clinical outcome. In this review, we will discuss potential relationships between ANS and higher level dysfunctions in a selection of neurological and neuropsychiatric disorders. In particular, we will focus on the effect of a documented fall in blood pressure fulfilling the criteria for orthostatic hypotension and/or autonomic-reflex impairment on cognitive performances. Some evidence supports the hypothesis that cardiovascular autonomic failure may play a negative prognostic role in most neurological disorders. Despite a clear causal relationship between ANS involvement and higher level dysfunctions that is still controversial, this might have implications for neuro-rehabilitation strategies aimed at improving patients’ clinical outcome.
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Affiliation(s)
- Andrea Bassi
- Clinical and Behavioural Neurology Laboratory, IRCCS Santa Lucia Foundation , Rome , Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation , Rome , Italy
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Effects of emotionally charged auditory stimulation on gait performance in the elderly: a preliminary study. Arch Phys Med Rehabil 2014; 96:690-6. [PMID: 25542677 DOI: 10.1016/j.apmr.2014.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/01/2014] [Accepted: 12/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the effect of a novel divided attention task-walking under auditory constraints-on gait performance in older adults and to determine whether this effect was moderated by cognitive status. DESIGN Validation cohort. SETTING General community. PARTICIPANTS Ambulatory older adults without dementia (N=104). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds. RESULTS The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5-10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences. CONCLUSIONS Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment. A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals, but lead to decompensation in those with minimal cognitive impairment. Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints.
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Abstract
Simon Lovestone discusses recent progress in the development of molecular biomarkers for the diagnosis and prognosis of Alzheimer’s disease.
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Lucca U, Tettamanti M, Logroscino G, Tiraboschi P, Landi C, Sacco L, Garrì M, Ammesso S, Bertinotti C, Biotti A, Gargantini E, Piedicorcia A, Nobili A, Pasina L, Franchi C, Djade CD, Riva E, Recchia A. Prevalence of dementia in the oldest old: The Monzino 80‐plus population based study. Alzheimers Dement 2014; 11:258-70.e3. [DOI: 10.1016/j.jalz.2014.05.1750] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/15/2014] [Accepted: 05/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ugo Lucca
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Mauro Tettamanti
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | | | - Pietro Tiraboschi
- Division of Neuropathology Fondazione IRCCS Istituto Neurologico “Carlo Besta” Milan Italy
| | - Cristina Landi
- Division of Neurological Rehabilitation European Foundation of Biomedical Research (FERB) Milan Italy
| | - Leonardo Sacco
- Division of Neurology Neurocentre of Southern Switzerland Lugano Switzerland
| | - Mariateresa Garrì
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Sonia Ammesso
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Chiara Bertinotti
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Anna Biotti
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Elena Gargantini
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Alessandro Piedicorcia
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Alessandro Nobili
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Luca Pasina
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Carlotta Franchi
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Codjo Djignefa Djade
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Emma Riva
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Angela Recchia
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
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Orthostatic hypotension and cognitive impairment: a dangerous association? Neurol Sci 2014; 35:951-7. [DOI: 10.1007/s10072-014-1686-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/12/2014] [Indexed: 11/29/2022]
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Reckess GZ, Brandt J, Luis CA, Zandi P, Martin B, Breitner JCS. Screening by telephone in the Alzheimer's disease anti-inflammatory prevention trial. J Alzheimers Dis 2014; 36:433-43. [PMID: 23645097 DOI: 10.3233/jad-130113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Compared with in-person assessment methods, telephone screening for dementia and other cognitive syndromes may improve efficiency of large population studies or prevention trials. We used data from the Alzheimer's Disease Anti-Inflammatory Prevention Trial to compare performance of a four-test Telephone Assessment Battery (TAB) that included the Telephone Interview for Cognitive Status (TICS) to that of a traditional in-person Cognitive Assessment Battery. Among 1,548 elderly participants with valid telephone and in-person screening results obtained within 90 days of each other, 225 persons were referred for a full cognitive diagnostic evaluation that was completed within six months of screening. Drawing on results from this panel of 225 individuals, we used the Capture-Recapture method to estimate population numbers of cognitively impaired participants. The latter estimates enabled us to compare the performance characteristics of the two screening batteries at specified cut-offs for detection of dementia and milder forms of impairment. Although our results provide relatively imprecise estimates of the performance characteristics of the two batteries, a comparison of their relative performance suggests that, at selected cut-off points, the TAB produces results broadly comparable to in-person screening and may be slightly more sensitive in detecting mild impairment. TAB performance characteristics also appeared slightly better than those of the TICS alone. Given its benefits in time and cost when screening for cognitive disorders, telephone screening should be considered for large samples.
