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Hinton L. Commentary: Illuminating the Role of Non-English Language Preference in Healthcare Disparities for Older Adults With Cognitive Impairment. Am J Geriatr Psychiatry 2024; 32:790-791. [PMID: 38580550 DOI: 10.1016/j.jagp.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral Sciences (LH), University of California, Davis, Sacramento, CA.
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de Sola-Smith K, Gilissen J, van der Steen JT, Mayan I, Van den Block L, Ritchie CS, Hunt LJ. Palliative Care in Early Dementia: A Scoping Review. J Pain Symptom Manage 2024:S0885-3924(24)00798-X. [PMID: 38848792 DOI: 10.1016/j.jpainsymman.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/14/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Palliative care is recommended for all people with dementia from diagnosis through end-of-life. However, palliative care needs and effective elements of palliative care are not well-defined for the earlier stages of dementia. OBJECTIVE To systematically map current research on palliative care early in the disease trajectory of dementia. DESIGN Scoping review of scientific literature. DATA SOURCES PubMed, CINAHL, EMBASE, Cochrane, PsycINFO, Web of Science REVIEW METHODS: We included studies published in English over the last decade (through March 2022) that focused on palliative care in early stages of dementia and targeted outcomes in palliative care domains. Two authors independently screened abstracts and full texts and scored the quality of included studies using tools by the Joanna Briggs Institute. RESULTS Among the 77 papers reviewed, few addressed early stages of dementia specifically. We found that: 1) While "early" palliative care was not well-defined in the literature, evidence indicated that palliative care needs were present at or before diagnosis and across the trajectory. Notable opportunities for palliative care arise at 'tipping points' (i.e., when symptoms, functional status, or caregiving needs change). 2) Palliative care needs in early dementia include advocacy for goal-aligned care in the future, reassurance against the threat of negligence and abandonment by caregivers, planning for future scenarios of care (practical, individual, and relational needs), and establishing of long-term relationships with providers entrusted for care later in disease. 3) Elements of effective palliative care in early dementia could include dementia-specific ACP and goals of care discussions, navigation for building a network of support, provision of tools and resources for family, tailored care and knowledge of the person, and well-prepared dementia-care providers. The scarcity of palliative care studies aimed at early disease indicates a gap in the evidence in dementia care. CONCLUSION The literature on palliative care in early dementia is sparse. Future studies should focus on assessment tools for optimizing timing of palliative care in early dementia, gaining better understanding of patient and family needs during early phases of disease, and providing training for providers and families in long-term relationships and communication around goals of care and future planning.
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Affiliation(s)
- Karen de Sola-Smith
- VA Quality Scholar Nurse Practitioner Fellow, San Francisco Veterans Affairs Medical Center; Department of Physiological Nursing, University of California San Francisco, CA, United States.
| | - Joni Gilissen
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States; End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Department of Public Health and Primary Care, Universiteit Gent, Brussels, Belgium
| | - Jenny T van der Steen
- Department of Primary and Community Care and radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, the Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Inbal Mayan
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States
| | - Lieve Van den Block
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Department of Public Health and Primary Care, Universiteit Gent, Brussels, Belgium
| | - Christine S Ritchie
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States; Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness (CASI), Massachusetts General Hospital (MGH), Boston, MA, United States; Harvard Medical School, Harvard University, Boston, MA, United States
| | - Lauren J Hunt
- Global Brain Health Institute (GBHI), University of California San Francisco, CA, United States; Department of Physiological Nursing, University of California San Francisco, CA, United States; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, United States
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Womack CL, Perkins A, Arnold JM. Cognitive Impairment in the Primary Care Clinic. Prim Care 2024; 51:233-251. [PMID: 38692772 DOI: 10.1016/j.pop.2024.02.010] [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: 05/03/2024]
Abstract
Cognitive impairment is a common problem in the geriatric population and is characterized by variable symptoms of memory difficulties, executive dysfunction, language or visuospatial problems, and behavioral changes. It is imperative that primary care clinicians recognize and differentiate the variable symptoms associated with cognitive impairment from changes attributable to normal aging or secondary to other medical conditions. A thorough evaluation for potentially reversible causes of dementia is required before diagnosis with a neurodegenerative dementia. Other abnormal neurologic findings, rapid progression, or early age of onset are red flags that merit referral to neurology for more specialized evaluation and treatment.
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Affiliation(s)
- Cindy L Womack
- Department of Neurology, Neuroscience Institute, Southern Illinois University School of Medicine, 751 North Rutledge Street, PO 19643, Springfield, IL 62794, USA
| | - Andrea Perkins
- Department of Neurology, Neuroscience Institute, Southern Illinois University School of Medicine, 751 North Rutledge Street, PO 19643, Springfield, IL 62794, USA
| | - Jennifer M Arnold
- Department of Neurology, Neuroscience Institute, Southern Illinois University School of Medicine, 751 North Rutledge Street, PO 19643, Springfield, IL 62794, USA.
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Ilyas K, Iqbal H, Akash MSH, Rehman K, Hussain A. Heavy metal exposure and metabolomics analysis: an emerging frontier in environmental health. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:37963-37987. [PMID: 38780845 DOI: 10.1007/s11356-024-33735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Exposure to heavy metals in various populations can lead to extensive damage to different organs, as these metals infiltrate and bioaccumulate in the human body, causing metabolic disruptions in various organs. To comprehensively understand the metal homeostasis, inter-organ "traffic," and extensive metabolic alterations resulting from heavy metal exposure, employing complementary analytical methods is crucial. Metabolomics is pivotal in unraveling the intricacies of disease vulnerability by furnishing thorough understandings of metabolic changes linked to different metabolic diseases. This field offers exciting prospects for enhancing the disease prevention, early detection, and tailoring treatment approaches to individual needs. This article consolidates the existing knowledge on disease-linked metabolic pathways affected by the exposure of diverse heavy metals providing concise overview of the underlying impact mechanisms. The main aim is to investigate the connection between the altered metabolic pathways and long-term complex health conditions induced by heavy metals such as diabetes mellitus, cardiovascular diseases, renal disorders, inflammation, neurodegenerative diseases, reproductive risks, and organ damage. Further exploration of common pathways may unveil the shared targets for treating associated pathological conditions. In this article, the role of metabolomics in disease susceptibility is emphasized that metabolomics is expected to be routinely utilized for the diagnosis and monitoring of diseases and practical value of biomarkers derived from metabolomics, as well as determining their appropriate integration into extensive clinical settings.
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Affiliation(s)
- Kainat Ilyas
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | - Hajra Iqbal
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | | | - Kanwal Rehman
- Department of Pharmacy, The Women University, Multan, Pakistan
| | - Amjad Hussain
- Institute of Chemistry, University of Okara, Okara, Pakistan
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Yuan Z, Li X, Hao Z, Tang Z, Yao X, Wu T. Intelligent prediction of Alzheimer's disease via improved multifeature squeeze-and-excitation-dilated residual network. Sci Rep 2024; 14:11994. [PMID: 38796518 PMCID: PMC11127948 DOI: 10.1038/s41598-024-62712-w] [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: 12/20/2023] [Accepted: 05/21/2024] [Indexed: 05/28/2024] Open
Abstract
This study aimed to address the issue of larger prediction errors existing in intelligent predictive tasks related to Alzheimer's disease (AD). A cohort of 487 enrolled participants was categorized into three groups: normal control (138 individuals), mild cognitive impairment (238 patients), and AD (111 patients) in this study. An improved multifeature squeeze-and-excitation-dilated residual network (MFSE-DRN) was proposed for two important AD predictions: clinical scores and conversion probability. The model was characterized as three modules: squeeze-and-excitation-dilated residual block (SE-DRB), multifusion pooling (MF-Pool), and multimodal feature fusion. To assess its performance, the proposed model was compared with two other novel models: ranking convolutional neural network (RCNN) and 3D vision geometrical group network (3D-VGGNet). Our method showed the best performance in the two AD predicted tasks. For the clinical scores prediction, the root-mean-square errors (RMSEs) and mean absolute errors (MAEs) of mini-mental state examination (MMSE) and AD assessment scale-cognitive 11-item (ADAS-11) were 1.97, 1.46 and 4.20, 3.19 within 6 months; 2.48, 1.69 and 4.81, 3.44 within 12 months; 2.67, 1.86 and 5.81, 3.83 within 24 months; 3.02, 2.03 and 5.09, 3.43 within 36 months, respectively. At the AD conversion probability prediction, the prediction accuracies within 12, 24, and 36 months reached to 88.0, 85.5, and 88.4%, respectively. The AD predication would play a great role in clinical applications.
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Affiliation(s)
- Zengbei Yuan
- College of Medical Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Xinlin Li
- College of Medical Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Zezhou Hao
- College of Medical Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Zhixian Tang
- College of Medical Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Xufeng Yao
- College of Medical Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
| | - Tao Wu
- College of Medical Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [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: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Pereira ML, Caramelli P, Sá VMD, Rocha PHM, Oliveira JPGD, Amorim RPD, Silva EVD, Delboni VS, Barbosa MT, Miranda LFJRD, de Souza LC. Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38849124 DOI: 10.1055/s-0044-1787138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. OBJECTIVE To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. METHODS Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire. RESULTS The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status. CONCLUSION Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.
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Affiliation(s)
- Marcos Leandro Pereira
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Khronus Saúde e Educação Ltda, Instituto Khronus de Desenvolvimento Humano, Patos de Minas MG, Brazil
- Centro Universitário de Patos de Minas, Curso de Medicina, Patos de Minas MG, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Vannessa Marinara de Sá
- Khronus Saúde e Educação Ltda, Instituto Khronus de Desenvolvimento Humano, Patos de Minas MG, Brazil
| | | | | | | | - Elvis Vieira da Silva
- Centro Universitário de Patos de Minas, Curso de Medicina, Patos de Minas MG, Brazil
| | | | - Maira Tonidandel Barbosa
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | | | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
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8
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Korte JA, Weakley A, Donjuan Fernandez K, Joiner WM, Fan AP. Neural Underpinnings of Learning in Dementia Populations: A Review of Motor Learning Studies Combined with Neuroimaging. J Cogn Neurosci 2024; 36:734-755. [PMID: 38285732 DOI: 10.1162/jocn_a_02116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
The intent of this review article is to serve as an overview of current research regarding the neural characteristics of motor learning in Alzheimer disease (AD) as well as prodromal phases of AD: at-risk populations, and mild cognitive impairment. This review seeks to provide a cognitive framework to compare various motor tasks. We will highlight the neural characteristics related to cognitive domains that, through imaging, display functional or structural changes because of AD progression. In turn, this motivates the use of motor learning paradigms as possible screening techniques for AD and will build upon our current understanding of learning abilities in AD populations.
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Hillerstrom H, Fisher R, Janicki MP, Chicoine B, Christian BT, Esbensen A, Esralew L, Fortea J, Hartley S, Hassenstab J, Keller SM, Krinsky‐McHale S, Lai F, Levin J, McCarron M, McDade E, Rebillat AS, Rosas HD, Silverman W, Strydom A, Zaman SH, Zetterberg H. Adapting prescribing criteria for amyloid-targeted antibodies for adults with Down syndrome. Alzheimers Dement 2024; 20:3649-3656. [PMID: 38480678 PMCID: PMC11095423 DOI: 10.1002/alz.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 05/16/2024]
Abstract
Prior authorization criteria for Federal Drug Administration (FDA) approved immunotherapeutics, among the class of anti-amyloid monoclonal antibodies (mAbs), established by state drug formulary committees, are tailored for adults with late-onset Alzheimer's disease. This overlooks adults with Down syndrome (DS), who often experience dementia at a younger age and with different diagnostic assessment outcomes. This exclusion may deny DS adults access to potential disease-modifying treatments. To address this issue, an international expert panel convened to establish adaptations of prescribing criteria suitable for DS patients and parameters for access to Centers for Medicare & Medicaid Services (CMS) registries. The panel proposed mitigating disparities by modifying CMS and payer criteria to account for younger onset age, using alternative language and assessment instruments validated for cognitive decline in the DS population. The panel also recommended enhancing prescribing clinicians' diagnostic capabilities for DS and initiated awareness-raising activities within healthcare organizations. These efforts facilitated discussions with federal officials, aimed at achieving equity in access to anti-amyloid immunotherapeutics, with implications for national authorities worldwide evaluating these and other new disease-modifying therapeutics for Alzheimer's disease.
