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Ersözlü E, Rauchmann BS. Analysis of Resting-State Functional Magnetic Resonance Imaging in Alzheimer's Disease. Methods Mol Biol 2024; 2785:89-104. [PMID: 38427190 DOI: 10.1007/978-1-0716-3774-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Alzheimer's disease (AD) has been characterized by widespread network disconnection among brain regions, widely overlapping with the hallmarks of the disease. Functional connectivity has been studied with an upward trend in the last two decades, predominantly in AD among other neuropsychiatric disorders, and presents a potential biomarker with various features that might provide unique contributions to foster our understanding of neural mechanisms of AD. The resting-state functional MRI (rs-fMRI) is usually used to measure the blood-oxygen-level-dependent signals that reflect the brain's functional connectivity. Nevertheless, the rs-fMRI is still underutilized, which might be due to the fairly complex acquisition and analytic methodology. In this chapter, we presented the common methods that have been applied in rs-fMRI literature, focusing on the studies on individuals in the continuum of AD. The key methodological aspects will be addressed that comprise acquiring, processing, and interpreting rs-fMRI data. More, we discussed the current and potential implications of rs-fMRI in AD.
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Affiliation(s)
- Ersin Ersözlü
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Geriatric Psychiatry and Developmental Disorders, kbo-Isar-Amper-Klinikum Munich East, Academic Teaching Hospital of LMU Munich, Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
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2
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Bader I, Bader I, Lopes Alves I, Vállez García D, Vellas B, Dubois B, Boada M, Marquié M, Altomare D, Scheltens P, Vandenberghe R, Hanseeuw B, Schöll M, Frisoni GB, Jessen F, Nordberg A, Kivipelto M, Ritchie CW, Grau-Rivera O, Molinuevo JL, Ford L, Stephens A, Gismondi R, Gispert JD, Farrar G, Barkhof F, Visser PJ, Collij LE. Recruitment of pre-dementia participants: main enrollment barriers in a longitudinal amyloid-PET study. Alzheimers Res Ther 2023; 15:189. [PMID: 37919783 PMCID: PMC10621165 DOI: 10.1186/s13195-023-01332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The mismatch between the limited availability versus the high demand of participants who are in the pre-dementia phase of Alzheimer's disease (AD) is a bottleneck for clinical studies in AD. Nevertheless, potential enrollment barriers in the pre-dementia population are relatively under-reported. In a large European longitudinal biomarker study (the AMYPAD-PNHS), we investigated main enrollment barriers in individuals with no or mild symptoms recruited from research and clinical parent cohorts (PCs) of ongoing observational studies. METHODS Logistic regression was used to predict study refusal based on sex, age, education, global cognition (MMSE), family history of dementia, and number of prior study visits. Study refusal rates and categorized enrollment barriers were compared between PCs using chi-squared tests. RESULTS 535/1856 (28.8%) of the participants recruited from ongoing studies declined participation in the AMYPAD-PNHS. Only for participants recruited from clinical PCs (n = 243), a higher MMSE-score (β = - 0.22, OR = 0.80, p < .05), more prior study visits (β = - 0.93, OR = 0.40, p < .001), and positive family history of dementia (β = 2.08, OR = 8.02, p < .01) resulted in lower odds on study refusal. General study burden was the main enrollment barrier (36.1%), followed by amyloid-PET related burden (PCresearch = 27.4%, PCclinical = 9.0%, X2 = 10.56, p = .001), and loss of research interest (PCclinical = 46.3%, PCresearch = 16.5%, X2 = 32.34, p < .001). CONCLUSIONS The enrollment rate for the AMYPAD-PNHS was relatively high, suggesting an advantage of recruitment via ongoing studies. In this observational cohort, study burden reduction and tailored strategies may potentially improve participant enrollment into trial readiness cohorts such as for phase-3 early anti-amyloid intervention trials. The AMYPAD-PNHS (EudraCT: 2018-002277-22) was approved by the ethical review board of the VU Medical Center (VUmc) as the Sponsor site and in every affiliated site.
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Affiliation(s)
- Ilse Bader
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV, Amsterdam, The Netherlands.