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Affiliation(s)
- Gila Z Reckess
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Meyer ACL, Boscardin WJ, Kwasa JK, Price RW. Is it time to rethink how neuropsychological tests are used to diagnose mild forms of HIV-associated neurocognitive disorders? Impact of false-positive rates on prevalence and power. Neuroepidemiology 2013; 41:208-16. [PMID: 24157541 DOI: 10.1159/000354629] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Between 0 and 48% of normal HIV-uninfected individuals score below threshold neuropsychological test scores for HIV-associated neurocognitive disorders (HAND) or are false positives. There has been little effort to understand the effect of varied interpretations of research criteria for HAND on false-positive frequencies, prevalence and analytic estimates. METHODS The proportion of normal individuals scoring below Z score thresholds drawn from research criteria for HAND, or false-positive frequencies, was estimated in a normal Kenyan population and a simulated normal population using varied interpretations of research criteria for HAND. We calculated the impact of false-positive frequencies on prevalence estimates and statistical power. RESULTS False-positive frequencies of 2-74% were observed for asymptomatic neurocognitive impairment/mild neurocognitive disorder and 0-8% for HIV-associated dementia. False-positive frequencies depended on the definition of an abnormal cognitive domain, Z score thresholds and neuropsychological battery size. Misclassification led to clinically important overestimation of prevalence and dramatic decreases in power. CONCLUSIONS Minimizing false-positive frequencies is critical to decrease bias in prevalence estimates and minimize reductions in power in studies of association, particularly for mild forms of HAND. We recommend changing the Z score threshold to ≤-1.5 for mild impairment, limiting analysis to 3-5 cognitive domains and using the average Z score to define an abnormal domain.
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Affiliation(s)
- Ana-Claire L Meyer
- Department of Neurology, San Francisco General Hospital, University of California, San Francisco, San Francisco, Calif., USA
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O'Bryant SE, Xiao G, Edwards M, Devous M, Gupta VB, Martins R, Zhang F, Barber R. Biomarkers of Alzheimer's disease among Mexican Americans. J Alzheimers Dis 2013; 34:841-9. [PMID: 23313927 DOI: 10.3233/jad-122074] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mexican Americans are the fastest aging segment of the U.S. population, yet little scientific literature exists regarding the Alzheimer's disease (AD) among this segment of the population. The extant literature suggests that biomarkers of AD will vary according to race/ethnicity though no prior work has explicitly studied this possibility. The aim of this study was to create a serum-based biomarker profile of AD among Mexican American. METHODS Data were analyzed from 363 Mexican American participants (49 AD and 314 normal controls) enrolled in the Texas Alzheimer's Research & Care Consortium (TARCC). Non-fasting serum samples were analyzed using a luminex-based multi-plex platform. A biomarker profile was generated using random forest analyses. RESULTS The biomarker profile of AD among Mexican Americans was different from prior work from non-Hispanic populations with regards to the variable importance plots. In fact, many of the top markers were related to metabolic factors (e.g., FABP, GLP-1, CD40, pancreatic polypeptide, insulin-like-growth factor, and insulin). The biomarker profile was a significant classifier of AD status yielding an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.77, 0.92, and 0.64, respectively. Combining biomarkers with clinical variables yielded a better balance of sensitivity and specificity. CONCLUSION The biomarker profile for AD among Mexican American cases is significantly different from that previously identified among non-Hispanic cases from many large-scale studies. This is the first study to explicitly examine and provide support for blood-based biomarkers of AD among Mexican Americans. Areas for future research are highlighted.