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Affiliation(s)
| | | | - Matthew P. Janicki
- Department of Disability and Human DevelopmentUniversity of Illinois ChicagoChicagoIllinoisUSA
- National Task Group on Intellectual Disabilities and Dementia PracticesRockportMaineUSA
| | - Brian Chicoine
- Advocate Health, Advocate Medical Group Adult Down Syndrome CenterAdvocate Lutheran General Hospital Family Medicine ResidencyPark RidgeIllinoisUSA
| | | | - Anna Esbensen
- Division of Developmental and Behavioral PediatricsCincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnati Children's HospitalCincinnatiOhioUSA
| | - Lucille Esralew
- California Department of Developmental ServicesSacramentoCaliforniaUSA
| | - Juan Fortea
- Biomedical Research Institute Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of NeurologyHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Sigan Hartley
- Waisman Center IDDRCUniversity of WisconsinMadisonWisconsinUSA
| | - Jason Hassenstab
- Departments of Neurology and Psychological & Brain SciencesKnight Alzheimer Disease Research CenterWashington UniversitySt. LouisMissouriUSA
| | - Seth M. Keller
- National Task Group on Intellectual Disabilities and Dementia PracticesRockportMaineUSA
- Neurology Associates of South JerseyLumbertonNew JerseyUSA
| | - Sharon Krinsky‐McHale
- Department of PsychologyNew York State Institute for Basic Research in Developmental DisabilitiesIslandNew YorkUSA
| | - Florence Lai
- MGH Neurology ResearchMass General Brigham HospitalMassachusetts General HospitalBostonMassachusettsUSA
| | - Johannes Levin
- Department of Neurology & German Center of Neurodegenerative Diseases (DZNE) e.V.Ludwig‐Maximilians UniversityMunichGermany
- Department of NeurologySahgrenska University HospitalMölndalSweden
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual DisabilityTrinity College, University of DublinDublinIreland
| | - Eric McDade
- Departments of Neurology and Psychological & Brain SciencesKnight Alzheimer Disease Research CenterWashington UniversitySt. LouisMissouriUSA
| | | | - Herminia Diana Rosas
- MGH Neurology ResearchMass General Brigham HospitalMassachusetts General HospitalBostonMassachusettsUSA
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Wayne Silverman
- Department of PediatricsUniversity of California IrvineIrvineCaliforniaUSA
| | - Andre Strydom
- Institute of PsychiatryPsychology and Neuroscience, Kings CollegeLondonUK
| | - Shahid H. Zaman
- Department of PsychiatryCambridge Intellectual and Developmental Disabilities Research GroupCambridge UniversityCambridgeUK
| | - Henrik Zetterberg
- Institute for Stroke and Dementia ResearchSahlgrenska Academy at the University of GothenburgMolndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMolndalSweden
- Munich Cluster for Systems Neurology (SyNergy)MunichGermany
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Rühl J, Brinkmann ST, Schaufler D, Gräßel E, Walker BB, Kolominsky-Rabas P. [Travel time to memory clinics in Bavaria: A geographical analyses within the framework of digiDEM Bayern]. DAS GESUNDHEITSWESEN 2024; 86:263-273. [PMID: 38579731 PMCID: PMC11003252 DOI: 10.1055/a-2233-6168] [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: 04/07/2024]
Abstract
BACKGROUND Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria. METHODS We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data. RESULTS The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas. CONCLUSION In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.
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Affiliation(s)
- Jana Rühl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisziplinäres
Zentrum für Health Technology Assessment (HTA) und Public Health (IZPH),
Erlangen, Germany
| | - Sebastian T. Brinkmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Dominik Schaufler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Elmar Gräßel
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische und
Psychotherapeutische Klinik, Universitätsklinikum Erlangen,
Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen,
Germany
| | - Blake Byron Walker
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für
Geographie, Erlangen, Germany
| | - Peter Kolominsky-Rabas
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisziplinäres
Zentrum für Health Technology Assessment (HTA) und Public Health (IZPH),
Erlangen, Germany
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Wahlberg K, Winblad B, Cole A, Herring WL, Ramsberg J, Torontali I, Visser PJ, Wimo A, Wollaert L, Jönsson L. People get ready! A new generation of Alzheimer's therapies may require new ways to deliver and pay for healthcare. J Intern Med 2024; 295:281-291. [PMID: 38098165 DOI: 10.1111/joim.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The development of disease-modifying therapies (DMTs) for Alzheimer's disease (AD) has progressed over the last decade, and the first-ever therapies with potential to slow the progression of disease are approved in the United States. AD DMTs could provide life-changing opportunities for people living with this disease, as well as for their caregivers. They could also ease some of the immense societal and economic burden of dementia. However, AD DMTs also come with major challenges due to the large unmet medical need, high prevalence of AD, new costs related to diagnosis, treatment and monitoring, and uncertainty in the therapies' actual clinical value. This perspective article discusses, from the broad perspective of various health systems and stakeholders, how we can overcome these challenges and improve society's readiness for AD DMTs. We propose that innovative payment models such as performance-based payments, in combination with learning healthcare systems, could be the way forward to enable timely patient access to treatments, improve accuracy of cost-effectiveness evaluations and overcome budgetary barriers. Other important considerations include the need for identification of key drivers of patient value, the relevance of different economic perspectives (i.e. healthcare vs. societal) and ethical questions in terms of treatment eligibility criteria.
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Affiliation(s)
- Karin Wahlberg
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | | | - William L Herring
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | | | | | - Pieter-Jelle Visser
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Psychiatry, Maastricht University, Maastricht, The Netherlands
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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Knopman DS. For a dementia diagnosis, clinical acumen must precede biomarkers. Lancet Neurol 2024; 23:225-226. [PMID: 38365363 DOI: 10.1016/s1474-4422(24)00021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/18/2024]
Affiliation(s)
- David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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13
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Chen M, Feng X, Liu J, Wang J, Yang X, Yu X, Kong W, Sun B, Wu H. Prokaryote-derived phosphorylated Tau epitope vaccine is immunogenic and non-T-cell activated in the mice model. Vaccine 2024; 42:1211-1219. [PMID: 38331660 DOI: 10.1016/j.vaccine.2023.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
Accumulation of phosphorylated Tau protein is a prominent pathological hallmark of Alzheimer's disease (AD). However, current vaccines targeting phosphorylation sites are primarily modified using chemical reactions, which exhibit low efficiency in terms of linking to the vaccine carrier. Despite the identification of over 2000 phosphorylation sites on approximately 20% of E. coli proteins through proteomic studies, it remains unclear whether recombinant Tau proteins expressed in bacteria undergo direct phosphorylation. Additionally, limited information is available regarding the immunogenicity and safety profiles of prokaryotic-derived pTau epitope vaccines. Our study discovered that the prokaryotic system can induce phosphorylation on four residues (T181, T205, S262, and S396) of the full-length Tau protein. Based on this finding, we developed a prokaryotic-modified phosphorylated Tau protein vaccine and immunized wild-type mice, resulting in enhanced immunogenicity and a favorable safety profile.
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Affiliation(s)
- Mo Chen
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China
| | - Xuejian Feng
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China
| | - Jiaxin Liu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China
| | - Jianan Wang
- Changchun BCHT Biotechnology, 1260 Huoju Road, Changchun High-tech Zone, Changchun, Jilin, China
| | - Xu Yang
- Chemistry Room, Jilin Institute for Drug Control, No. 657, Zhanjiang Road, Changchun, Jilin, China
| | - Xianghui Yu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China; Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, China
| | - Wei Kong
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China; Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, China
| | - Bo Sun
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China; Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, China.
| | - Hui Wu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun 130012, China; Key Laboratory for Molecular Enzymology and Engineering, The Ministry of Education, School of Life Sciences, Jilin University, Changchun 130012, China.
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14
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Saffari SE, Soo SA, Mohammadi R, Ng KP, Greene W, Kandiah N. Modelling the Distribution of Cognitive Outcomes for Early-Stage Neurocognitive Disorders: A Model Comparison Approach. Biomedicines 2024; 12:393. [PMID: 38397995 PMCID: PMC10886528 DOI: 10.3390/biomedicines12020393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Cognitive assessments for patients with neurocognitive disorders are mostly measured by the Montreal Cognitive Assessment (MoCA) and Visual Cognitive Assessment Test (VCAT) as screening tools. These cognitive scores are usually left-skewed and the results of the association analysis might not be robust. This study aims to study the distribution of the cognitive outcomes and to discuss potential solutions. Materials and Methods: In this retrospective cohort study of individuals with subjective cognitive decline or mild cognitive impairment, the inverse-transformed cognitive outcomes are modelled using different statistical distributions. The robustness of the proposed models are checked under different scenarios: with intercept-only, models with covariates, and with and without bootstrapping. Results: The main results were based on the VCAT score and validated via the MoCA score. The findings suggested that the inverse transformation method improved the modelling the cognitive scores compared to the conventional methods using the original cognitive scores. The association of the baseline characteristics (age, gender, and years of education) and the cognitive outcomes were reported as estimates and 95% confidence intervals. Bootstrap methods improved the estimate precision and the bootstrapped standard errors of the estimates were more robust. Cognitive outcomes were widely analysed using linear regression models with the default normal distribution as a conventional method. We compared the results of our suggested models with the normal distribution under various scenarios. Goodness-of-fit measurements were compared between the proposed models and conventional methods. Conclusions: The findings support the use of the inverse transformation method to model the cognitive outcomes instead of the original cognitive scores for early-stage neurocognitive disorders where the cognitive outcomes are left-skewed.
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Affiliation(s)
- Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore;
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore;
| | - See Ann Soo
- Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (S.A.S.); (N.K.)
| | - Raziyeh Mohammadi
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore;
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore;
- Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| | - William Greene
- Stern School of Business (Emeritus), New York University, New York, NY 10012, USA;
| | - Negaenderan Kandiah
- Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (S.A.S.); (N.K.)
- Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
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15
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Young SR, Dworak EM, Byrne GJ, Jones CM, Yao L, Yoshino Benavente JN, Diaz MV, Curtis L, Gershon R, Wolf M, Nowinski CJ. Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App. JMIR Form Res 2024; 8:e54299. [PMID: 38324368 PMCID: PMC10882476 DOI: 10.2196/54299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians' ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics' time, encourage broader screening practices, and increase early detection of cognitive decline. OBJECTIVE The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? METHODS A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. RESULTS All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants' rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants' abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. CONCLUSIONS Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia.
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Affiliation(s)
- Stephanie Ruth Young
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Elizabeth McManus Dworak
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Greg Joseph Byrne
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Callie Madison Jones
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lihua Yao
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Julia Noelani Yoshino Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maria Varela Diaz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Laura Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Richard Gershon
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cindy J Nowinski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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16
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Scott IA. Monoclonal antibodies for treating early Alzheimer disease-a commentary on recent 'positive' trials. Age Ageing 2024; 53:afae023. [PMID: 38411409 DOI: 10.1093/ageing/afae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 12/30/2023] [Indexed: 02/28/2024] Open
Abstract
Recent phase 3 randomised controlled trials of amyloid-targeting monoclonal antibodies in people with pre-clinical or early Alzheimer disease have reported positive results, raising hope of finally having disease-modifying drugs. Given their far-reaching implications for clinical practice, the methods and findings of these trials, and the disease causation theory underpinning the mechanism of drug action, need to be critically appraised. Key considerations are the representativeness of trial populations; balance of prognostic factors at baseline; psychometric properties and minimal clinically important differences of the primary efficacy outcome measures; level of study fidelity; consistency of subgroup analyses; replication of findings in similar trials; sponsor role and potential conflicts of interest; consistency of results with disease causation theory; cost and resource estimates; and alternative prevention and treatment strategies. In this commentary, we show shortcomings in each of these areas and conclude that monoclonal antibody treatment for early Alzheimer disease is lacking high-quality evidence of clinically meaningful impacts at an affordable cost.