| | - Ilona Bader
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
| | - Isadora Lopes Alves
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
- Brain Research Center, 1081 GN, Amsterdam, The Netherlands
| | - David Vállez García
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
| | - Bruno Vellas
- Gérontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), 31300, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, 31062, Toulouse, France
| | - Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A) and Brain Institute, Salpetriere Hospital, Sorbonne University, 75013, Paris, France
| | - Mercè Boada
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Marta Marquié
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Daniele Altomare
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV, Amsterdam, The Netherlands
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Leuven Brain Institute, KU Leuven, 3001, Louvain, Belgium
| | - Bernard Hanseeuw
- Institute of Neuroscience, Université Catholique de Louvain, 1200, Brussels, Belgium
- Department of Neurology, Clinique Universitaires Saint-Luc, 1200, Brussels, Belgium
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02155, USA
- WELBIO Department, WEL Research Institute, Avenue Pasteur, 6, 1300, Wavre, Belgium
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, 405 30, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
- Dementia Research Centre, Queen Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, 1205, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), 53127, Bonn, Germany
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, 171 77, Stockholm, Sweden
- Theme Inflammation, Karolinska University Hospital, Stockholm, 171 77, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, 171 77, Sweden
| | - Miia Kivipelto
- Kuopio University Hospital, 70210, Kuopio, Finland
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, 171 77, Stockholm, Sweden
- Imperial College London, London, SW7 2AZ, UK
| | | | - Oriol Grau-Rivera
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, 08005, Barcelona, Spain
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, 08005, Barcelona, Spain
- H. Lundbeck A/S, 2500, Copenhagen, Denmark
| | - Lisa Ford
- Janssen Research and Development, Titusville, NJ, 08560, USA
| | | | | | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, 08005, Barcelona, Spain
| | - Gill Farrar
- GE Healthcare, Pharmaceutical Diagnostics, Amersham, HP7 9LL, UK
| | - Frederik Barkhof
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
- Institutes of Neurology and Healthcare Engineering, UCL, London, WC1N 3BG, UK
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Lyduine E Collij
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 221 00, Malmö, Sweden
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3
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Olazarán J, Carnero-Pardo C, Fortea J, Sánchez-Juan P, García-Ribas G, Viñuela F, Martínez-Lage P, Boada M. Prevalence of treated patients with Alzheimer's disease: current trends and COVID-19 impact. Alzheimers Res Ther 2023; 15:130. [PMID: 37537656 PMCID: PMC10401753 DOI: 10.1186/s13195-023-01271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND There are few updated studies on the prevalence and management of Alzheimer's disease (AD), which could be underdiagnosed or undertreated. The COVID-19 pandemic may have worsened the deficiencies in the diagnosis and treatment of these patients. Electronic medical records (EMR) offer an opportunity to assess the impact and management of medical processes and contingencies in the population. OBJECTIVE To estimate AD prevalence in Spain over a 6-year period, based on treated patients, according to usual clinical practice. Additionally, to describe the management of AD-treated patients and the evolution of that treatment during the 2020 COVID-19 pandemic. METHODS Retrospective study using the Spanish IQVIA EMR database. Patients treated with donepezil, galantamine, rivastigmine, and/or memantine were included in the study. Annual AD prevalence (2015-2020) was estimated and extrapolated to the national population level. Most frequent treatments and involved specialties were described. To assess the effect of COVID-19, the incidence of new AD cases in 2020 was calculated and compared with newly diagnosed cases in 2019. RESULTS Crude AD prevalence (2015-2020) was estimated at 760.5 per 100,000 inhabitants, and age-standardized prevalence (2020) was 664.6 (male 595.7, female 711.0). Monotherapy was the most frequent way to treat AD (86.2%), in comparison with dual therapy (13.8%); rivastigmine was the most prescribed treatment (37.3%), followed by memantine (36.4%) and donepezil (33.0%). Rivastigmine was also the most utilized medication in newly treated patients (46.7%), followed by donepezil (29.8%), although donepezil persistence was longer (22.5 vs. 20.6 months). Overall, donepezil 10 mg, rivastigmine 9.5 mg, and memantine 20 mg were the most prescribed presentations. The incidence rate of AD decreased from 148.1/100,000 (95% confidence interval [CI] 147.0-149.2) in 2019 to 118.4/100,000 (95% CI 117.5-119.4) in 2020. CONCLUSIONS The obtained prevalence of AD-treated patients was consistent with previous face-to-face studies. In contrast with previous studies, rivastigmine, rather than donepezil, was the most frequent treatment. A decrease in the incidence of AD-treated patients was observed during 2020 in comparison with 2019, presumably due to the significant impact of the COVID-19 pandemic on both diagnosis and treatment. EMR databases emerge as valuable tools to monitor in real time the incidence and management of medical conditions in the population, as well as to assess the health impact of global contingencies and interventions.
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Affiliation(s)
- Javier Olazarán
- Unidad de Trastornos de La Memoria, HM Hospitales and Servicio de Neurología, HGU Gregorio Marañón, Madrid, Spain.
| | | | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Pascual Sánchez-Juan
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Fundación CIEN (Centro de Investigación de Enfermedades Neurológicas), Madrid, Spain
| | | | - Félix Viñuela
- Instituto Neurológico Andaluz, Hospital Victoria Eugenia, Seville y Unidad de Deterioro Cognitivo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Mercè Boada
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
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Tate A, Suárez-Calvet M, Ekelund M, Eriksson S, Eriksdotter M, Van Der Flier WM, Georges J, Kivipelto M, Kramberger MG, Lindgren P, López JDG, Lötjönen J, Persson S, Pla S, Solomon A, Thurfjell L, Wimo A, Winblad B, Jönsson L. Precision medicine in neurodegeneration: the IHI-PROMINENT project. Front Neurol 2023; 14:1175922. [PMID: 37602259 PMCID: PMC10433183 DOI: 10.3389/fneur.2023.1175922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Neurodegenerative diseases are one of the most important contributors to morbidity and mortality in the elderly. In Europe, over 14 million people are currently living with dementia, at a cost of over 400 billion EUR annually. Recent advances in diagnostics and approval for new pharmaceutical treatments for Alzheimer's disease (AD), the most common etiology of dementia, heralds the beginning of precision medicine in this field. However, their implementation will challenge an already over-burdened healthcare systems. There is a need for innovative digital solutions that can drive the related clinical pathways and optimize and personalize care delivery. Public-private partnerships are ideal vehicles to tackle these challenges. Here we describe the Innovative Health Initiative (IHI) public-private partnership project PROMINENT that has been initiated by connecting leading dementia researchers, medical professionals, dementia patients and their care partners with the latest innovative health technologies using a precision medicine based digital platform. The project builds upon the knowledge and already implemented digital tools from several collaborative initiatives that address new models for early detection, diagnosis, and monitoring of AD and other neurodegenerative disorders. The project aims to provide support to improvement efforts to each aspect of the care pathway including diagnosis, prognosis, treatment, and data collection for real world evidence and cost effectiveness studies. Ultimately the PROMINENT project is expected to lead to cost-effective care and improved health outcomes.
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Affiliation(s)
- Ashley Tate
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marc Suárez-Calvet
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Servei de Neurologia, Hospital del Mar, Barcelona, Spain
| | | | | | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Theme Inflammation and Aging, Stockholm, Sweden
| | - Wiesje M. Van Der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | | | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Theme Inflammation and Aging, Stockholm, Sweden
| | - Milica G. Kramberger
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- University Medical Center Ljubljana and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Lindgren
- IHE, The Swedish Institute for Health Economics, Lund, Sweden
| | - Juan Domingo Gispert López
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pomepu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | | | - Sofie Persson
- IHE, The Swedish Institute for Health Economics, Lund, Sweden
| | - Sandra Pla
- Synapse Research Management Partners SL, Madrid, Spain
| | - Alina Solomon
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Medicine and Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Linus Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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5
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Langbaum JB, Zissimopoulos J, Au R, Bose N, Edgar CJ, Ehrenberg E, Fillit H, Hill CV, Hughes L, Irizarry M, Kremen S, Lakdawalla D, Lynn N, Malzbender K, Maruyama T, Massett HA, Patel D, Peneva D, Reiman EM, Romero K, Routledge C, Weiner MW, Weninger S, Aisen PS. Recommendations to address key recruitment challenges of Alzheimer's disease clinical trials. Alzheimers Dement 2023; 19:696-707. [PMID: 35946590 PMCID: PMC9911558 DOI: 10.1002/alz.12737] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022]
Abstract
Clinical trials for Alzheimer's disease (AD) are slower to enroll study participants, take longer to complete, and are more expensive than trials in most other therapeutic areas. The recruitment and retention of a large number of qualified, diverse volunteers to participate in clinical research studies remain among the key barriers to the successful completion of AD clinical trials. An advisory panel of experts from academia, patient-advocacy organizations, philanthropy, non-profit, government, and industry convened in 2020 to assess the critical challenges facing recruitment in Alzheimer's clinical trials and develop a set of recommendations to overcome them. This paper briefly reviews existing challenges in AD clinical research and discusses the feasibility and implications of the panel's recommendations for actionable and inclusive solutions to accelerate the development of novel therapies for AD.
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Affiliation(s)
| | - Julie Zissimopoulos
- Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Rhoda Au
- Departments of Anatomy & Neurobiology, Neurology and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
| | | | | | | | - Howard Fillit
- Alzheimer’s Drug Discovery Foundation, New York, New York, USA
| | | | | | | | - Sarah Kremen
- The Jona Goldrich Center for Alzheimer’s and Memory Disorders, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Darius Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Nancy Lynn
- BrightFocus Foundation, Clarksburg, Maryland, USA
| | | | | | | | | | - Desi Peneva
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Michael W. Weiner
- Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology, University of California San Francisco, San Francisco, California, USA
| | | | - Paul S. Aisen
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, California, USA
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Ciudin A, Simó R. New methods for the diagnosis and monitoring of cognitive function in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2022; 13:1024794. [PMID: 36531450 PMCID: PMC9751391 DOI: 10.3389/fendo.2022.1024794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022] Open
Abstract
The presence of type 2 diabetes acts as an accelerator of cognitive impairment (mild cognitive impairment and later dementia), with a significant impact on the management of the disease and its complications. Therefore, it is recommended to perform an annual evaluation of cognitive function in patients with diabetes older than 65 years. Current guidelines still recommend the use of the Minimental State Evaluation Test (MMSE) as screening test, but it has a modest sensitivity and specificity for identifying mild cognitive impairment. This represents an important gap because patients with mild cognitive impairment are at risk of progressing to dementia. The neurocognitive diagnosis is based on complex neuropsychological tests, which require specifically trained personnel and are time consuming, making its routine incorporation into daily clinical practice unfeasible. Therefore, at present there are no reliable biomarkers to identify patients with type 2 diabetes at increased risk of developing cognitive impairment. Since the brain and the retina have a common embryological origin, our Research Group, has worked over the last 10 years evaluating the usefulness of the retina as a "window" to the brain. We provided evidence that retinal microperimetry is a simple, feasible and useful tool for screening and monitoring cognitive function in patients with type 2 diabetes. We propose a review of actual tests recommended for screening of cognitive impairment as well as an update of new emerging methods, such as retinal microperimetry.
