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Szymański P, Weidinger F, Lordereau-Richard I, Himmelmann A, Arca M, Chaves J, Lee C, Jonker C, Kotecha D, O'Kelly J, Plueschke K, Ryś A, Segec A, Wallentin L, Veltrop R, James S. Real world evidence: Perspectives from a European Society of Cardiology Cardiovascular Round Table with contribution from the European Medicines Agency. Eur Heart J Qual Care Clin Outcomes 2023; 9:109-118. [PMID: 36746430 DOI: 10.1093/ehjqcco/qcad009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Real world data (RWD) refers to healthcare information that is routinely collected in electronic healthcare records (EHR), hospital and pharmacy records, patient and disease registries, and health insurance databases. The collection and analysis of this vast amount of data is an important complement to that obtained from conventional randomised controlled trials (RCT). Real world data has been used for healthcare quality improvements, to conduct clinical trials, to support drug and device development, and to inform medical guidelines. The utility of RWD may be facilitated by common data models, which standardise format and content, and allow data from different health systems to be analysed together. The European Society of Cardiology (ESC) supports the use of RWD in collaboration with national cardiac societies, regulatory authorities, and industry to encourage continuous quality of care improvements at the hospital and country level, to conduct registry-based randomised clinical trials (R-RCT) and to facilitate safety surveillance of novel drugs and devices. The European Medicines Agency (EMA) is developing systems and processes to enable the use of RWD that can help in trial planning, defining clinical contexts, and enhancing outcome assessments. RWD can also contribute to the measurement of the impact of regulatory actions, such as contraindications or restriction of indications by looking at medicines use patterns over time across European Member States. A number of other initiatives from the European Commission and the EMA are underway to strengthen the EU's health security framework, and foster the collection and utilisation of RWD.
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Affiliation(s)
- Piotr Szymański
- Clinical Cardiology Department, National Institute of Medicine MSWiA, Warsaw, Poland.,Center for Postgraduate Medical Education, Warsaw, Poland
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstraße, Vienna, Austria
| | | | - Anders Himmelmann
- Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), Clinical, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome -Hospital Policlinico Umberto I, Rome, Italy
| | - Jose Chaves
- Global Medical Affairs, Internal Medicine Business Unit, Pfizer Biopharmaceuticals Group, Madrid, Spain
| | - Charles Lee
- Late Development Cardiovascular, Renal and Metabolism (CVRM) Regulatory Affairs, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Carla Jonker
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, The Netherlands
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Kelly Plueschke
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, The Netherlands
| | - Andrzej Ryś
- Health Systems, Medical Products and Innovation, Directorate-General for Health and Food Safety (DG SANTE), European Commission, Brussels, Belgium
| | - Andrej Segec
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, The Netherlands
| | - Lars Wallentin
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Rogier Veltrop
- Department of Biochemistry, CARIM, Maastricht University, Maastricht, The Netherlands.,Institute for Molecular Cardiovascular Research IMCAR, RWTH Aachen University Hospital, Aachen, Germany
| | - Stefan James
- Dept. of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Zokufa N, Lebelo K, Hacking D, Tabo L, Runeyi P, Malabi N, Sibanda SB, Cassidy T, Makanda G, Norman B, Khuzani S, Furin J, Jonker C, Nkasana B, Scott V, Pfaff C. Community-based TB testing as an essential part of TB recovery plans in the COVID-19 era. Int J Tuberc Lung Dis 2021; 25:406-408. [PMID: 33977911 PMCID: PMC8091909 DOI: 10.5588/ijtld.21.0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- N Zokufa
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - K Lebelo
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - D Hacking
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - L Tabo
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - P Runeyi
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - N Malabi
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - S B Sibanda
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - T Cassidy
- Médecins Sans Frontières, Khayelitsha, South Africa, Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - G Makanda
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - B Norman
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - S Khuzani
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - C Jonker
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - B Nkasana
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - V Scott
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - C Pfaff
- Médecins Sans Frontières, Khayelitsha, South Africa
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Sud S, O'Callaghan C, Jonker C, Karapetis C, Price T, Tebbutt N, Shapiro J, Van Hazel G, Pavlakis N, Gibbs P, Jeffrey M, Siu L, Gill S, Wong R, Jonker D, Tu D, Goodwin R. Hypertension as a predictor of advanced colorectal cancer outcome and cetuximab treatment response. ACTA ACUST UNITED AC 2018; 25:e516-e526. [PMID: 30607118 DOI: 10.3747/co.25.4069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Adrenergic receptor stimulation is involved in the development of hypertension (htn) and has been implicated in cancer progression and dissemination of metastases in various tumours, including colon cancer. Adrenergic antagonists such as beta-blockers (bbs) demonstrate inhibition of invasion and migration in colon cancer cell lines and have been associated with decreased mortality in colorectal cancer (crc). We examined the association of baseline htn and bb use with overall (os) and progression-free survival (pfs) in patients with pretreated, chemotherapy refractory, metastatic crc (mcrc). We also examined baseline htn as a predictor of cetuximab efficacy. Methods Using data from the Canadian Cancer Trials Group co.17 study [cetuximab vs. best supportive care (bsc)], we coded baseline htn and use of anti-htn medications, including bbs, for 572 patients. The chi-square test was used to assess the associations between those variables and baseline characteristics. Cox regression models were used for univariate and multivariate analyses of os and pfs by htn diagnosis and bb use. Results Baseline htn, bb use, and anti-htn medication use were not found to be prognostic for improved os. Baseline htn and bb use were not significant predictors of cetuximab benefit. Conclusions In chemorefractory mcrc, neither baseline htn nor bb use is a significant prognostic factor. Baseline htn and bb use are not predictive of cetuximab benefit. Further investigation to determine whether baseline htn or bb use have a similarly insignificant impact on prognosis in patients receiving earlier lines of treatment remains warranted.