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Affiliation(s)
- Sid E O'Bryant
- Department of Internal Medicine, University of North Texas Health Sciences Center, Fort Worth, TX 76107, USA. Sid.O’
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Relating memory to functional performance in normal aging to dementia using hierarchical Bayesian cognitive processing models. Alzheimer Dis Assoc Disord 2013; 27:16-22. [PMID: 22407225 DOI: 10.1097/wad.0b013e31824d5668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Determining how cognition affects functional abilities is important in Alzheimer disease and related disorders. A total of 280 patients (normal or Alzheimer disease and related disorders) received a total of 1514 assessments using the functional assessment staging test (FAST) procedure and the MCI Screen. A hierarchical Bayesian cognitive processing model was created by embedding a signal detection theory model of the MCI Screen-delayed recognition memory task into a hierarchical Bayesian framework. The signal detection theory model used latent parameters of discriminability (memory process) and response bias (executive function) to predict, simultaneously, recognition memory performance for each patient and each FAST severity group. The observed recognition memory data did not distinguish the 6 FAST severity stages, but the latent parameters completely separated them. The latent parameters were also used successfully to transform the ordinal FAST measure into a continuous measure reflecting the underlying continuum of functional severity. Hierarchical Bayesian cognitive processing models applied to recognition memory data from clinical practice settings accurately translated a latent measure of cognition into a continuous measure of functional severity for both individuals and FAST groups. Such a translation links 2 levels of brain information processing and may enable more accurate correlations with other levels, such as those characterized by biomarkers.
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Ho L, Zhao W, Dams-O'Connor K, Tang CY, Gordon W, Peskind ER, Yemul S, Haroutunian V, Pasinetti GM. Elevated plasma MCP-1 concentration following traumatic brain injury as a potential "predisposition" factor associated with an increased risk for subsequent development of Alzheimer's disease. J Alzheimers Dis 2013; 31:301-13. [PMID: 22543850 DOI: 10.3233/jad-2012-120598] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We explored whether changes in the expression profile of peripheral blood plasma proteins may provide a clinical, readily accessible "window" into the brain, reflecting molecular alterations following traumatic brain injury (TBI) that might contribute to TBI complications. We recruited fourteen TBI and ten control civilian participants for the study, and also analyzed banked plasma specimens from 20 veterans with TBI and 20 control cases. Using antibody arrays and ELISA assays, we explored differentially-regulated protein species in the plasma of TBI compared to healthy controls from the two independent cohorts. We found three protein biomarker species, monocyte chemotactic protein-1 (MCP-1), insulin-like growth factor-binding protein-3, and epidermal growth factor receptor, that are differentially regulated in plasma specimens of the TBI cases. A three-biomarker panel using all three proteins provides the best potential criterion for separating TBI and control cases. Plasma MCP-1 contents are correlated with the severity of TBI and the index of compromised axonal fiber integrity in the frontal cortex. Based on these findings, we evaluated postmortem brain specimens from 7 mild cognitive impairment (MCI) and 7 neurologically normal cases. We found elevated MCP-1 expression in the frontal cortex of MCI cases that are at high risk for developing Alzheimer's disease. Our findings suggest that additional application of the three-biomarker panel to current diagnostic criteria may lead to improved TBI detection and more sensitive outcome measures for clinical trials. Induction of MCP-1 in response to TBI might be a potential predisposing factor that may increase the risk for development of Alzheimer's disease.
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Affiliation(s)
- Lap Ho
- Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA
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Abstract
The numbers and proportions of elderly are increasing rapidly in developing countries, where prevalence of dementia is often high. Providing cost-effective services for dementia sufferers and their caregivers in these resource-poor regions poses numerous challenges; developing resources for diagnosis must be the first step. Capacity building for diagnosis involves training and education of healthcare providers, as well as the general public, development of infrastructure, and resolution of economic and ethical issues. Recent progress in some low-to-middle-income countries (LMICs) provides evidence that partnerships between wealthy and resource-poor countries, and between developing countries, can improve diagnostic capabilities. Without the involvement of the mental health community of developed countries in such capacity-building programs, dementia in the developing world is a disaster waiting to happen.
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Affiliation(s)
- Gladys E Maestre
- Laboratory of Neurosciences, University of Zulia, Edificio del Instituto de Enfermedades Cardiovasculares de la Universidad del Zulia, Primer Piso, Av Universidad diagonal al MACZUL, Maracaibo, 4002 Zulia, Venezuela.