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Affiliation(s)
- Andreea Ciudin
- Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autónoma de Barcelona, Department of Human Physiology and Inmunology, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autónoma de Barcelona, Department of Medicine, Barcelona, Spain
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7
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Boccardi M, Handels R, Gold M, Grazia A, Lutz MW, Martin M, Nosheny R, Robillard JM, Weidner W, Alexandersson J, Thyrian JR, Winblad B, Barbarino P, Khachaturian AS, Teipel S. Clinical research in dementia: A perspective on implementing innovation. Alzheimers Dement 2022; 18:2352-2367. [PMID: 35325508 DOI: 10.1002/alz.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 01/31/2023]
Abstract
The increasing global prevalence of dementia demands concrete actions that are aimed strategically at optimizing processes that drive clinical innovation. The first step in this direction requires outlining hurdles in the transition from research to practice. The different parties needed to support translational processes have communication mismatches; methodological gaps hamper evidence-based decision-making; and data are insufficient to provide reliable estimates of long-term health benefits and costs in decisional models. Pilot projects are tackling some of these gaps, but appropriate methods often still need to be devised or adapted to the dementia field. A consistent implementation perspective along the whole translational continuum, explicitly defined and shared among the relevant stakeholders, should overcome the "research-versus-adoption" dichotomy, and tackle the implementation cliff early on. Concrete next steps may consist of providing tools that support the effective participation of heterogeneous stakeholders and agreeing on a definition of clinical significance that facilitates the selection of proper outcome measures.
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Affiliation(s)
- Marina Boccardi
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany
| | - Ron Handels
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Alice Grazia
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
| | - Michael W Lutz
- Department of Neurology Duke University School of Medicine, Durham, North Carolina, USA
| | - Mike Martin
- Gerontology Center, University of Zurich, Zürich, Switzerland
| | - Rachel Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.,San Francisco Veteran's Administration Medical Center, San Francisco, California, USA
| | - Julie M Robillard
- The University of British Columbia; BC Children's & Women's Hospitals, Vancouver, Canada
| | | | | | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Healthcare, University Medicine of Greifswald, Greifswald, Germany
| | - Bengt Winblad
- Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Ara S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association, Rockville, Maryland, USA.,Campaign to Prevent Alzheimer's Disease, Rockville, Maryland, USA
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
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8
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Smedinga M, Bunnik EM, Richard E, Schermer MHN. Should Doctors Offer Biomarker Testing to Those Afraid to Develop Alzheimer's Dementia? : Applying the Method of Reflective Equilibrium for a Clinical Dilemma. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:287-297. [PMID: 35306635 DOI: 10.1007/s11673-022-10167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/23/2021] [Indexed: 06/14/2023]
Abstract
An increasing number of people seek medical attention for mild cognitive symptoms at older age, worried that they might develop Alzheimer's disease. Some clinical practice guidelines suggest offering biomarker testing in such cases, using a brain scan or a lumbar puncture, to improve diagnostic certainty about Alzheimer's disease and enable an earlier diagnosis. Critics, on the other hand, point out that there is no effective Alzheimer treatment available and argue that biomarker tests lack clinical validity. The debate on the ethical desirability of biomarker testing is currently polarized; advocates and opponents tend to focus on their own line of arguments. In this paper, we show how the method of reflective equilibrium (RE) can be used to systematically weigh the relevant arguments on both sides of the debate to decide whether to offer Alzheimer biomarker testing. In the tradition of RE, we reflect upon these arguments in light of their coherence with other argumentative elements, including relevant facts (e.g. on the clinical validity of the test), ethical principles, and theories on societal ideals or relevant concepts, such as autonomy. Our stance in the debate therefore rests upon previously set out in-depth arguments and reflects a wide societal perspective.
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Affiliation(s)
- Marthe Smedinga
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands.