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Affiliation(s)
- Ian A Scott
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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17
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Oxbøll AB, Jørgensen K, Nielsen TR, Christiansen SD, Nielsen A, Waldorff FB, Waldemar G. Diagnostic accuracy of BASIC-Q for detection of cognitive impairment in a primary care setting - a cross-validation study. BMC Geriatr 2024; 24:53. [PMID: 38212693 PMCID: PMC10785536 DOI: 10.1186/s12877-024-04675-1] [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: 09/19/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES This study aims to evaluate the diagnostic accuracy and reliability of a new, brief questionnaire, 'Brief Assessment of Impaired Cognition- Questionnaire' (BASIC-Q) for detection of cognitive impairment, primarily developed for use in primary care. BASIC-Q has three components: Self-report, Informant report, and Orientation. Self-report and Orientation are completed by the individual and Informant report is answered by a close relative. METHODS We included 275 participants ≥ 70 years, without a prior diagnosis of dementia, and with a close relative who agreed to participate as an informant. Participants were included prospectively in 14 general practices in urban and rural Denmark using a convenience sampling method. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the informant-completed Functional Activities Questionnaire (FAQ) and reported memory concern were used as a reference standard for the classification of the participants' cognitive function. RESULTS BASIC-Q demonstrated a fair to good diagnostic accuracy to differentiate between people with cognitive impairment and normal cognition with an area under the ROC curve (AUC) of 0.84 (95% CI 0.79-0.89) and a sensitivity and specificity of 0.80 (95% CI 0.72-0.87) and 0.71 (95% CI 0.63-0.78). A prorated BASIC-Q score derived from BASIC-Q without Informant report had significantly lower classification accuracy than the full BASIC-Q. The test-retest reliability of BASIC-Q was good with an intraclass correlation coefficient of 0.84. CONCLUSION BASIC-Q is a brief, easy-to-use questionnaire for identification of cognitive impairment in older adults. It demonstrated fair to good classification accuracy in a general practice setting and can be a useful case-finding tool when suspecting dementia in primary health care.
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Affiliation(s)
- Anne-Britt Oxbøll
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark.
| | - Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Sofie D Christiansen
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Frans B Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Chen Y, Su Y, Wu J, Chen K, Atri A, Caselli RJ, Reiman EM, Wang Y. Combining Blood-Based Biomarkers and Structural MRI Measurements to Distinguish Persons with and without Significant Amyloid Plaques. J Alzheimers Dis 2024; 98:1415-1426. [PMID: 38578889 DOI: 10.3233/jad-231162] [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: 04/07/2024]
Abstract
Background Amyloid-β (Aβ) plaques play a pivotal role in Alzheimer's disease. The current positron emission tomography (PET) is expensive and limited in availability. In contrast, blood-based biomarkers (BBBMs) show potential for characterizing Aβ plaques more affordably. We have previously proposed an MRI-based hippocampal morphometry measure to be an indicator of Aβ plaques. Objective To develop and validate an integrated model to predict brain amyloid PET positivity combining MRI feature and plasma Aβ42/40 ratio. Methods We extracted hippocampal multivariate morphometry statistics from MR images and together with plasma Aβ42/40 trained a random forest classifier to perform a binary classification of participant brain amyloid PET positivity. We evaluated the model performance using two distinct cohorts, one from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the other from the Banner Alzheimer's Institute (BAI), including prediction accuracy, precision, recall rate, F1 score, and AUC score. Results Results from ADNI (mean age 72.6, Aβ+ rate 49.5%) and BAI (mean age 66.2, Aβ+ rate 36.9%) datasets revealed the integrated multimodal (IMM) model's superior performance over unimodal models. The IMM model achieved prediction accuracies of 0.86 in ADNI and 0.92 in BAI, surpassing unimodal models based solely on structural MRI (0.81 and 0.87) or plasma Aβ42/40 (0.73 and 0.81) predictors. CONCLUSIONS Our IMM model, combining MRI and BBBM data, offers a highly accurate approach to predict brain amyloid PET positivity. This innovative multiplex biomarker strategy presents an accessible and cost-effective avenue for advancing Alzheimer's disease diagnostics, leveraging diverse pathologic features related to Aβ plaques and structural MRI.
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Affiliation(s)
- Yanxi Chen
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
| | - Yi Su
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Jianfeng Wu
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
| | - Kewei Chen
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Alireza Atri
- Banner Alzheimer's Institute, Phoenix, AZ, USA
- Banner Sun Health Research Institute, Sun City, AZ, USA
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Yalin Wang
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, USA
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19
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Ahn S, Cobb SJ, Crouter SE, Lee CE, Crane MK, Anderson JG. Physical activity together for couples living with mild cognitive impairment (PAT-MCI): A feasibility study. Geriatr Nurs 2024; 55:221-228. [PMID: 38035459 DOI: 10.1016/j.gerinurse.2023.11.011] [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: 08/21/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
Mild cognitive impairment is a prodromal phase of Alzheimer's disease and related dementias. Cognitive and/or neuropsychiatric symptoms that could worsen over time cause challenges for patients and romantic partners, who often assume the role of informal caregivers. Although physical activity is beneficial, older adults with mild cognitive impairment and their romantic care partners are generally physically inactive. Our 16-week study was performed to see whether physical activity together is feasible to increase physical activity among four dyads (individuals with mild cognitive impairment and their spouses). Our dyadic intervention was feasible given more than 70 % of participants self-reported adherence to physical activity based on the guidelines for adults in the United States. In exit interviews, togetherness was highlighted as one of the biggest strengths of this study. Future studies with more representative samples are needed, as well as adopting a more tailored approach that accounts for individuals' levels of physical fitness.
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Affiliation(s)
- Sangwoo Ahn
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States.
| | - Sandra J Cobb
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, Tennessee, United States
| | - Chung Eun Lee
- Paul H. Chook Department of Information Systems and Statistics, Baruch College, New York, New York, United States
| | - Monica K Crane
- Genesis Neuroscience Clinic, Knoxville, Tennessee, United States
| | - Joel G Anderson
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States
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20
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Diaz-Asper C, Chandler C, Elvevåg B. Cognitive Screening for Mild Cognitive Impairment: Clinician Perspectives on Current Practices and Future Directions. J Alzheimers Dis 2024; 99:869-876. [PMID: 38728193 DOI: 10.3233/jad-240293] [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: 05/12/2024]
Abstract
This study surveyed 51 specialist clinicians for their views on existing cognitive screening tests for mild cognitive impairment and their opinions about a hypothetical remote screener driven by artificial intelligence (AI). Responses revealed significant concerns regarding the sensitivity, specificity, and time taken to administer current tests, along with a general willingness to consider adopting telephone-based screening driven by AI. Findings highlight the need to design screeners that address the challenges of recognizing the earliest stages of cognitive decline and that prioritize not only accuracy but also stakeholder input.
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Affiliation(s)
- Catherine Diaz-Asper
- Department of Psychology & Center for Optimal Aging, Marymount University, Arlington, VA, USA
| | - Chelsea Chandler
- Institute of Cognitive Science, University of Colorado, Boulder, CO, USA
| | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø-the Arctic University of Norway, Tromsø-, Norway
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21
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Bergman H, Borson S, Jessen F, Krolak-Salmon P, Pirani A, Rasmussen J, Rodrigo J, Taddeo D. Dementia and comorbidities in primary care: a scoping review. BMC PRIMARY CARE 2023; 24:277. [PMID: 38097969 PMCID: PMC10720181 DOI: 10.1186/s12875-023-02229-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND People with dementia (PwD) are known to have more chronic conditions compared to those without dementia, which can impact the clinical presentation of dementia, complicate clinical management and reduce overall quality of life. While primary care providers (PCPs) are integral to dementia care, it is currently unclear how PCPs adapt dementia care practices to account for comorbidities. This scoping review maps recent literature that describes the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities, identifies critical knowledge gaps and proposes potential avenues for future research. METHODS We searched for peer-reviewed literature published between 2017-2022 in MEDLINE, Cochrane Library, and Scopus using key terms related to dementia, primary care, and comorbidity. The literature was screened for relevance by title-abstract screening and subsequent full-text screening. The prioritized papers were categorized as either 'Risk Assessment and Prevention', 'Screening, Detection, and Diagnosis' or 'Management' and were further labelled as either 'Tools and Technologies', 'Recommendations for Clinical Practice' or 'Programs and Initiatives'. RESULTS We identified 1,058 unique records in our search and respectively excluded 800 and 230 publications during title-abstract and full-text screening. Twenty-eight articles were included in our review, where ~ 50% describe the development and testing of tools and technologies that use pre-existing conditions to assess dementia risk. Only one publication provides official dementia screening guidelines for PCPs in people with pre-existing conditions. About 30% of the articles discuss managing the care of PwD, where most were anchored around models of multidisciplinary care and mitigating potentially inappropriate prescribing. CONCLUSION To our knowledge, this is the first scoping review that examines the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities. Given our findings, we recommend that future studies: 1) further validate tools for risk assessment, timely detection and diagnosis that incorporate other health conditions; 2) provide additional guidance into how comorbidities could impact dementia care (including prescribing medication) in primary care settings; 3) incorporate comorbidities into primary care quality indicators for dementia; and 4) explore how to best incorporate dementia and comorbidities into models/frameworks of holistic, person-centred care.
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Affiliation(s)
- Howard Bergman
- Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada.
| | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | | | | | | | - Jesus Rodrigo
- Spanish Alzheimer's Confederation (Confederación Española de Alzheimer), Pamplona, Spain
| | - Daiana Taddeo
- Italian College of General Practitioners and Primary Care (SIMG - Società Italiana Di Medicina Genrale E Cure Primarie), Florence, Italy
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22
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Itkyal VS, Abrol A, LaGrow TJ, Fedorov A, Calhoun VD. Voxel-wise Fusion of Resting fMRI Networks and Gray Matter Volume for Alzheimer's Disease Classification using Deep Multimodal Learning. RESEARCH SQUARE 2023:rs.3.rs-3740218. [PMID: 38168287 PMCID: PMC10760243 DOI: 10.21203/rs.3.rs-3740218/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Alzheimer's disease (AD) is a prevalent neurodegenerative disorder requiring accurate and early diagnosis for effective treatment. Resting-state functional magnetic resonance imaging (rs-fMRI) and gray matter volume analysis from structural MRI have emerged as valuable tools for investigating AD-related brain alterations. However, the potential benefits of integrating these modalities using deep learning techniques remain unexplored. In this study, we propose a novel framework that fuses composite images of multiple rs-fMRI networks (called voxelwise intensity projection) and gray matter segmentation images through a deep learning approach for improved AD classification. We demonstrate the superiority of fMRI networks over commonly used metrics such as amplitude of low-frequency fluctuations (ALFF) and fractional ALFF in capturing spatial maps critical for AD classification. We use a multi-channel convolutional neural network incorporating the AlexNet dropout architecture to effectively model spatial and temporal dependencies in the integrated data. Extensive experiments on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset of AD patients and cognitively normal (CN) validate the efficacy of our approach, showcasing improved classification performance of 94.12% test accuracy and an area under the curve (AUC) score of 97.79 compared to existing methods. Our results show that the fusion results generally outperformed the unimodal results. The saliency visualizations also show significant differences in the hippocampus, amygdala, putamen, caudate nucleus, and regions of basal ganglia which are in line with the previous neurobiological literature. Our research offers a novel method to enhance our grasp of AD pathology. By integrating data from various functional networks with structural MRI insights, we significantly improve diagnostic accuracy. This accuracy is further boosted by the effective visualization of this combined information. This lays the groundwork for further studies focused on providing a more accurate and personalized approach to AD diagnosis. The proposed framework and insights gained from fMRI networks provide a promising avenue for future research in deep multimodal fusion and neuroimaging analysis.