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Prestia A, Caroli A, Herholz K, Reiman E, Chen K, Jagust WJ, Frisoni GB. Diagnostic accuracy of markers for prodromal Alzheimer's disease in independent clinical series. Alzheimers Dement 2013; 9:677-86. [PMID: 23375562 DOI: 10.1016/j.jalz.2012.09.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 09/12/2012] [Accepted: 09/19/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To capitalize on data from different clinical series to compare sensitivity and specificity of individual biomarkers for predicting mild cognitive impairment (MCI) progression to Alzheimer's disease (AD). METHODS Medial temporal atrophy, cortical hypometabolism, and cerebrospinal fluid biomarkers were assessed in 18 patients with mild cognitive impairment (MCI) with prodromal AD (pAD; conversion time, 26 ± 12 months) and 18 stable MCI (sMCI) patients from the Translational Outpatient Memory Clinic cohort, as well as in 24 pAD patients (conversion time, 36 ± 12 months) and 33 sMCI patients from the Alzheimer's Disease Neuroimaging Initiative cohort. Medial temporal atrophy was measured by manual, semi-automated, and automated hippocampal volumetry; cortical hypometabolism was measured using several indices of AD-related hypometabolism pattern; and cerebrospinal fluid markers were amyloid β (Aβ)42 and total tau protein concentrations. For each biomarker, sensitivity for pAD, specificity for sMCI, and diagnostic accuracy were computed. RESULTS Sensitivity to predict MCI conversion to AD in the Alzheimer's Disease Neuroimaging Initiative and Translational Outpatient Memory Clinic cohorts was 79% and 94% based on Aβ42, 46% and 28% based on hippocampal volumes, 33% to 66% and 56% to 78% based on different hypometabolism indices, and 46% and 61% based on total tau levels, respectively. Specificity to exclude sMCI was 27% and 50% based on Aβ42, 76% and 94% based on hippocampal volumes, 58% to 67% and 55% to 83% based on different hypometabolism indices, and 61% and 83% based on total tau levels, respectively. CONCLUSIONS Current findings suggest that Aβ42 concentrations and hippocampal volumes may be used in combination to best identify pAD.
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Affiliation(s)
- Annapaola Prestia
- Laboratory of Epidemiology Neuroimaging and Telemedicine, and Unit for the Clinical Translation of Research, IRCCS Centro San Giovanni di Dio FBF, Brescia, Italy
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Xu XH, Huang Y, Wang G, Chen SD. Metabolomics: a novel approach to identify potential diagnostic biomarkers and pathogenesis in Alzheimer's disease. Neurosci Bull 2012; 28:641-8. [PMID: 23054640 PMCID: PMC5561924 DOI: 10.1007/s12264-012-1272-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/20/2012] [Indexed: 01/23/2023] Open
Abstract
Although the pathogenesis of Alzheimer's disease (AD) is still not fully understood, it is acknowledged that intervention should be made at the early stage. Therefore, identifying biomarkers for the clinical diagnosis is critical. Metabolomics, a novel "omics", uses methods based on low-molecular-weight molecules, with high-throughput evaluation of a large number of metabolites that may lead to the identification of new disease-specific biomarkers and the elucidation of pathophysiological mechanisms. This review discusses metabolomics investigations of AD and potential future developments in this field.
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Affiliation(s)
- Xu-Hua Xu
- Department of Neurology and Institute of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Yue Huang
- Neuroscience Research Australia and the University of New South Wales, Randwick, New South Wales Australia
| | - Gang Wang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Sheng-Di Chen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
- Laboratory of Neurodegenerative Diseases, Institute of Health Science, Shanghai Institutes of Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
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Alves L, Correia ASA, Miguel R, Alegria P, Bugalho P. Alzheimer's disease: a clinical practice-oriented review. Front Neurol 2012; 3:63. [PMID: 22529838 PMCID: PMC3330267 DOI: 10.3389/fneur.2012.00063] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/02/2012] [Indexed: 12/12/2022] Open
Abstract
Investigation in the field of Alzheimer's disease (AD), the commonest cause of dementia, has been very active in recent years and it may be difficult for the clinician to keep up with all the innovations and to be aware of the implications they have in clinical practice. The authors, thus, reviewed recent literature on the theme in order to provide the clinician with an updated overview, intended to support decision-making on aspects of diagnosis and management. This article begins to focus on the concept of AD and on its pathogenesis. Afterward, epidemiology and non-genetic risk factors are approached. Genetics, including genetic risk factors and guidelines for genetic testing, are mentioned next. Recommendations for diagnosis of AD, including recently proposed criteria, are then reviewed. Data on the variants of AD is presented. First approach to the patient is dealt with next, followed by neuropsychological evaluation. Biomarkers, namely magnetic resonance imaging, single photon emission tomography, FDG PET, PiB PET, CSF tau, and Aβ analysis, as well as available data on their diagnostic accuracy, are also discussed. Factors predicting rate of disease progression are briefly mentioned. Finally, non-pharmacological and pharmacological treatments, including established and emerging drugs, are addressed.