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands.
| | - Eline M Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands
| | - Maartje H N Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands
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9
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Effective cognitive screening tools for Alzheimer's disease in the primary care setting: the role of the visual paired associative learning task. Int Psychogeriatr 2021; 33:1111-1114. [PMID: 34127156 DOI: 10.1017/s1041610221000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Lyu D, Li T, Lyu X. Resting-state functional reorganisation in Alzheimer's disease and amnestic mild cognitive impairment: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e049798. [PMID: 34642194 PMCID: PMC8513263 DOI: 10.1136/bmjopen-2021-049798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The incidence of Alzheimer's disease (AD) is increasing rapidly, causing a growing burden to health and economic worldwide. Several clinical trials in the past decade failed to find solutions, and there remains a lack of an effective treatment. The evidence suggests that early intervention for neurodegeneration would likely be effective in preventing cognitive decline. Cognitive decline in AD occurs continuously over a long period; however, there remains a lack of simple, rapid and accurate approach for diagnosis of amnestic mild cognitive impairment or subjective cognitive decline due to underlying Alzheimer's pathology. Resting-state functional MRI (rs-fMRI) determines the functional activities of the human brain non-invasively. The amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF) and regional homogeneity (ReHo) are rs-fMRI indicators with high repeatability. They have been studied as early diagnostic imaging markers for other diseases and may be promising markers also for AD. METHODS AND ANALYSIS The following electronic literature databases will be searched from inception to December 2021: Medline-Ovid, Medline-PubMed, EMBase-Ovid, Cochrane Central and ClinicalTrials.gov. Two independent reviewers will select studies with eligible criteria, extract data and assess the quality of the original studies with our quality assessment tool individually. Missing data will be requested by sending emails to the corresponding authors. Brain regions will be presented for ALFF/fALFF and ReHo by performing activation likelihood estimation with the Seed-based d Mapping-Permutation of subject images V.6.21 software. Meta-regression will be performed to determine the potential brain regions that may strongly correlate with cognitive decline progression. Subgroup analysis, funnel plot, Egger's test and sensitivity analysis will be conducted to detect and explain potential heterogeneity. ETHICS AND DISSEMINATION This study does not require formal ethical approval. The findings will be submitted to a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42021229009.
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Affiliation(s)
- Diyang Lyu
- Capital Medical University, Beijing, China
| | - Taoran Li
- Capital Medical University, Beijing, China
| | - Xuanxin Lyu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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11
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Wimo A, Belger M, Bon J, Jessen F, Dumas A, Kramberger MG, Jamilis L, Johansson G, Rodrigo Salas A, Rodríguez Gómez O, Sannemann L, Stoekenbroek M, Gurruchaga Telleria M, Valero S, Vermunt L, Waterink L, Winblad B, Visser PJ, Zwan M, Boada M. A Cost-Consequence Analysis of Different Screening Procedures in Alzheimer's Disease: Results from the MOPEAD Project. J Alzheimers Dis 2021; 83:1149-1159. [PMID: 34420954 PMCID: PMC8543247 DOI: 10.3233/jad-210303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: For care planning and support, under-detection and late diagnosis of Alzheimer’s disease (AD) is a great challenge. Models of Patient-Engagement for Alzheimer’s Disease (MOPEAD) is an EU-funded project aiming at testing different strategies to improve this situation. Objective: To make a cost-consequence analysis of MOPEAD. Methods: Four screening strategies were tested in five countries (Germany, the Netherlands, Slovenia, Spain, and Sweden): 1) a web-approach; 2) Open-House initiative; 3) in primary care; and 4) by diabetes specialists. Persons-at-risk of AD in all strategies were offered referral to a hospital-based specialist. The primary health-economic outcome was the cost per true-positive case (TP) of AD from the screened population. Results: Of 2,847 screened persons, 1,121 screened positive (39%), 402 were evaluated at memory clinics (14%), and 236 got an AD diagnosis (8%). The cost per TP of those screened was €3,115 with the web-approach, €2,722 with the Open-House, €1,530 in primary care, and €1,190 by diabetes specialists. Sensitivity analyses that more likely reflect the real-world situation confirmed the results. The number-needed-to-screen was 30 with the web-approach, 8 with the Open-House and primary care, and 6 with the diabetes specialists. There were country differences in terms of screening rates, referrals to memory clinics, staff-types involved, and costs per TP. Conclusion: In primary care and by the diabetes specialist, the costs per TP/screened population were lowest, but the capacity of such settings to identify cases with AD-risk must be discussed. Hence new diagnostic strategies such as web-solutions and Open-House initiatives may be valuable after modifications.