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23
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Min S, Mohallem R, Aryal UK, Kinzer-Ursem TL, Rochet JC. Effects of Neighboring Phosphorylation Events on the Affinities of pT181-Tau Antibodies. Anal Chem 2023; 95:18241-18248. [PMID: 38014879 DOI: 10.1021/acs.analchem.3c04081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
A tau variant phosphorylated on threonine 181 (pT181-tau) has been widely investigated as a potential Alzheimer's disease (AD) biomarker in cerebrospinal fluid (CSF) and blood. pT181-tau is present in neurofibrillary tangles (NFTs) of AD brains, and CSF levels of pT181-tau correlate with the overall NFT burden. Various immunobased analytical methods, including Western blotting and ELISA, have been used to quantify pT181-tau in human biofluids. The reliability of these methods is dependent on the affinity and binding specificity of the antibodies used to measure pT181-tau levels. Although both of these properties could, in principle, be affected by phosphorylation within or near the antibody's cognate antigen, such effects have not been extensively studied. Here, we developed a biolayer interferometry assay to determine the degree to which the affinity of pT181-tau antibodies is altered by the phosphorylation of serine or threonine residues near the target epitope. Our results revealed that phosphorylation near T181 negatively affected the binding of pT181-tau antibodies to their cognate antigen to varying degrees. In particular, two of three antibodies tested showed a complete loss of affinity for the pT181 target when S184 or S185 was phosphorylated. These findings highlight the importance of selecting antibodies that have been thoroughly characterized in terms of affinity and binding specificity, addressing the potential disruptive effects of post-translational modifications in the epitope region to ensure accurate biomarker quantitation.
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Affiliation(s)
- Sehong Min
- Borch Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana 47907, United States
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, Indiana 47907, United States
| | - Rodrigo Mohallem
- Purdue Proteomics Facility, Bindley Bioscience Center, Purdue University, West Lafayette, Indiana 47907, United States
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana 47907, United States
| | - Uma K Aryal
- Purdue Proteomics Facility, Bindley Bioscience Center, Purdue University, West Lafayette, Indiana 47907, United States
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, Indiana 47907, United States
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana 47907, United States
| | - Tamara L Kinzer-Ursem
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, Indiana 47907, United States
| | - Jean-Christophe Rochet
- Borch Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, Indiana 47907, United States
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, Indiana 47907, United States
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Ahn S, Chung JW, Crouter SE, Lee JA, Lee CE, Anderson JG. Gait and/or balance disturbances associated with Alzheimer's dementia among older adults with amnestic mild cognitive impairment: A longitudinal observational study. J Adv Nurs 2023; 79:4815-4827. [PMID: 37386779 PMCID: PMC10646827 DOI: 10.1111/jan.15768] [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: 05/26/2022] [Revised: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
AIMS To explore whether gait and/or balance disturbances are associated with the onset of Alzheimer's dementia (AD) among older adults with amnestic mild cognitive impairment (MCI). DESIGN This study employed a longitudinal retrospective cohort design. METHODS We obtained data from the National Alzheimer's Coordinating Center's Uniform Data Set collected from 35 National Institute on Aging Alzheimer's Disease Research Centers between September 2005 and December 2021. The mean age of participants (n = 2692) was 74.5 years with women making up 47.2% of the sample. Risk of incident AD according to baseline gait and/or balance disturbances as measured using the Postural Instability and Gait Disturbance Score, a subscale of the Unified Parkinson's Disease Rating Scale Motor Score, was examined by the Cox proportional hazards regression models adjusting for baseline demographics, medical conditions and study sites. The mean follow-up duration was 4.0 years. RESULTS Among all the participants, the presence or the severity of gait and/or balance disturbances was associated with an increased risk of AD. The presence or the severity of gait and/or balance disturbances was associated with a higher risk of Alzheimer's dementia among the subgroups of female and male participants. CONCLUSION Gait and/or balance disturbances may increase the risk of developing AD, regardless of sex. IMPACT Gait and/or balance disturbances among community-dwelling older adults with amnestic MCI may need to be frequently assessed by nurses to identify potential risk factors for cognitive decline. NO PATIENT OR PUBLIC CONTRIBUTION Given the secondary analysis, patients, service users, caregivers or members of the public were not directly involved in this study.
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Affiliation(s)
- Sangwoo Ahn
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Jae Woo Chung
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Scott E. Crouter
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, Tennessee, USA
| | - Jung-Ah Lee
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, California, USA
| | - Chung Eun Lee
- Paul H. Chook Department of Information Systems and Statistics, Baruch College, New York, New York, USA
| | - Joel G. Anderson
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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Waziry R, Williams OA. Alzheimer Disease: A Life-Limiting Disease With a Burden of a Terminal Illness. Neurol Clin Pract 2023; 13:e200208. [PMID: 37854176 PMCID: PMC10581074 DOI: 10.1212/cpj.0000000000200208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
Purpose of Review An estimated 6.5 million Americans live with Alzheimer dementia. Better understanding of advanced stages of Alzheimer disease (AD) and timely monitoring of its preventable complications would translate to improved survival and quality of life in this population. Recent Findings In this perspective review, we proposed shifting the narrative to recognizing AD as a chronic life-limiting illness instead of a terminal disease. In support of this view, we discussed the following: (1) the biochemical, cellular (preclinical), and clinical phases of AD; (2) survival after AD; (3) AD therapeutics and potential implications for the population with AD in the advanced stages. Summary On the bases of the prolonged preclinical phase in AD, promising advances in AD therapeutics and the varying survival after AD, we proposed a new classification for AD and more broadly neurodegenerative disorders to be recognized as chronic life-limiting illnesses rather than terminal diseases with important implications for patients with AD in the advanced stages given the challenges that are specific to this population.
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Affiliation(s)
- Reem Waziry
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, NY
| | - Olajide A Williams
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, NY
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26
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Borson S, Small GW, O'Brien Q, Morrello A, Boustani M. Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician. BMC PRIMARY CARE 2023; 24:233. [PMID: 37932666 PMCID: PMC10626639 DOI: 10.1186/s12875-023-02185-4] [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: 06/12/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Primary care clinicians (PCCs) are typically the first practitioners to detect cognitive impairment in their patients, including those with Alzheimer's disease or related dementias (ADRD). However, conversations around cognitive changes can be challenging for patients, family members, and clinicians to initiate, with all groups reporting barriers to open dialogue. With the expanding array of evidence-based interventions for ADRD, from multidomain care management to novel biotherapeutics for early-stage AD, incorporating conversations about brain health into routine healthcare should become a standard of care. We conducted a systematic review to identify barriers to and facilitators of brain health conversations in primary care settings. METHODS We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for qualitative or quantitative studies conducted in the US between January 2000 and October 2022 that evaluated perceptions of cognition and provider-patient brain health conversations prior to formal screening for, or diagnosis of, mild cognitive impairment or ADRD. We assessed the quality of the included studies using the Mixed Methods Appraisal Tool. RESULTS In total, 5547 unique abstracts were screened and 22 articles describing 19 studies were included. The studies explored perceptions of cognition among laypersons or clinicians, or provider-patient interactions in the context of a patient's cognitive concerns. We identified 4 main themes: (1) PCCs are hesitant to discuss brain health and cognitive concerns; (2) patients are hesitant to raise cognitive concerns; (3) evidence to guide clinicians in developing treatment plans that address cognitive decline is often poorly communicated; and (4) social and cultural context influence perceptions of brain health and cognition, and therefore affect clinical engagement. CONCLUSIONS Early conversations about brain health between PCCs and their patients are rare, and effective tools, processes, and strategies are needed to make these vital conversations routine.
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Affiliation(s)
- Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, 31 E. MacArthur Crescent B414, Santa Ana, Los Angeles, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Gary W Small
- Department of Psychiatry and Behavioral Health, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Quentin O'Brien
- Scientific and Medical Services, Health & Wellness Partners, LLC, Upper Saddle River, NJ, USA
- The School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Andrea Morrello
- Scientific and Medical Services, Health & Wellness Partners, LLC, Upper Saddle River, NJ, USA
| | - Malaz Boustani
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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27
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Ahuja M, Siddhpuria S, Karimi A, Lewis K, Wong E, Lee J, Reppas-Rindlisbacher C, Sood E, Gabor C, Patterson C. Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis. Age Ageing 2023; 52:afad205. [PMID: 37993407 DOI: 10.1093/ageing/afad205] [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: 05/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Cholinesterase inhibitors are commonly used to treat patients with neurocognitive disorders, who often have an elevated risk of falling. Effective use of these medications requires a thoughtful assessment of risks and benefits. OBJECTIVE To provide an update on previous reviews and determine the association between cholinesterase inhibitors and falls, syncope, fracture and accidental injuries in patients with neurocognitive disorders. METHODS Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and AgeLine were systematically searched through March 2023 to identify all randomised controlled trials of cholinesterase inhibitors (donepezil, galantamine, rivastigmine) in patients with cognitive impairment. Corresponding authors were contacted for additional data necessary for meta-analysis. Inclusion criteria consisted of adults ≥19 years, with a diagnosis of dementia, Parkinson's disease, mild cognitive impairment or traumatic brain injury. Data were extracted in duplicate for the aforementioned primary outcomes and all outcomes were analysed using random-effects meta-analysis. RESULTS Fifty three studies (30 donepezil, 14 galantamine, 9 rivastigmine) were included providing data on 25, 399 patients. Cholinesterase inhibitors, compared to placebo, were associated with reduced risk of falls (risk ratio [RR] 0.84 [95% confidence interval [CI] = 0.73-0.96, P = 0.009]) and increased risk of syncope (RR 1.50 [95% CI = 1.02-2.21, P = 0.04]). There was no association with accidental injuries or fractures. CONCLUSION In patients with neurocognitive disorders, cholinesterase inhibitors were associated with decreased risk of falls, increased risk of syncope and no association with accidental trauma or fractures. These findings will help clinicians better evaluate risks and benefits of cholinesterase inhibitors.
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Affiliation(s)
- Manan Ahuja
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shailee Siddhpuria
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arian Karimi
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Kaitlin Lewis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eric Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Justin Lee
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Emma Sood
- Faculty of Science, Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | | | - Christopher Patterson
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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28
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Gao H, Zhao S, Zheng G, Wang X, Zhao R, Pan Z, Li H, Lu F, Shen M. Using a dual-stream attention neural network to characterize mild cognitive impairment based on retinal images. Comput Biol Med 2023; 166:107411. [PMID: 37738896 DOI: 10.1016/j.compbiomed.2023.107411] [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: 05/09/2023] [Revised: 08/08/2023] [Accepted: 08/27/2023] [Indexed: 09/24/2023]
Abstract
Mild cognitive impairment (MCI) is a critical transitional stage between normal cognition and dementia, for which early detection is crucial for timely intervention. Retinal imaging has been shown as a promising potential biomarker for MCI. This study aimed to develop a dual-stream attention neural network to classify individuals with MCI based on multi-modal retinal images. Our approach incorporated a cross-modality fusion technique, a variable scale dense residual model, and a multi-classifier mechanism within the dual-stream network. The model utilized a residual module to extract image features and employed a multi-level feature aggregation method to capture complex context information. Self-attention and cross-attention modules were utilized at each convolutional layer to fuse features from optical coherence tomography (OCT) and fundus modalities, resulting in multiple output losses. The neural network was applied to classify individuals with MCI, Alzheimer's disease, and control participants with normal cognition. Through fine-tuning the pre-trained model, we classified community-dwelling participants into two groups based on cognitive impairment test scores. To identify retinal imaging biomarkers associated with accurate prediction, we used the Gradient-weighted Class Activation Mapping technique. The proposed method achieved high precision rates of 84.96% and 80.90% in classifying MCI and positive test scores for cognitive impairment, respectively. Notably, changes in the optic nerve head on fundus photographs or OCT images among patients with MCI were not used to discriminate patients from the control group. These findings demonstrate the potential of our approach in identifying individuals with MCI and emphasize the significance of retinal imaging for early detection of cognitive impairment.