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Affiliation(s)
- Luísa Alves
- Serviço de Neurologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa OcidentalLisboa, Portugal
- Faculdade de Ciências Médicas, Universidade nova de LisboaLisboa, Portugal
- Centro de Estudos de Doenças CrónicasLisboa, Portugal
| | - Ana Sofia A. Correia
- Serviço de Neurologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa OcidentalLisboa, Portugal
| | - Rita Miguel
- Serviço de Neurologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa OcidentalLisboa, Portugal
| | | | - Paulo Bugalho
- Serviço de Neurologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa OcidentalLisboa, Portugal
- Faculdade de Ciências Médicas, Universidade nova de LisboaLisboa, Portugal
- Centro de Estudos de Doenças CrónicasLisboa, Portugal
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Teresi JA, Grober E, Eimicke JP, Ehrlich AR. Are clinical diagnoses of Alzheimer's disease and other dementias affected by education and self-reported race? Psychol Assess 2012; 24:531-44. [PMID: 22309001 DOI: 10.1037/a0027008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A randomized controlled trial examined whether the diagnostic process for Alzheimer's disease and other dementias may be influenced by knowledge of the patient's education and/or self-reported race. Four conditions were implemented: diagnostic team knows (a) race and education, (b) education only, (c) race only, or (d) neither. Diagnosis and clinical staging was established at baseline, at Wave 2, and for a random sample of Wave 3 respondents by a consensus panel. At study end, a longitudinal, "gold standard" diagnosis was made for patients with follow-up data (71%). Group differences in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis were estimated using logistic regression and generalized estimating equations. Sensitivity and specificity were examined for baseline diagnosis in relation to the gold standard, longitudinal diagnosis. Despite equivalent status on all measured variables across waves, members of the "knows race only" group were less likely than those of other groups to receive a diagnosis of dementia. At final diagnosis, 19% of the "knows race only" group was diagnosed with dementia versus 38% to 40% in the other 3 conditions (p = .038). Examination of sensitivities and specificities of baseline diagnosis in relation to the gold standard diagnosis showed a nonsignificant trend for lower sensitivities in the knowing race conditions (0.3846), as contrasted with knowing education only (0.480) or neither (0.600). The finding that knowledge of race may influence the diagnostic process in some unknown way is timely, given the recent State-of-the-Science conference on Alzheimer's disease prevention, the authors of which called for information about and standardization of the diagnostic process.
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Hayden KM, Welsh-Bohmer KA. Epidemiology of cognitive aging and Alzheimer's disease: contributions of the cache county utah study of memory, health and aging. Curr Top Behav Neurosci 2012; 10:3-31. [PMID: 21809193 DOI: 10.1007/7854_2011_152] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Epidemiological studies of Alzheimer's disease (AD) provide insights into changing public health trends and their contribution to disease incidence. The current chapter considers how the population-based approach has contributed to our understanding of lifetime exposures that contribute to later disease risk and may act to modify onset of symptoms. We focus on the findings from a recent survey of an exceptionally long-lived population, the Cache County Utah Study of Memory, Health, and Aging. This study is confined to a single geographic population has allowed estimation of the genetic and environmental influences on AD expression across the expected human lifespan of 95+ years. Given the emphasis of this text on the behavioral neurosciences of aging, we highlight within the current chapter the particular contributions of this population-based study to the neuropsychology of aging and AD. We also discuss hypotheses generated from this survey with respect to factors that may either accelerate or delay symptom onset in AD and the conditions that appear to be associated with successful cognitive aging.