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Affiliation(s)
- Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden
| | - Mark Belger
- Eli Lilly and Company Ltd (ELI), Bracknell, UK
| | - Jaka Bon
- University Medical Centre Ljubljana (UMCL), Ljubljana, Slovenia
| | - Frank Jessen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) Universität zu Köln, Köln, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Germany
| | - Annette Dumas
- ASDM Consulting, EU Affairs Director, Brussels, Belgium
| | - Milica G Kramberger
- Department of Neurology, University Medical Center Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Laura Jamilis
- GMV Soluciones Globales Internet S.A.U. (GMV), Spain
| | - Gunilla Johansson
- Department of Neurobiology, Care sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden
| | | | | | - Lena Sannemann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry, Cologne, Germany
| | | | - Miren Gurruchaga Telleria
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sergi Valero
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Lisa Vermunt
- Amsterdam UMC, VU University, Amsterdam, Amsterdam, the Netherlands
| | - Lisa Waterink
- Amsterdam UMC, VU University, Amsterdam, Amsterdam, the Netherlands
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Solna, Sweden.,Karolinska University Hospital, Theme Inflammation and Aging, Huddinge, Sweden
| | | | - Marissa Zwan
- Amsterdam UMC, VU University, Amsterdam, Amsterdam, the Netherlands
| | - Mercè Boada
- Fundació ACE (FACE), Barcelona, Spain.,Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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12
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Boada M, Rodrigo A, Jessen F, Wimblad B, Kramberger M, Visser PJ, Simó R, Rodríguez-Gomez O, Ciudin A, Georges J, Dumas A, Maguire P, Krivec D, Wimo A, Valero S, Alegret M, Jamilis L, Zwan M, Sannemann L, Arrufat J, Stomrud E, Johansson G, Shering C, Glaysher B, Stewart N, Belger M, Iradier F, Campo L. Complementary pre-screening strategies to uncover hidden prodromal and mild Alzheimer's disease: Results from the MOPEAD project. Alzheimers Dement 2021; 18:1119-1127. [PMID: 34310061 PMCID: PMC9290633 DOI: 10.1002/alz.12441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/12/2022]
Abstract
Introduction The Models of Patient Engagement for Alzheimer's Disease (MOPEAD) project was conceived to explore innovative complementary strategies to uncover hidden prodromal and mild Alzheimer's disease (AD) dementia cases and to raise awareness both in the general public and among health professionals about the importance of early diagnosis. Methods Four different strategies or RUNs were used: (a) a web‐based (WB) prescreening tool, (2) an open house initiative (OHI), (3) a primary care–based protocol for early detection of cognitive decline (PC), and (4) a tertiary care–based pre‐screening at diabetologist clinics (DC). Results A total of 1129 patients at high risk of having prodromal AD or dementia were identified of 2847 pre‐screened individuals (39.7%). The corresponding proportion for the different initiatives were 36.8% (WB), 35.6% (OHI), 44.4% (PC), and 58.3% (DC). Conclusion These four complementary pre‐screening strategies were useful for identifying individuals at high risk of having prodromal or mild AD.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Frank Jessen
- Department of Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Bengt Wimblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Theme Aging, Karolinska Univ Hospital, Stockholm, Sweden
| | - Milika Kramberger
- Center for Cognitive Impairments, Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Rafael Simó
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas. Instituto de Salud Carlos III, Spain
| | - Octavio Rodríguez-Gomez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya, Barcelona, Spain
| | - Andreea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas. Instituto de Salud Carlos III, Spain
| | | | | | - Peggy Maguire
- European Institute of Women's Health, Dublin, Ireland
| | | | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Sergi Valero
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Barcelona, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Marissa Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Lena Sannemann
- Department of Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Erik Stomrud
- Clinical Memory Research Unit, Lund University, Malmö, Sweden.,Emmaboda Health Centre, Region Kalmar County, Emmaboda, Sweden
| | - Gunilla Johansson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | | | - Neil Stewart
- Modus Research and Innovation Limited, Dundee, Scotland
| | - Mark Belger
- Eli Lilly and Company (Lilly UK), Surrey, UK
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13
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Öhman F, Hassenstab J, Berron D, Schöll M, Papp KV. Current advances in digital cognitive assessment for preclinical Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12217. [PMID: 34295959 PMCID: PMC8290833 DOI: 10.1002/dad2.12217] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/30/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022]
Abstract
There is a pressing need to capture and track subtle cognitive change at the preclinical stage of Alzheimer's disease (AD) rapidly, cost-effectively, and with high sensitivity. Concurrently, the landscape of digital cognitive assessment is rapidly evolving as technology advances, older adult tech-adoption increases, and external events (i.e., COVID-19) necessitate remote digital assessment. Here, we provide a snapshot review of the current state of digital cognitive assessment for preclinical AD including different device platforms/assessment approaches, levels of validation, and implementation challenges. We focus on articles, grants, and recent conference proceedings specifically querying the relationship between digital cognitive assessments and established biomarkers for preclinical AD (e.g., amyloid beta and tau) in clinically normal (CN) individuals. Several digital assessments were identified across platforms (e.g., digital pens, smartphones). Digital assessments varied by intended setting (e.g., remote vs. in-clinic), level of supervision (e.g., self vs. supervised), and device origin (personal vs. study-provided). At least 11 publications characterize digital cognitive assessment against AD biomarkers among CN. First available data demonstrate promising validity of this approach against both conventional assessment methods (moderate to large effect sizes) and relevant biomarkers (predominantly weak to moderate effect sizes). We discuss levels of validation and issues relating to usability, data quality, data protection, and attrition. While still in its infancy, digital cognitive assessment, especially when administered remotely, will undoubtedly play a major future role in screening for and tracking preclinical AD.