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Affiliation(s)
- Hebei Gao
- School of Artificial Intelligence, Wenzhou Polytechnic, Wenzhou, 325035, China; Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Shuaiye Zhao
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, 325035, China
| | - Gu Zheng
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Xinmin Wang
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Runyi Zhao
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Zhigeng Pan
- School of Artificial Intelligence, Nanjing University of Information Science & Technology, Nanjing, 210044, China
| | - Hong Li
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, 325035, China.
| | - Fan Lu
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Meixiao Shen
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China.
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Gopalakrishna G, Brunton S, Pruzin J, Alford S, Hamersky C, Sabharwal A. Understanding the role of psychiatrists in the diagnosis and management of mild cognitive impairment and mild Alzheimer's disease dementia: a cross-sectional survey. BMC Psychiatry 2023; 23:716. [PMID: 37794326 PMCID: PMC10548681 DOI: 10.1186/s12888-023-05129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive neurological disorder and the most common cause of dementia. The clinical continuum of AD ranges from asymptomatic disease to mild cognitive impairment (MCI), followed by AD dementia, categorized as mild, moderate, or severe. Almost one-third of patients suspected of having MCI or mild AD dementia are referred to specialists including psychiatrists. We sought to better understand the role that psychiatrists play in the diagnosis, treatment, and management of patients with all-cause MCI or mild AD dementia. METHODS We conducted an anonymous, online survey among physicians in the United States between February 4, 2021, and March 1, 2021. We surveyed psychiatrists, primary care physicians (PCPs), geriatricians, and neurologists who treat patients with all-cause MCI or mild AD dementia. RESULTS A total of 301 physicians participated in the survey, 50 of whom were psychiatrists. Of their patients with all-cause MCI or mild AD dementia, psychiatrists reported personally diagnosing two-thirds (67%). Psychiatrists used various methods to diagnose MCI or mild AD dementia including mental status testing (94%), review of patient medical history (86%), and neurological exams (61%). Upon diagnosis, psychiatrists reported most commonly discussing treatments (86%), management strategies (80%), disease progression (72%), and etiology of MCI or mild AD dementia (72%) with their patients. Most psychiatrists surveyed (82%) reported receiving advanced formal training in MCI and AD dementia care, primarily via residency training (38%), continuing medical education (22%) or fellowship (18%). Additionally, almost all psychiatrists (92%) reported receiving referrals for ongoing management of patients with MCI or mild AD dementia, primarily from PCPs or neurologists. However, only 46% of psychiatrists viewed themselves as the coordinator of care for their patients with MCI or mild AD dementia. CONCLUSIONS Many psychiatrists indicated that they were well-informed about MCI and AD dementia and have a strong interest in providing care for these patients. They can provide timely and accurate diagnosis of clinical MCI and mild AD dementia and develop optimal treatment plans for patients. Although many psychiatrists consider other physicians to be the care coordinators for patients with MCI and mild AD dementia, psychiatrists can play a key role in diagnosing and managing patients with MCI and mild AD dementia.
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Affiliation(s)
- Ganesh Gopalakrishna
- Banner Alzheimer’s Institute, University of Arizona College of Medicine, 901 E. Willetta St, Phoenix, AZ 85006 USA
| | - Stephen Brunton
- Primary Care Education Consortium, 608 Wateree Key Court, Winnsboro, SC 29180 USA
| | - Jeremy Pruzin
- Banner Alzheimer’s Institute, University of Arizona College of Medicine, 901 E. Willetta St, Phoenix, AZ 85006 USA
| | - Susan Alford
- Novo Nordisk Inc, 800 Scudders Mill Rd, Plainsboro Township, NJ 08536 USA
| | - Carol Hamersky
- Novo Nordisk Inc, 800 Scudders Mill Rd, Plainsboro Township, NJ 08536 USA
| | - Anup Sabharwal
- Novo Nordisk Inc, 800 Scudders Mill Rd, Plainsboro Township, NJ 08536 USA
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30
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Guo Y, Liang R, Ren J, Cheng L, Wang M, Chai H, Cheng X, Yang Y, Sun Y, Li J, Zhao S, Hou W, Zhang J, Liu F, Wang R, Niu Q, Yu H, Yang S, Bai J, Zhang H, Qin X, Xia N. Cognitive status and its risk factors in patients with hypertension and diabetes in a low-income rural area of China: A cross-sectional study. Int J Geriatr Psychiatry 2023; 38:e6010. [PMID: 37794769 DOI: 10.1002/gps.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES The proportion of older people with dementia in China is gradually increasing with the increase in the aging population over recent years. Hypertension and diabetes are common non-communicable diseases among rural populations in China. However, it remains unclear whether these conditions affect the occurrence and development of cognitive impairment as there is limited research on cognitive status and its risk factors among residents of rural areas. METHODS A multi-stage stratified cluster random sampling method was used to select 5400 participants from rural permanent residents. A self-designed structured questionnaire was used to investigate demographic data of the participants. Cognitive function was assessed using the Montreal Cognitive Function Assessment Scale (MoCA). The results were analyzed using chi-square test, ANOVA and multiple linear regression analysis. RESULTS A total of 5028 participants returned the survey, giving a response rate of 93.1%. Higher education (odds ratio (OR) = 3.2, 95% confidence interval (CI) 2.87-3.54, p < 0.001), higher income (OR = 1.61, 95% CI 1.16-2.07, p < 0.001), and dietary control (OR = 0.66, 95%CI 0.34-0.98, p < 0.001) were protective factors. A visual representation of the relationship between annual income and MoCA score showed an inverted U-curve, the group with an annual income of 6000-7999 RMB had a maximum OR of 1.93 (95%CI 0.12-2.74, p < 0.001). While difficulty in maintaining sleep were risk factors for cognitive impairment (OR = -2.28, 95% CI-4.18-0.39, p = 0.018). CONCLUSIONS Participants with middle incomes had better cognitive status than those with the highest incomes. Higher education, proper diet control and good sleep are beneficial to the cognitive status of residents in rural areas.
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Affiliation(s)
- Yuyan Guo
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Ruifeng Liang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jingjuan Ren
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Liting Cheng
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
- Jinzhong Center for Disease Control and Prevention, Health Commission of Shanxi Province, Jinzhong, China
| | - Mengqin Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Huilin Chai
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoyu Cheng
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yaowen Yang
- Health Commission Supervision & Inspection Center, Health Commission of Shanxi Province, Taiyuan, China
| | - Yajuan Sun
- Evaluation Center for Medical Service and Administration, Health Commission of Shanxi Province, Taiyuan, China
| | - Jiantao Li
- Department of Health Economics, School of Management, Shanxi Medical University, Taiyuan, China
| | - Shuhong Zhao
- Evaluation Center for Medical Service and Administration, Health Commission of Shanxi Province, Taiyuan, China
| | - Wenjing Hou
- Evaluation Center for Medical Service and Administration, Health Commission of Shanxi Province, Taiyuan, China
| | - Jianhua Zhang
- Health Commission and Sports Bureau of Yangqu County, Taiyuan, China
| | - Feng Liu
- Yangqu People's Hospital, Taiyuan, China
| | - Rong Wang
- Yangqu People's Hospital, Taiyuan, China
| | - Qiao Niu
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, China
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Shoulin Yang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jianying Bai
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hongmei Zhang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaojiang Qin
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Na Xia
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
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31
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Frölich L, von Arnim C, Bohlken J, Pantel J, Peters O, Förstl H. [Mild cognitive impairment in geriatric practice: patient orientation, diagnostics, treatment and ethics]. Z Gerontol Geriatr 2023; 56:492-497. [PMID: 36006476 DOI: 10.1007/s00391-022-02098-4] [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] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
Mild cognitive impairment (MCI) is a common problem in old people, which can be distressing for patients and their families. The main feature of MCI is a decrease in cognitive performance with activities of daily living still unimpaired. The identification of treatable risk factors, recognition of early cognitive changes and a timely differential diagnosis, comprehensive information and counselling are important tasks in geriatric medicine. The aim of this article is to present practical recommendations to support physicians working with geriatric patients in recognizing cognitive deficits at an early stage, provide high-quality care focusing on counselling, treatment, and comorbidity management and to maximize the potential of the available treatment options.
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Affiliation(s)
- Lutz Frölich
- Abteilung Gerontopsychiatrie, Zentralinstitut für Seelische Gesundheit, 68163, Mannheim, Deutschland.
| | | | - Jens Bohlken
- Institut für Arbeitsmedizin, Sozialmedizin und Public Health, Universitätklinikum Leipzig, Leipzig, Deutschland
| | - Johannes Pantel
- Bereich Altersmedizin, Institut für Allgemeinmedizin, Universität Frankfurt, Frankfurt, Deutschland
| | - Oliver Peters
- Zentrum für Demenzprävention, Klinik für Psychiatrie und Psychotherapie CBF, Charité, Berlin, Deutschland
| | - Hans Förstl
- Klinik für Psychiatrie und Psychotherapie, TU München, München, Deutschland
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32
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Visconte C, Fenoglio C, Serpente M, Muti P, Sacconi A, Rigoni M, Arighi A, Borracci V, Arcaro M, Arosio B, Ferri E, Golia MT, Scarpini E, Galimberti D. Altered Extracellular Vesicle miRNA Profile in Prodromal Alzheimer's Disease. Int J Mol Sci 2023; 24:14749. [PMID: 37834197 PMCID: PMC10572781 DOI: 10.3390/ijms241914749] [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: 09/01/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Extracellular vesicles (EVs) are nanosized vesicles released by almost all body tissues, representing important mediators of cellular communication, and are thus promising candidate biomarkers for neurodegenerative diseases like Alzheimer's disease (AD). The aim of the present study was to isolate total EVs from plasma and characterize their microRNA (miRNA) contents in AD patients. We isolated total EVs from the plasma of all recruited subjects using ExoQuickULTRA exosome precipitation solution (SBI). Subsequently, circulating total EVs were characterized using Nanosight nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and Western blotting. A panel of 754 miRNAs was determined with RT-qPCR using TaqMan OpenArray technology in a QuantStudio 12K System (Thermo Fisher Scientific). The results demonstrated that plasma EVs showed widespread deregulation of specific miRNAs (miR-106a-5p, miR-16-5p, miR-17-5p, miR-195-5p, miR-19b-3p, miR-20a-5p, miR-223-3p, miR-25-3p, miR-296-5p, miR-30b-5p, miR-532-3p, miR-92a-3p, and miR-451a), some of which were already known to be associated with neurological pathologies. A further validation analysis also confirmed a significant upregulation of miR-16-5p, miR-25-3p, miR-92a-3p, and miR-451a in prodromal AD patients, suggesting these dysregulated miRNAs are involved in the early progression of AD.
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Affiliation(s)
- Caterina Visconte
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (C.V.); (P.M.); (M.R.); (M.T.G.); (D.G.)
| | - Chiara Fenoglio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (C.V.); (P.M.); (M.R.); (M.T.G.); (D.G.)
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (A.A.); (V.B.); (M.A.); (E.S.)
| | - Maria Serpente
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (A.A.); (V.B.); (M.A.); (E.S.)
| | - Paola Muti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (C.V.); (P.M.); (M.R.); (M.T.G.); (D.G.)