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Affiliation(s)
- Kathleen M Hayden
- Department of Psychiatry, Joseph and Kathleen Bryan Alzheimer's Disease Research Center-Division of Neurology, 2200 W. Main Street, Suite A200, Durham, NC, 27705, USA
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Neill D. Should Alzheimer's disease be equated with human brain ageing? A maladaptive interaction between brain evolution and senescence. Ageing Res Rev 2012; 11:104-22. [PMID: 21763787 DOI: 10.1016/j.arr.2011.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/26/2011] [Accepted: 06/28/2011] [Indexed: 10/18/2022]
Abstract
In this review Alzheimer's disease is seen as a maladaptive interaction between human brain evolution and senescence. It is predicted to occur in everyone although does not necessarily lead to dementia. The pathological process is initiated in relation to a senescence mediated functional down-regulation in the posteromedial cortex (Initiation Phase). This leads to a loss of glutamatergic excitatory input to layer II entorhinal cortex neurons. A human specific maladaptive neuroplastic response is initiated in these neurons leading to neuronal dysfunction, NFT formation and death. This leads to further loss of glutamatergic excitatory input and propagation of the maladaptive response along excitatory pathways linking evolutionary progressed vulnerable neurons (Propagation Phase). Eventually neurons are affected in many brain areas resulting in dementia. Possible therapeutic approaches include enhancing glutamatergic transmission. The theory may have implications with regards to how Alzheimer's disease is classified.
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Mauri M, Sinforiani E, Zucchella C, Cuzzoni MG, Bono G. Progression to dementia in a population with amnestic mild cognitive impairment: clinical variables associated with conversion. FUNCTIONAL NEUROLOGY 2012; 27:49-54. [PMID: 22687167 PMCID: PMC3812753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of this study was to investigate clinical predictors of, and rates of conversion to, dementia syndrome in a case series of patients with amnestic mild cognitive impairment (aMCI). Two hundred and eight aMCI subjects were followed over a six-year period. A lower Mini Mental State Examination score was a significant predictor of dementia, and mild cognitive impairment patients with behavioral and psychiatric symptoms showed a faster conversion rate.
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Affiliation(s)
- Marco Mauri
- Section of Neurology, Department of Clinical Medicine, Circolo Hospital, University of Insubria, Varese, Italy
| | - Elena Sinforiani
- Alzheimer’s Assessment Unit, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
| | - Chiara Zucchella
- Alzheimer’s Assessment Unit, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
| | - Maria Giovanna Cuzzoni
- Section of Neurology, Department of Clinical Medicine, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giorgio Bono
- Section of Neurology, Department of Clinical Medicine, Circolo Hospital, University of Insubria, Varese, Italy
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Papadopoulos V. Implications of a new diagnostic blood test for Alzheimer’s disease on future disease management. Neurodegener Dis Manag 2011. [DOI: 10.2217/nmt.11.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Vassilios Papadopoulos
- The Research Institute of the McGill University Health Centre, Montreal General Hospital & Departments of Medicine, Biochemistry & Pharmacology & Therapeutics, McGill University, 1650 Cedar Avenue, C10–148, Montreal, Quebec H3G 1A4, Canada
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Han X, Rozen S, Boyle SH, Hellegers C, Cheng H, Burke JR, Welsh-Bohmer KA, Doraiswamy PM, Kaddurah-Daouk R. Metabolomics in early Alzheimer's disease: identification of altered plasma sphingolipidome using shotgun lipidomics. PLoS One 2011; 6:e21643. [PMID: 21779331 PMCID: PMC3136924 DOI: 10.1371/journal.pone.0021643] [Citation(s) in RCA: 302] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/04/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The development of plasma biomarkers could facilitate early detection, risk assessment and therapeutic monitoring in Alzheimer's disease (AD). Alterations in ceramides and sphingomyelins have been postulated to play a role in amyloidogensis and inflammatory stress related neuronal apoptosis; however few studies have conducted a comprehensive analysis of the sphingolipidome in AD plasma using analytical platforms with accuracy, sensitivity and reproducibility. METHODS AND FINDINGS We prospectively analyzed plasma from 26 AD patients (mean MMSE 21) and 26 cognitively normal controls in a non-targeted approach using multi-dimensional mass spectrometry-based shotgun lipidomics to determine the levels of over 800 molecular species of lipids. These data were then correlated with diagnosis, apolipoprotein E4 genotype and cognitive performance. Plasma levels of species of sphingolipids were significantly altered in AD. Of the 33 sphingomyelin species tested, 8 molecular species, particularly those containing long aliphatic chains such as 22 and 24 carbon atoms, were significantly lower (p<0.05) in AD compared to controls. Levels of 2 ceramide species (N16:0 and N21:0) were significantly higher in AD (p<0.05) with a similar, but weaker, trend for 5 other species. Ratios of ceramide to sphingomyelin species containing identical fatty acyl chains differed significantly between AD patients and controls. MMSE scores were correlated with altered mass levels of both N20:2 SM and OH-N25:0 ceramides (p<0.004) though lipid abnormalities were observed in mild and moderate AD. Within AD subjects, there were also genotype specific differences. CONCLUSIONS In this prospective study, we used a sensitive multimodality platform to identify and characterize an essentially uniform but opposite pattern of disruption in sphingomyelin and ceramide mass levels in AD plasma. Given the role of brain sphingolipids in neuronal function, our findings provide new insights into the AD sphingolipidome and the potential use of metabolomic signatures as peripheral biomarkers.