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Affiliation(s)
- Fredrik Öhman
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgGothenburgSweden
| | - Jason Hassenstab
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
- Department of Psychological & Brain SciencesWashington University in St. LouisSt. LouisMissouriUSA
| | - David Berron
- German Center for Neurodegenerative Diseases (DZNE)MagdeburgGermany
- Clinical Memory Research Unit, Department of Clinical Sciences MalmöLund UniversityLundSweden
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgGothenburgSweden
- Dementia Research Centre, Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Kathryn V. Papp
- Center for Alzheimer Research and TreatmentDepartment of Neurology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of Neurology, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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14
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Rodrigo A, Trigueros P, Jamilis L, Alegret M, Rodríguez O, Tárraga L, González-Pérez A, Kramberger M, Winblad B, Visser PJ, Jessen F, Campo L, Boada M. Identification of undiagnosed dementia cases using a web-based pre-screening tool: The MOPEAD project. Alzheimers Dement 2021; 17:1307-1316. [PMID: 33860599 PMCID: PMC8453736 DOI: 10.1002/alz.12297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/29/2020] [Accepted: 01/01/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Innovative patient engagement models are required to identify people with prodromal and mild Alzheimer's disease who are "hidden" in their communities and not normally found in a memory clinic setting. METHODS A marketing campaign and a web-based pre-screening tool were used to identify individuals at risk of dementia in five European countries. Harmonized clinical evaluation of these patients was performed in participating memory clinics within the MOPEAD project. RESULTS A total of 1487 individuals completed the pre-screening, with 547 of them found to be at risk of dementia (36.8%). Among the subset of 91 patients with a positive pre-screening result that underwent full clinical evaluation, 49 (53.8%) were diagnosed with either mild cognitive impairment or Alzheimer's disease. CONCLUSION This novel web-based pre-screening tool showed to be a valid strategy to identify undiagnosed people with cognitive impairment.
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Affiliation(s)
| | | | | | - Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Octavio Rodríguez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lluís Tárraga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio González-Pérez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Milica Kramberger
- Center for Cognitive Impairments, Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Karolinska University Hospital, Theme Aging, Stockholm, Sweden
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frank Jessen
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | | | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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15
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Sannemann L, Müller T, Waterink L, Zwan M, Wimo A, Stomrud E, Pinó S, Arrufat J, Rodríguez‐Gomez O, Benaque A, Bon J, Ferreira D, Johansson G, Dron A, Dumas A, Georges J, Kramberger MG, Visser PJ, Winblad B, Campo L, Boada M, Jessen F. General practitioners' attitude toward early and pre-dementia diagnosis of AD in five European countries-A MOPEAD project survey. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12130. [PMID: 33665337 PMCID: PMC7901232 DOI: 10.1002/dad2.12130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION General practitioners (GPs) play a key role in early identification of dementia, yet diagnosis is often missed or delayed in primary care. As part of the multinational Models of Patient Engagement for Alzheimer's Disease project, we assess GPs' attitude toward early and pre-dementia diagnosis of AD and explore barriers to early diagnosis. METHODS Our survey covered general attitude toward early diagnosis, diagnostic procedures, resources, and opinion on present and future treatment options across five European countries. RESULTS In total 343 GPs completed the survey; 74% of GPs indicated that an early diagnosis is valuable. There were country-specific differences in GPs' perceptions of reimbursement and time available for the patient. If a drug were available to slow down the progression of AD, 59% of the GPs would change their implementation of early diagnosis. DISCUSSION Our findings provide insight into GPs' attitudes by exploring differences in perception and management of early diagnosis.
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Affiliation(s)
- Lena Sannemann
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
| | - Theresa Müller
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
| | - Lisa Waterink
- Department of NeurologyAlzheimer Center Amsterdam, Amsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Marissa Zwan
- Department of NeurologyAlzheimer Center Amsterdam, Amsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Anders Wimo
- Department of NeurobiologyDivision of Neurogeriatrics, Care Sciences and Society, Karolinska InstitutetSolnaSweden
| | - Erik Stomrud
- Clinical Memory Research UnitLund UniversityMalmöSweden
- Emmaboda Health CentreRegion Kalmar CountyEmmabodaSweden
| | - Susana Pinó
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
| | | | - Octavio Rodríguez‐Gomez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Alba Benaque
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
| | - Jaka Bon
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana and Medical FacultyUniversity of LjubljanaLjubljanaSlovenia
| | - Daniel Ferreira
- Department of NeurobiologyDivision of Clinical Geriatrics, Centre for Alzheimer Research, Care Sciences, and Society, Karolinska InstitutetHuddingeStockholmSweden
| | - Gunilla Johansson
- Department of NeurobiologyDivision of Neurogeriatrics, Care Sciences and Society, Karolinska InstitutetSolnaSweden
| | - Amanda Dron
- Modus Research and Innovation LimitedDundee Technology ParkDundeeUK
| | | | | | - Milica G Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana and Medical FacultyUniversity of LjubljanaLjubljanaSlovenia
| | - Pieter Jelle Visser
- Department of NeurologyAlzheimer Center Amsterdam, Amsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Bengt Winblad
- Department of NeurobiologyDivision of Neurogeriatrics, Care Sciences and Society, Karolinska InstitutetSolnaSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | | | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Frank Jessen
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD)University of CologneKölnGermany
| | - MOPEAD consortium
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
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16
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Zwan MD, van der Flier WM, Cleutjens S, Schouten TC, Vermunt L, Jutten RJ, van Maurik IS, Sikkes SA, Flenniken D, Howell T, Weiner MW, Scheltens P, Prins ND. Dutch Brain Research Registry for study participant recruitment: Design and first results. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12132. [PMID: 33614897 PMCID: PMC7882519 DOI: 10.1002/trc2.12132] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Dutch Brain Research Registry aims to facilitate online recruitment of participants for brain disease studies. METHODS Registrants were primarily recruited through an online social media campaign. The registration process included a short questionnaire, which was subsequently used in the prescreening process to match participants to studies. RESULTS In the first 18 months, 17,218 registrants signed up (58±11 years old, 78% female). Out of 34,696 study invitations that were sent, 36% were accepted by registrants, of which 50% to 84% were finally enrolled, resulting in 10,661 participants in 28 studies. Compared to non-participants, study participants were more often older, male, more highly educated, retired or unemployed, non-smoking, healthier, and more often had a family member with dementia. DISCUSSION The Dutch Brain Research Registry facilitates effective matching of participants to brain disease studies. Participant factors related to study enrollment may reflect facilitators or barriers for participation, which is useful for improving recruitment strategies.