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Sacconi
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, Regina Elena National Cancer Institute—IRCCS, 00144 Rome, Italy;
| | - Marta Rigoni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (C.V.); (P.M.); (M.R.); (M.T.G.); (D.G.)
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Arighi
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (A.A.); (V.B.); (M.A.); (E.S.)
| | - Vittoria Borracci
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (A.A.); (V.B.); (M.A.); (E.S.)
| | - Marina Arcaro
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (A.A.); (V.B.); (M.A.); (E.S.)
| | - Beatrice Arosio
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
| | - Evelyn Ferri
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Maria Teresa Golia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (C.V.); (P.M.); (M.R.); (M.T.G.); (D.G.)
- National Research Council of Italy, Institute of Neuroscience, Via Raoul Follereau 3, 20854 Vedano al Lambro, Italy
| | - Elio Scarpini
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (A.A.); (V.B.); (M.A.); (E.S.)
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (C.V.); (P.M.); (M.R.); (M.T.G.); (D.G.)
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (A.A.); (V.B.); (M.A.); (E.S.)
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Salis F, Pili D, Collu M, Serchisu L, Laconi R, Mandas A. Six-item cognitive impairment test (6-CIT)'s accuracy as a cognitive screening tool: best cut-off levels in emergency department setting. Front Med (Lausanne) 2023; 10:1186502. [PMID: 37547596 PMCID: PMC10401263 DOI: 10.3389/fmed.2023.1186502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background Nowadays, elderly patients represent a significant number of accesses to the Emergency Department (ED). Working rhythms do not allow to perform complete cognitive analysis, which would, however, be useful for the health care. This study aims to define the optimal cut-off values of the six-item Cognitive Impairment Test (6-CIT) as a cognitive screening tool in ED. Methods This study included 215 subjects, evaluated at the Emergency Department of the University Hospital of Monserrato, Cagliari, Italy, from July to December 2021. The accuracy of 6-CIT as a cognitive screening tool was assessed by comparison with Mini Mental State Examination (MMSE). Results The correlation coefficient between the two tests was -0.836 (CI: -0.87 to -0.79; p < 0.0001), and 6-CIT showed AUC = 0.947 (CI: 0.908-0.973; p < 0.0001). The 8/9 6-CIT cut-off score presented 86.76% sensitivity (CI: 76.4-93.8) and 91.84% specificity (CI: 86.2-95.7), and Youden index for this score was 0.786. Conclusion Our study demonstrates that 6-CIT is a reliable cognitive screening tool in ED, offering excellent sensitivity and specificity with a 8/9 points cut-off score.
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Affiliation(s)
- Francesco Salis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Pili
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
| | - Manuel Collu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Serchisu
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
| | - Rosanna Laconi
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
| | - Antonella Mandas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
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Wolf A, Tripanpitak K, Umeda S, Otake-Matsuura M. Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review. Front Psychol 2023; 14:1197567. [PMID: 37546488 PMCID: PMC10399700 DOI: 10.3389/fpsyg.2023.1197567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023] Open
Abstract
Mild cognitive impairment (MCI), representing the 'transitional zone' between normal cognition and dementia, has become a novel topic in clinical research. Although early detection is crucial, it remains logistically challenging at the same time. While traditional pen-and-paper tests require in-depth training to ensure standardized administration and accurate interpretation of findings, significant technological advancements are leading to the development of procedures for the early detection of Alzheimer's disease (AD) and facilitating the diagnostic process. Some of the diagnostic protocols, however, show significant limitations that hamper their widespread adoption. Concerns about the social and economic implications of the increasing incidence of AD underline the need for reliable, non-invasive, cost-effective, and timely cognitive scoring methodologies. For instance, modern clinical studies report significant oculomotor impairments among patients with MCI, who perform poorly in visual paired-comparison tasks by ascribing less attentional resources to novel stimuli. To accelerate the Global Action Plan on the Public Health Response to Dementia 2017-2025, this work provides an overview of research on saccadic and exploratory eye-movement deficits among older adults with MCI. The review protocol was drafted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were systematically searched to identify peer-reviewed articles published between 2017 and 2022 that examined visual processing in older adults with MCI and reported gaze parameters as potential biomarkers. Moreover, following the contemporary trend for remote healthcare technologies, we reviewed studies that implemented non-commercial eye-tracking instrumentation in order to detect information processing impairments among the MCI population. Based on the gathered literature, eye-tracking-based paradigms may ameliorate the screening limitations of traditional cognitive assessments and contribute to early AD detection. However, in order to translate the findings pertaining to abnormal gaze behavior into clinical applications, it is imperative to conduct longitudinal investigations in both laboratory-based and ecologically valid settings.
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Affiliation(s)
- Alexandra Wolf
- Cognitive Behavioral Assistive Technology (CBAT), Goal-Oriented Technology Group, RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kornkanok Tripanpitak
- Cognitive Behavioral Assistive Technology (CBAT), Goal-Oriented Technology Group, RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
| | - Satoshi Umeda
- Department of Psychology, Keio University, Tokyo, Japan
| | - Mihoko Otake-Matsuura
- Cognitive Behavioral Assistive Technology (CBAT), Goal-Oriented Technology Group, RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
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Clevenger CK, Schlenger A, Gunter D, Glasgow GB. Cognitive assessment in primary care: Practical recommendations. Nurse Pract 2023; 48:26-35. [PMID: 37368555 DOI: 10.1097/01.npr.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Primary care clinicians play a critical role in both the identification and management of cognitive impairment due to common diseases. Primary care practices should incorporate feasible, reliable, and helpful tools into existing workflow to recognize and support people living with dementia and their care partners.
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Lane HY, Wang SH, Lin CH. Differential relationships of NMDAR hypofunction and oxidative stress with cognitive decline. Psychiatry Res 2023; 326:115288. [PMID: 37343463 DOI: 10.1016/j.psychres.2023.115288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
NMDAR hypofunction and oxidative stress are implicated in the pathogenesis of Alzheimer's disease. D-amino acid oxidase (DAO) regulates NMDAR function. Glutathione, superoxide dismutase, and catalase are three first-line endogenous antioxidants. This study explored the associations of these potential biomarkers with mild cognitive impairment. Cognitive function and blood levels of DAO, glutathione, superoxide dismutase, and catalase were measured in 63 mild cognitive impairment patients and 24 healthy individuals every 6 months for 2 years. Among the patients, DAO and glutathione levels at baseline contributed to the cognitive decline 2 years later. Among the healthy individuals, only glutathione levels were associated with cognitive change. The four biomarkers differed in change directions (upward vs. downward) in the patients and in the healthy individuals. Among patients, glutathione levels were negatively correlated with superoxide dismutase and positively correlated with catalase, and DAO levels were negatively correlated with superoxide dismutase. To our knowledge, this is the first study to demonstrate the differential associations of NMDAR hypofunction and oxidative stress with cognitive change between the mild cognitive impairment patients and healthy people. Glutathione may be regarded as an aging marker for both mild cognitive impairment and normal aging; and DAO, a biomarker exclusively for mild cognitive impairment.
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Affiliation(s)
- Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Shi-Heng Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan; College of Public Health, China Medical University, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Lam JO, Hou CE, Gilsanz P, Lee C, Lea AN, Satre DD, Silverberg MJ. Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care. Open Forum Infect Dis 2023; 10:ofad284. [PMID: 37342311 PMCID: PMC10279416 DOI: 10.1093/ofid/ofad284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
Background Little is known about the prevalence of undiagnosed cognitive impairment and its impact on instrumental activities of daily living (IADL) among people with HIV (PWH) in primary care. Methods PWH were recruited from an integrated health care setting in the United States. PWH were eligible for recruitment if they were ≥50 years old, taking antiretroviral therapy (ie, ≥1 antiretroviral therapy [ART] prescription fill in the past year), and had no clinical diagnosis of dementia. Participants completed a cognitive screen (St. Louis University Mental Status exam) and a questionnaire on IADL (modified Lawton-Brody). Results Study participants (n = 47) were mostly male (85.1%), 51.1% White, 25.5% Black, 17.0% Hispanic, and the average age (SD) was 59.7 (7.0) years. Overall, 27 (57.5%) participants were categorized as cognitively normal, 17 (36.2%) as having mild cognitive impairment, and 3 (6.4%) as having possible dementia. Of the 20 participants with mild cognitive impairment or possible dementia, 85.0% were men, the average age (SD) was 60.4 (7.1) years; 45.0% were White, 40.0% were Black, 10.0% were Hispanic, and 30.0% reported difficulty with at least 1 IADL. Most (66.7%) attributed difficulty with IADL primarily (33.3%) or in part (33.3%) to cognitive problems. Conclusions Undiagnosed cognitive impairment is frequent among ART-treated PWH, with possible elevated risk among Black PWH, and may be accompanied by difficulty with IADL. Efforts are needed to optimize identification of factors contributing to cognitive and IADL difficulties among ART-treated PWH in primary care.
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Affiliation(s)
- Jennifer O Lam
- Correspondence: Jennifer Lam, PhD, MPH, Division of Research, Kaiser Permanente Northern California; 2000 Broadway, Oakland, CA 94612 (); or Michael Silverberg, PhD, MPH, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ()
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California, USA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Michael J Silverberg
- Correspondence: Jennifer Lam, PhD, MPH, Division of Research, Kaiser Permanente Northern California; 2000 Broadway, Oakland, CA 94612 (); or Michael Silverberg, PhD, MPH, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ()
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Ashraf G, McGuinness M, Khan MA, Obtinalla C, Hadoux X, van Wijngaarden P. Retinal imaging biomarkers of Alzheimer's disease: A systematic review and meta-analysis of studies using brain amyloid beta status for case definition. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12421. [PMID: 37250908 PMCID: PMC10210353 DOI: 10.1002/dad2.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 05/31/2023]
Abstract
Introduction We performed a systematic review and meta-analysis of the association between retinal imaging parameters and Alzheimer's disease (AD). Methods PubMed, EMBASE, and Scopus were systematically searched for prospective and observational studies. Included studies had AD case definition based on brain amyloid beta (Aβ) status. Study quality assessment was performed. Random-effects meta-analyses of standardized mean difference, correlation, and diagnostic accuracy were conducted. Results Thirty-eight studies were included. There was weak evidence of peripapillary retinal nerve fiber layer thinning on optical coherence tomography (OCT) (p = 0.14, 11 studies, n = 828), increased foveal avascular zone area on OCT-angiography (p = 0.18, four studies, n = 207), and reduced arteriole and venule vessel fractal dimension on fundus photography (p < 0.001 and p = 0.08, respectively, three studies, n = 297) among AD cases. Discussion Retinal imaging parameters appear to be associated with AD. Small study sizes and heterogeneity in imaging methods and reporting make it difficult to determine utility of these changes as AD biomarkers. Highlights We performed a systematic review on retinal imaging and Alzheimer's disease (AD).We only included studies in which cases were based on brain amyloid beta status.Several retinal biomarkers were associated with AD but clinical utility is uncertain.Studies should focus on biomarker-defined AD and use standardized imaging methods.