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Affiliation(s)
- Xianlin Han
- Sanford-Burnham Medical Research Institute, Orlando, Florida, United States of America
| | - Steve Rozen
- Department of Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Stephen H. Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Caroline Hellegers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Hua Cheng
- Sanford-Burnham Medical Research Institute, Orlando, Florida, United States of America
| | - James R. Burke
- Bryan Alzheimer Disease Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kathleen A. Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Bryan Alzheimer Disease Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Institute of Brain Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
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Makino KM, Porsteinsson AP. Memantine: a treatment for Alzheimer’s disease with a new formulation. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In nearly 20 years, aside from cholinesterase inhibitors, memantine is the only drug approved for the treatment of Alzheimer’s disease (AD). Memantine is an uncompetitive N-methyl-D-aspartate receptor antagonist that blocks pathological glutamate activity while permitting normal physiological function, thus preventing glutamate-induced excitotoxicity. Three Phase III pivotal trials demonstrated memantine’s efficacy in treating moderate-to-severe AD, which led to its initial approval by the EMA in 2002 and US FDA in 2003. The recommended target dose is 10 mg twice daily. The US FDA recently approved an extended-release (ER) formulation of memantine for once-daily 28-mg dosing. Memantine ER was evaluated in a 24-week placebo-controlled trial of patients with moderate-to-severe AD, which found significant benefits for cognition, global assessment, behavior and caregiver burden, but not function. The most common adverse events were headache, dizziness, diarrhea, hypertension, anxiety and influenza. Overall, memantine in all formulations has a favorable safety/tolerability profile and is safe to use with cholinesterase inhibitors. Memantine ER has yet to be evaluated against conventionally dosed immediate-release memantine.
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Affiliation(s)
- Kelly M Makino
- University of Rochester School of Medicine & Dentistry, Rochester, NY 14620, USA
| | - Anton P Porsteinsson
- University of Rochester School of Medicine & Dentistry, Rochester, NY 14620, USA
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Nelson PT, Head E, Schmitt FA, Davis PR, Neltner JH, Jicha GA, Abner EL, Smith CD, Van Eldik LJ, Kryscio RJ, Scheff SW. Alzheimer's disease is not "brain aging": neuropathological, genetic, and epidemiological human studies. Acta Neuropathol 2011; 121:571-87. [PMID: 21516511 PMCID: PMC3179861 DOI: 10.1007/s00401-011-0826-y] [Citation(s) in RCA: 225] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 04/12/2011] [Accepted: 04/13/2011] [Indexed: 01/18/2023]
Abstract
Human studies are reviewed concerning whether "aging"-related mechanisms contribute to Alzheimer's disease (AD) pathogenesis. AD is defined by specific neuropathology: neuritic amyloid plaques and neocortical neurofibrillary tangles. AD pathology is driven by genetic factors related not to aging per se, but instead to the amyloid precursor protein (APP). In contrast to genes involved in APP-related mechanisms, there is no firm connection between genes implicated in human "accelerated aging" diseases (progerias) and AD. The epidemiology of AD in advanced age is highly relevant but deceptively challenging to address given the low autopsy rates in most countries. In extreme old age, brain diseases other than AD approximate AD prevalence while the impact of AD pathology appears to peak by age 95 and decline thereafter. Many distinct brain diseases other than AD afflict older human brains and contribute to cognitive impairment. Additional prevalent pathologies include cerebrovascular disease and hippocampal sclerosis, both high-morbidity brain diseases that appear to peak in incidence later than AD chronologically. Because of these common brain diseases of extreme old age, the epidemiology differs between clinical "dementia" and the subset of dementia cases with AD pathology. Additional aging-associated mechanisms for cognitive decline such as diabetes and synapse loss have been linked to AD and these hypotheses are discussed. Criteria are proposed to define an "aging-linked" disease, and AD fails all of these criteria. In conclusion, it may be most fruitful to focus attention on specific pathways involved in AD rather than attributing it to an inevitable consequence of aging.