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Affiliation(s)
- Marissa D. Zwan
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Solange Cleutjens
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Tamara C Schouten
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Lisa Vermunt
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
- Department of Clinical ChemistryNeurochemistry LaboratoryAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Roos J. Jutten
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Ingrid S. van Maurik
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Sietske A.M. Sikkes
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Derek Flenniken
- Center for Imaging of Neurodegenerative Diseases (CIND)San Francisco Veterans Affair Medical CenterSan FranciscoCaliforniaUSA
| | - Taylor Howell
- Center for Imaging of Neurodegenerative Diseases (CIND)San Francisco Veterans Affair Medical CenterSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases (CIND)San Francisco Veterans Affair Medical CenterSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Philip Scheltens
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Niels D. Prins
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
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17
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Ortiz Zuñiga AM, Simó R, Rodriguez-Gómez O, Hernández C, Rodrigo A, Jamilis L, Campo L, Alegret M, Boada M, Ciudin A. Clinical Applicability of the Specific Risk Score of Dementia in Type 2 Diabetes in the Identification of Patients with Early Cognitive Impairment: Results of the MOPEAD Study in Spain. J Clin Med 2020; 9:jcm9092726. [PMID: 32847012 PMCID: PMC7565958 DOI: 10.3390/jcm9092726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction: Although the Diabetes Specific Dementia Risk Score (DSDRS) was proposed for predicting risk of dementia at 10 years, its usefulness as a screening tool is unknown. For this purpose, the European consortium MOPEAD included the DSDRS within the specific strategy for screening of cognitive impairment in type 2 diabetes (T2D) patients attended in a third-level hospital. Material and Methods: T2D patients > 65 years, without known cognitive impairment, attended in a third-level hospital, were evaluated. As per MOPEAD protocol, patients with MMSE ≤ 27 or DSDRS ≥ 7 were referred to the memory clinic for complete neuropsychological assessment. Results: 112 T2D patients were recruited. A total of 82 fulfilled the criteria for referral to the memory unit (43 of them declined referral: 48.8% for associated comorbidities, 37.2% lack of interest, 13.95% lack of social support). At the Fundació ACE’s Memory Clinic, 34 cases (87.2%) of mild cognitive impairment (MCI) and 3 cases (7.7%) of dementia were diagnosed. The predictive value of DSDRS ≥ 7 as a screening tool of cognitive impairment was AUROC = 0.739, p 0.024, CI 95% (0.609–0.825). Conclusions: We found a high prevalence of unknown cognitive impairment in TD2 patients who attended a third-level hospital. The DSDRS was found to be a useful screening tool. The presence of associated comorbidities was the main factor of declining referral.
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Affiliation(s)
- Angel Michael Ortiz Zuñiga
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain; (A.M.O.Z.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Rafael Simó
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain; (A.M.O.Z.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.S.); (M.B.); (A.C.)
| | - Octavio Rodriguez-Gómez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, 08028 Barcelona, Spain; (O.R.-G.); (M.A.)
| | - Cristina Hernández
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain; (A.M.O.Z.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Adrian Rodrigo
- GMV Soluciones Globales Internet SAU, 28760 Valencia, Spain; (A.R.); (L.J.)
| | - Laura Jamilis
- GMV Soluciones Globales Internet SAU, 28760 Valencia, Spain; (A.R.); (L.J.)
| | - Laura Campo
- International Corporate Affairs, Alzheimer’s Disease, Eli Lilly and Co., 50019 Firenze, Italy;
| | - Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, 08028 Barcelona, Spain; (O.R.-G.); (M.A.)
| | - Merce Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, 08028 Barcelona, Spain; (O.R.-G.); (M.A.)
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.S.); (M.B.); (A.C.)
| | - Andreea Ciudin
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain; (A.M.O.Z.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.S.); (M.B.); (A.C.)
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