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Affiliation(s)
- Gizem Ashraf
- Centre for Eye Research AustraliaRoyal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia
- OphthalmologyDepartment of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Myra McGuinness
- Centre for Eye Research AustraliaRoyal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Muhammad Azaan Khan
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Czarina Obtinalla
- Discipline of OrthopticsSchool of Allied HealthHuman Services & SportCollege of ScienceHealth & EngineeringLa Trobe UniversityMelbourneVictoriaAustralia
| | - Xavier Hadoux
- Centre for Eye Research AustraliaRoyal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia
| | - Peter van Wijngaarden
- Centre for Eye Research AustraliaRoyal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia
- OphthalmologyDepartment of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
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Dhikav V, Jadeja B, Gupta P. Cognition and cardiovascular comorbidities among older adults in primary care in West India. J Neurosci Rural Pract 2023; 14:230-234. [PMID: 37181169 PMCID: PMC10174158 DOI: 10.25259/jnrp_23_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 01/03/2023] Open
Abstract
Objectives Cardiovascular risk factors (e.g., diabetes and hypertension) are comorbidities associated with cognitive impairment. The present study was planned to study the relationship between cardiovascular risk factors and cognitive impairment using General Practitioner assessment of Cognition (GPCOG) scale, which is easy to use scale in the primary care. Materials and Methods A total of 350 older adults (mean age=66.71 ± 6.53 years; M:F = 220:130) among 3000 who reported to the primary care center in West India were screened. Cardiovascular risk factors were assessed based on written medical records. GPCOG was used for cognitive screening of those over the age of 60 with subjective memory complaints. Results Frequency of cardiovascular (CV) risk factors in those with cognitive impairment was 46.2% (n = 162/350) and 29% (101/350) in those without cognitive impairment. A Chi-square test of proportion showed values to be statistically significantly different (Chi-square value = 22.04; P =< 0.001; 95% confidence interval [CI] = 10.0463-24.1076%). Odds ratio was found to be 1.6 (95% CI =2-2.1; P =< 0.05). Conclusion A higher CV risk factors were observed among those with cognitive impairment compared to those cognitively normal older adults in the primary care.
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Affiliation(s)
- Vikas Dhikav
- Department of Health Research, Indian Council of Medical Research-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Bhargavi Jadeja
- Department of Health Research, Indian Council of Medical Research-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Pooja Gupta
- Department of Health Research, Indian Council of Medical Research-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Perez-Cruz C, Rodriguez-Callejas JDD. The common marmoset as a model of neurodegeneration. Trends Neurosci 2023; 46:394-409. [PMID: 36907677 DOI: 10.1016/j.tins.2023.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/29/2023] [Accepted: 02/14/2023] [Indexed: 03/12/2023]
Abstract
Human life expectancy has increased over the past few centuries, and the incidence of dementia in the older population is also projected to continue to rise. Neurodegenerative diseases are complex multifactorial conditions for which no effective treatments are currently available. Animal models are necessary to understand the causes and progression of neurodegeneration. Nonhuman primates (NHPs) offer significant advantages for the study of neurodegenerative disease. Among them, the common marmoset, Callithrix jacchus, stands out due to its easy handling, complex brain architecture, and occurrence of spontaneous beta-amyloid (Aβ) and phosphorylated tau aggregates with aging. Furthermore, marmosets present physiological adaptations and metabolic alterations associated with the increased risk of dementia in humans. In this review, we discuss the current literature on the use of marmosets as a model of aging and neurodegeneration. We highlight aspects of marmoset physiology associated with aging, such as metabolic alterations, which may help understand their vulnerability to developing a neurodegenerative phenotype that goes beyond normal aging.
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Affiliation(s)
- Claudia Perez-Cruz
- Department of Pharmacology, Center of Research and Advance Studies (Cinvestav-I.P.N.), Av. Politecnico Nacional 2508, San Pedro Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico.
| | - Juan de Dios Rodriguez-Callejas
- Department of Pharmacology, Center of Research and Advance Studies (Cinvestav-I.P.N.), Av. Politecnico Nacional 2508, San Pedro Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico
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Chapman S, Rentería MA, Dworkin JD, Garriga SM, Barker MS, Avila-Rieger J, Gonzalez C, Joyce JL, Vonk JMJ, Soto E, Manly JJ, Brickman AM, Mayeux RP, Cosentino SA. Association of Subjective Cognitive Decline With Progression to Dementia in a Cognitively Unimpaired Multiracial Community Sample. Neurology 2023; 100:e1020-e1027. [PMID: 36450605 PMCID: PMC9990861 DOI: 10.1212/wnl.0000000000201658] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This prospective study seeks to examine the utility of subjective cognitive decline (SCD) as a marker of future progression to dementia in a community-based cohort of non-Latinx White, non-Latinx Black, and Latinx individuals. Debate surrounds the utility of SCD, the subjective perception of decline in one's cognition before such impairment is evident in traditional neuropsychological assessments, as an early indicator of impending Alzheimer disease. Unfortunately, most studies examining SCD have been conducted in non-Latinx White samples and commonly exclude groups of individuals shown to be most vulnerable to dementia. METHODS Participants were enrolled into this cohort study from the Washington Heights-Inwood Columbia Aging Project if they were cognitively unimpaired, had baseline measurement of SCD, and self-identified as non-Latinx White, non-Latinx Black, or Latinx. SCD was measured as a continuous sum of 10 items assessing cognitive complaints. Competing risk models tested the main effects of baseline SCD on progression to dementia. Models were adjusted for age, sex/gender, years of education, medical comorbidity burden, enrollment cohort, and baseline memory test performance with death jointly modelled as a function of race/ethnicity. RESULTS A total of 4,043 (1,063 non-Latinx White, 1,267 non-Latinx Black, and 1,713 Latinx) participants were selected for this study with a mean age of 75 years, 67% women, and with a mean follow-up of 5 years. Higher baseline SCD was associated with increased rates of incident dementia over time in the full sample (hazard ratio [HR] 1.085, CI 1.047-1.125, p < 0.001) and within Latinx (HR 1.084, CI 1.039-1.130, p < 0.001) and non-Latinx Black individuals (HR 1.099, CI 1.012-1.194, p = 0.024). DISCUSSION Overall results of this study support SCD as a prodromal marker of dementia in a multiracial community sample, and in Latinx and non-Latinx Black individuals in particular. Because models examining the risk of dementia were adjusted for baseline memory test performance, the results support the idea that SCD, a subjective reflection of one's own current cognitive functioning, contributes information above and beyond standard memory testing. Current findings highlight the importance of carefully evaluating any memory concerns raised by older adults during routine visits and underscore the potential utility of screening older adults for SCD.
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Affiliation(s)
- Silvia Chapman
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Miguel Arce Rentería
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jordan D Dworkin
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Stella M Garriga
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Megan S Barker
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Justina Avila-Rieger
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Christopher Gonzalez
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jillian L Joyce
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jet M J Vonk
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Elizabeth Soto
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jennifer J Manly
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Adam M Brickman
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Richard P Mayeux
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Stephanie A Cosentino
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands.
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MicroRNAs and MAPKs: Evidence of These Molecular Interactions in Alzheimer's Disease. Int J Mol Sci 2023; 24:ijms24054736. [PMID: 36902178 PMCID: PMC10003111 DOI: 10.3390/ijms24054736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder known to be the leading cause of dementia worldwide. Many microRNAs (miRNAs) were found deregulated in the brain or blood of AD patients, suggesting a possible key role in different stages of neurodegeneration. In particular, mitogen-activated protein kinases (MAPK) signaling can be impaired by miRNA dysregulation during AD. Indeed, the aberrant MAPK pathway may facilitate the development of amyloid-beta (Aβ) and Tau pathology, oxidative stress, neuroinflammation, and brain cell death. The aim of this review was to describe the molecular interactions between miRNAs and MAPKs during AD pathogenesis by selecting evidence from experimental AD models. Publications ranging from 2010 to 2023 were considered, based on PubMed and Web of Science databases. According to obtained data, several miRNA deregulations may regulate MAPK signaling in different stages of AD and conversely. Moreover, overexpressing or silencing miRNAs involved in MAPK regulation was seen to improve cognitive deficits in AD animal models. In particular, miR-132 is of particular interest due to its neuroprotective functions by inhibiting Aβ and Tau depositions, as well as oxidative stress, through ERK/MAPK1 signaling modulation. However, further investigations are required to confirm and implement these promising results.
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Rao SM, Galioto R, Sokolowski M, Pierce M, Penn L, Sturtevant A, Skugor B, Anstead B, Leverenz JB, Schindler D, Blum D, Alberts JL, Posk L. Cleveland Clinic Cognitive Battery (C3B): Normative, Reliability, and Validation Studies of a Self-Administered Computerized Tool for Screening Cognitive Dysfunction in Primary Care. J Alzheimers Dis 2023; 92:1051-1066. [PMID: 36847000 PMCID: PMC10116145 DOI: 10.3233/jad-220929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND The self-administered iPad-based Cleveland Clinic Cognitive Battery (C3B) was designed specifically for the efficient screening of cognitive functioning of older adults in a primary care setting. OBJECTIVE 1) Generate regression-based norms from healthy participants to enable demographic corrections to facilitate clinical interpretation; 2) estimate test-retest reliability and practice effects; 3) examine ability to discriminate mild cognitive impairment (MCI) from healthy aging; 4) d etermine validity of screening in a distracting clinical environment; and 5) determine completion rates and patient satisfaction in a primary care setting. METHODS Study 1 (S1) recruited a stratified sample of 428 healthy adults, ages 18-89, to generate regression-based equations. S2 assessed 2-week test-retest reliability and practice effects in 30 healthy elders. S3 recruited 30 MCI patients and 30 demographically-matched healthy controls. In S4, 30 healthy elders self-administered the C3B in a distracting environment and in a quiet private room in counterbalanced order. In a demonstration project, 470 consecutive primary care patients were administered the C3B as part of routine clinical care (S5). RESULTS C3B performance was primarily influenced by age, education, and race (S1), had acceptably high test-retest reliability and minimal practice effects (S2), discriminated MCI from healthy controls (S3), was not negatively impacted by a distracting clinical environment (S4), had high completion rates (>92%) and positive ratings from primary care patients (S5). CONCLUSION The C3B is a computerized cognitive screening tool that is reliable, validated, self-administered, and is conducive to integration into a busy primary care clinical workflow for detecting MCI, early Alzheimer's disease, and other related dementias.
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Affiliation(s)
- Stephen M Rao
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rachel Galioto
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Megan Sokolowski
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madelyn Pierce
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Penn
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Sturtevant
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Blazenka Skugor
- Twinsburg Family Health and Surgery Center, Internal Medicine and Geriatrics Department, Twinsburg, OH, USA
| | - Brent Anstead
- Family Medicine, Hillcrest Hospital, Cleveland Clinic, Mayfield Heights, OH, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Schindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Qr8 Health, Inc., Cleveland, OH, USA
| | | | - Jay L Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lori Posk
- Health and Wellness Center, Cleveland Clinic, Vero Beach, FL, USA
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Tangen GG, Sverdrup K, Taraldsen K, Persson K, Engedal K, Bekkhus-Wetterberg P, Knapskog AB. Mobility and associations with levels of cerebrospinal fluid amyloid β and tau in a memory clinic cohort. Front Aging Neurosci 2023; 15:1101306. [PMID: 36820757 PMCID: PMC9939466 DOI: 10.3389/fnagi.2023.1101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
Background Mobility impairments, in terms of gait and balance, are common in persons with dementia. To explore this relationship further, we examined the associations between mobility and cerebrospinal fluid (CSF) core biomarkers for Alzheimer's disease (AD). Methods In this cross-sectional study, we included 64 participants [two with subjective cognitive decline (SCD), 13 with mild cognitive impairment (MCI) and 49 with dementia] from a memory clinic. Mobility was examined using gait speed, Mini-Balance Evaluation Systems test (Mini-BESTest), Timed Up and Go (TUG), and TUG dual-task cost (TUG DTC). The CSF biomarkers included were amyloid-β 42 (Aβ42), total-tau (t-tau), and phospho tau (p-tau181). Associations between mobility and biomarkers were analyzed through correlations and multiple linear regression analyses adjusted for (1) age, sex, and comorbidity, and (2) SCD/MCI vs. dementia. Results Aβ42 was significantly correlated with each of the mobility outcomes. In the adjusted multiple regression analyses, Aβ42 was significantly associated with Mini-BESTest and TUG in the fully adjusted model and with TUG DTC in step 1 of the adjusted model (adjusting for age, sex, and comorbidity). T-tau was only associated with TUG DTC in step 1 of the adjusted model. P-tau181 was not associated with any of the mobility outcomes in any of the analyses. Conclusion Better performance on mobility outcomes were associated with higher levels of CSF Aβ42. The association was strongest between Aβ42 and Mini-BESTest, suggesting that dynamic balance might be closely related with AD-specific pathology.