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Affiliation(s)
- Peter T Nelson
- Department of Pathology, University of Kentucky, Lexington, KY 40536-0230, USA.
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Brookmeyer R, Evans DA, Hebert L, Langa KM, Heeringa SG, Plassman BL, Kukull WA. National estimates of the prevalence of Alzheimer's disease in the United States. Alzheimers Dement 2011; 7:61-73. [PMID: 21255744 DOI: 10.1016/j.jalz.2010.11.007] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several methods of estimating prevalence of dementia are presented in this article. For both Brookmeyer and the Chicago Health and Aging project (CHAP), the estimates of prevalence are derived statistically, forward calculating from incidence and survival figures. The choice of incidence rates on which to build the estimates may be critical. Brookmeyer used incidence rates from several published studies, whereas the CHAP investigators applied the incidence rates observed in their own cohort. The Aging, Demographics, and Memory Study (ADAMS) and the East Boston Senior Health Project (EBSHP) were sample surveys designed to ascertain the prevalence of Alzheimer's disease and dementia. ADAMS obtained direct estimates by relying on probability sampling nationwide. EBSHP relied on projection of localized prevalence estimates to the national population. The sampling techniques of ADAMS and EBSHP were rather similar, whereas their disease definitions were not. By contrast, EBSPH and CHAP have similar disease definitions internally, but use different calculation techniques, and yet arrive at similar prevalence estimates, which are considerably greater than those obtained by either Brookmeyer or ADAMS. Choice of disease definition may play the larger role in explaining differences in observed prevalence between these studies.
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Affiliation(s)
- Ron Brookmeyer
- Department of Biostatistics, University of California, Los Angeles, USA.
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Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment-Part 2. Alzheimers Dement 2011; 7:35-52. [PMID: 21255742 DOI: 10.1016/j.jalz.2010.12.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article focuses on the effects of operational differences in case ascertainment on estimates of prevalence and incidence of cognitive impairment and/or dementia of the Alzheimer type. Experience and insights are discussed by investigators from the Framingham Heart Study, the East Boston Senior Health Project, the Chicago Health and Aging Project, the Mayo Clinic Study of Aging, the Baltimore Longitudinal Study of Aging, and the Aging, Demographics, and Memory Study. There is a general consensus that the single most important factor determining prevalence estimates of Alzheimer's disease (AD) is the severity of cognitive impairment used as a threshold to define cases. Studies that require a level of cognitive impairment in which persons are unable to provide self-care will have much lower estimates than the studies aimed at identifying persons in the earliest stages of AD. There are limited autopsy data from the aforementioned epidemiological studies to address accuracy in the diagnosis of etiological subtype, namely the specification of AD alone or in combination with other types of pathology. However, other community-based cohort studies show that many persons with mild cognitive impairment and also some persons without dementia or mild cognitive impairment meet pathological criteria for AD, thereby suggesting that the number of persons who would benefit from an effective secondary prevention intervention is probably higher than the published prevalence estimates. Improved accuracy in the clinical diagnosis of AD is anticipated with the addition of molecular and structural biomarkers in the next generation of epidemiological studies.
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Abstract
The change in the world's age demographics and the predicted rise in the incidence of age-related diseases, including dementia, is a source of major public health concern. Major research effort in both the United States and Europe has been targeted toward understanding the pathogenesis and epidemiology of dementia. This article presents a general overview of the history of dementia research in Europe and how it compares with that in the United States. The review highlights the common issues which both U.S. and European researchers have identified and attempted to tackle. To maximize information gained from studies across the world, better harmonization of methodology is needed, as informed from current research practice.
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Affiliation(s)
- Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, United Kingdom.
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