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Affiliation(s)
- Gro Gujord Tangen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway,*Correspondence: Gro Gujord Tangen,
| | - Karen Sverdrup
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Karin Persson
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Engedal
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Visconte C, Golia MT, Fenoglio C, Serpente M, Gabrielli M, Arcaro M, Sorrentino F, Busnelli M, Arighi A, Fumagalli G, Rotondo E, Rossi P, Arosio B, Scarpini E, Verderio C, Galimberti D. Plasma microglial-derived extracellular vesicles are increased in frail patients with Mild Cognitive Impairment and exert a neurotoxic effect. GeroScience 2023:10.1007/s11357-023-00746-0. [PMID: 36725819 PMCID: PMC10400496 DOI: 10.1007/s11357-023-00746-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
Extracellular vesicles (EVs) are mediators of cellular communication that can be released by almost all cell types in both physiological and pathological conditions and are present in most biological fluids. Such characteristics make them attractive in the research of biomarkers for age-related pathological conditions. Based on this, the aim of the present study was to examine the changes in EV concentration and size in the context of frailty, a geriatric syndrome associated with a progressive physical and cognitive decline. Specifically, total EVs and neural and microglial-derived EVs (NDVs and MDVs respectively) were investigated in plasma of frail and non-frail controls (CTRL), mild cognitive impairment (MCI) subjects, and in Alzheimer's disease (AD) patients. Results provided evidence that AD patients displayed diminished NDV concentration (3.61 × 109 ± 1.92 × 109 vs 7.16 × 109 ± 4.3 × 109 particles/ml) and showed high diagnostic performance. They are able to discriminate between AD and CTRL with an area under the curve of 0.80, a sensitivity of 78.95% and a specificity of 85.7%, considering the cut-off of 5.27 × 109 particles/ml. Importantly, we also found that MDV concentration was increased in frail MCI patients compared to CTRL (5.89 × 109 ± 3.98 × 109 vs 3.16 × 109 ± 3.04 × 109 particles/ml, P < 0.05) and showed high neurotoxic effect on neurons. MDV concentration discriminate frail MCI vs non-frail CTRL (AUC = 0.76) with a sensitivity of 80% and a specificity of 70%, considering the cut-off of 2.69 × 109 particles/ml. Altogether, these results demonstrated an alteration in NDV and MDV release during cognitive decline, providing important insight into the role of EVs in frailty status.
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Affiliation(s)
- C Visconte
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - M T Golia
- CNR, Institute of Neuroscience, Vedano al Lambro, Monza and Brianza, Milan, Italy
| | - C Fenoglio
- Department of Physiopathology and Transplantation, University of Milan, "Dino Ferrari" Center, Milan, Italy.
| | - M Serpente
- Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gabrielli
- CNR, Institute of Neuroscience, Vedano al Lambro, Monza and Brianza, Milan, Italy
| | - M Arcaro
- Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - F Sorrentino
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - M Busnelli
- CNR, Institute of Neuroscience, Vedano al Lambro, Monza and Brianza, Milan, Italy
| | - A Arighi
- Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Fumagalli
- Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Rotondo
- Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Rossi
- Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Scarpini
- Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Verderio
- CNR, Institute of Neuroscience, Vedano al Lambro, Monza and Brianza, Milan, Italy
| | - D Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Fondazione, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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47
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Da D, Ge S, Zhang H, Zeng X, Jiang Y, Yu J, Wang H, Wu W, Xiao Z, Liang X, Zhao Q, Ding D, Zhang Y. Association between occlusal support and cognitive impairment in older Chinese adults: a community-based study. Front Aging Neurosci 2023; 15:1146335. [PMID: 37139086 PMCID: PMC10149703 DOI: 10.3389/fnagi.2023.1146335] [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: 01/17/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The loss of occlusal support due to tooth loss is associated with systemic diseases. However, there was little about the association between occlusal support and cognitive impairment. The cross-sectional study aimed to investigate their association. Methods Cognitive function was assessed and diagnosed in 1,225 community-dwelling adults aged 60 years or older in Jing'an District, Shanghai. Participants were diagnosed with mild cognitive impairment (MCI) by Peterson's criteria, or dementia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We determined the number of functional occlusal supporting areas according to Eichner classifications. We used multivariate logistic regression models to analyze the relationship between occlusal support and cognitive impairment and mediation effect models to analyze the mediation effect of age. Results Six hundred sixty participants were diagnosed with cognitive impairment, averaging 79.92 years old. After adjusting age, sex, education level, cigarette smoking, alcohol drinking, cardiovascular disease, and diabetes, individuals with poor occlusal support had an OR of 3.674 (95%CI 1.141-11.829) for cognitive impairment compared to those with good occlusal support. Age mediated 66.53% of the association between the number of functional occlusal supporting areas and cognitive impairment. Discussion In this study, cognitive impairment was significantly associated with the number of missing teeth, functional occlusal areas, and Eichner classifications with older community residents. Occlusal support should be a significant concern for people with cognitive impairment.
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Affiliation(s)
- Dongxin Da
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Suyu Ge
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Hao Zhang
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Xiaoli Zeng
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yiwei Jiang
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Jin Yu
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Huning Wang
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Wanqing Wu
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenxu Xiao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Ding Ding,
| | - Ying Zhang
- Department of Preventive Dentistry, Shanghai Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- *Correspondence: Ying Zhang,
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48
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Liu LY, Xing Y, Zhang ZH, Zhang QG, Dong M, Wang H, Cai L, Wang X, Tang Y. Validation of a Computerized Cognitive Training Tool to Assess Cognitive Impairment and Enable Differentiation Between Mild Cognitive Impairment and Dementia. J Alzheimers Dis 2023; 96:93-101. [PMID: 37742644 DOI: 10.3233/jad-230416] [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: 09/26/2023]
Abstract
BACKGROUND Age-related cognitive decline is a chronic, progressive process that requires active clinical management as cognitive status changes. Computerized cognitive training (CCT) provides cognitive exercises targeting specific cognitive domains delivered by computer or tablet. Meanwhile, CCT can be used to regularly monitor the cognitive status of patients, but it is not clear whether CCT can reliably assess cognitive ability or be used to diagnose different stages of cognitive impairment. OBJECTIVE To investigate whether CCT can accurately monitor the cognitive status of patients with cognitive impairment as well as distinguish patients with dementia from patients with mild cognitive impairment (MCI). METHOD We included 116 patients (42 dementia and 74 MCI) in final analysis. Cognitive ability was assessed by averaging the patient performance on the CCT to determine the Cognitive Index. The validity of the Cognitive Index was evaluated by its correlation with neuropsychological tests, and internal consistency was measured to assess the reliability. Additionally, we determined the diagnostic ability of the Cognitive Index to detect dementia using receiver operating characteristic (ROC) analysis. RESULTS The Cognitive Index was highly correlated with the Montreal Cognitive Assessment (r = 0.812) and the Mini-Mental State Examination (r = 0.694), indicating good convergent validity, and the Cronbach's alpha coefficient was 0.936, indicating excellent internal consistency. The area under the ROC curve, sensitivity, and specificity of the Cognitive Index to diagnose dementia were 0.943, 83.3%, and 91.9%, respectively. CONCLUSIONS CCT can be used to assess cognitive status and detect dementia in patients with cognitive impairment.
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Affiliation(s)
- Li-Yang Liu
- Department of Neurology & Innovation Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - Yi Xing
- Department of Neurology & Innovation Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - Zi-Heng Zhang
- Beijing Wisdom Spirit Technology Co., Ltd., Beijing, China
| | - Qing-Ge Zhang
- Beijing Wisdom Spirit Technology Co., Ltd., Beijing, China
| | - Ming Dong
- Beijing Wisdom Spirit Technology Co., Ltd., Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Longjun Cai
- Beijing Wisdom Spirit Technology Co., Ltd., Beijing, China
| | - Xiaoyi Wang
- Beijing Wisdom Spirit Technology Co., Ltd., Beijing, China
| | - Yi Tang
- Department of Neurology & Innovation Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China
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49
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Sandison H, Callan NG, Rao RV, Phipps J, Bradley R. Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline. J Alzheimers Dis 2023; 94:993-1004. [PMID: 37355891 PMCID: PMC10473097 DOI: 10.3233/jad-230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is a chronic condition marked by progressive objective cognitive impairment (OCI). No monotherapy has substantially altered disease progression, suggesting the disease is multifactorial and may require a multimodal therapeutic approach. OBJECTIVE We sought to determine if cognitive function in a sample with OCI would change in response to a multimodal, individualized care plan based on potential contributors to cognitive decline (e.g., nutritional status, infection, etc.). METHODS Participants (n = 34) were recruited from the San Diego, CA area. The multimodal intervention included lifestyle changes (i.e., movement, diet, and stress management), nutraceutical support, and medications. It was delivered pragmatically over four clinical visits, and outcome measures were gathered at four study visits, occurring at baseline, one, three, and six months (primary endpoint). Study participants received weekly phone calls for nutrition support throughout study participation. Outcome measures included the Cambridge Brain Sciences (CBS) battery, and the Montreal Cognitive Assessment (MoCA). RESULTS At 6 months, mean MoCA scores improved from 19.6±3.1 to 21.7±6.2 (p = 0.013). Significant improvement was observed in mean scores of the CBS memory domain [25.2 (SD 23.3) to 35.8 (SD 26.9); p < 0.01] and CBS overall composite cognition score [24.5 (SD 16.1) to 29.7 (SD 20.5); p = 0.02]. All CBS domains improved. CONCLUSION Multiple measures of cognitive function improved after six months of intervention. Our results support the feasibility and impact of a multimodal, individualized treatment approach to OCI, warranting further research.
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Affiliation(s)
| | - Nini G.L. Callan
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | | | - John Phipps
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California, San Diego, La Jolla, CA, USA
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50
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Meng S, Chen H, Deng C, Meng Z. Catalpol Mitigates Alzheimer's Disease Progression by Promoting the Expression of Neural Stem Cell Exosomes Released miR-138-5p. Neurotox Res 2023; 41:41-56. [PMID: 36595161 PMCID: PMC9944361 DOI: 10.1007/s12640-022-00626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
Alzheimer's disease (Alzheimer's disease, AD) is a neurodegenerative disease characterized by senile plaque deposition and neurofibrillary tangles. The pathogenesis of AD is complicated and the drugs used to treat AD are single-targeted drugs, which can only improve or alleviate the symptoms of patients, but cannot delay or prevent the progress of the disease. Because of its ability to act on multiple targets, multiple systems, multiple links, and multiple pathways, Chinese herbal compound prescriptions have shown unique advantages in the research and treatment of AD. Our previous study has demonstrated the protect role of the Chinese medicine Rehmannia in AD. However, the underlying mechanism remains unclear. In the present study, both in vitro and vivo experiments were employed, and we found Catalpol (Ca), the main extract of Rehmannia, could mitigate AD progression both in vitro and in vivo by promoting miR-138-5p level in neural stem cell secreted exosomes.
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Affiliation(s)
- Shengxi Meng
- Department of Traditional Chinese Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, No.600 Yi Shan Road, Shanghai, 200233, China.
| | - Huize Chen
- Department of Traditional Chinese Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, No.600 Yi Shan Road, Shanghai, 200233, China
| | - Chunjun Deng
- Department of Traditional Chinese Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, No.600 Yi Shan Road, Shanghai, 200233, China
| | - Zeyu Meng
- Second Clinical Medicine College, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
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