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Affiliation(s)
- S Sud
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - C O'Callaghan
- ncic Clinical Trials Group, Queen's University, Kingston, ON
| | - C Jonker
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - C Karapetis
- Flinders University and Flinders Medical Centre, Flinders Centre for Innovation in Cancer, Bedford Park, SA
| | - T Price
- The Queen Elizabeth and University of Adelaide, Adelaide, SA
| | | | - J Shapiro
- Department of Medical Oncology, Monash University, Melbourne, VIC
| | | | - N Pavlakis
- Royal North Shore Hospital, Northern Clinical School, University of Sydney, St. Leonards, NSW
| | - P Gibbs
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - M Jeffrey
- Oncology Service, Christchurch Hospital, Christchurch, N.Z
| | - L Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - S Gill
- University of British Columbia, BC Cancer, Vancouver, BC
| | - R Wong
- CancerCare Manitoba, Winnipeg, MB
| | - D Jonker
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - D Tu
- ncic Clinical Trials Group, Queen's University, Kingston, ON
| | - R Goodwin
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
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Atherley AE, Taylor CG, Whittington A, Jonker C. Knowledge, attitudes and practices towards blood donation in Barbados. Transfus Med 2016; 26:415-421. [PMID: 27634655 DOI: 10.1111/tme.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 07/14/2016] [Accepted: 08/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. E. Atherley
- Faculty of Medical Sciences; The University of the West Indies; Cave Hill Campus Barbados
| | - C. G. Taylor
- Faculty of Medical Sciences; The University of the West Indies; Cave Hill Campus Barbados
| | - A. Whittington
- Faculty of Medical Sciences; The University of the West Indies; Cave Hill Campus Barbados
| | - C. Jonker
- University of Liverpool; Liverpool UK
- School of Service Development and Improvement; University of Bradford; Bradford UK
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Schouws SNTM, Jonker C, Meynen G. [The importance of neuropsychological assessment for forensic psychiatric evaluations of defendants]. Tijdschr Psychiatr 2016; 58:872-880. [PMID: 27976785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In criminal law, increased interest is being shown in brain disorders, cognitive impairment and neuroimaging, particularly in connection with pre-trial reports. In a number of cases the contribution made by neuropsychology to the forensic diagnosis is considerable, and there is a need for further clarification.<br/> AIM: To clarify the relevance of the neuropsychological assessment of suspects and to explore the implications for forensic psychiatry.<br/> METHOD: We discuss recent literature and present a characteristic case selected from the Dutch jurisdiction.<br/> RESULTS: On the basis of neuropsychological assessment it is possible to obtain insight into the relation between brain disorders and criminal behaviour. The case that we present shows that the court may consider the influence of cognitive impairment on behavior to be very important.<br/> CONCLUSION: Neurocognitive disorders can make an important contribution to psychiatric assessments of defendants. In the forensic practice a combined diagnostic approach consisting of psychiatric evaluation, neurological assessment of behaviour, imaging techniques and neuropsychological assessment, is clearly preferable.
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van der Vyver PJ, Jonker C. Reciprocating instruments in endodontics: a review of the literature. SADJ 2014; 69:404-409. [PMID: 26571923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Jonker C, van der Vyver PJ. Factors influencing the life span of modern root canal instruments--a literature review. SADJ 2013; 68:14-23. [PMID: 23951756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- C Jonker
- Department of Odontology, School of Dentistry, University of Pretoria, Pretoria, South Africa
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Holwerda TJ, Beekman ATF, Deeg DJH, Stek ML, van Tilburg TG, Visser PJ, Schmand B, Jonker C, Schoevers RA. Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL). Psychol Med 2012; 42:843-853. [PMID: 21896239 DOI: 10.1017/s0033291711001772] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors. METHOD In our prospective cohort study of 4004 older persons aged 65-84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors. RESULTS At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04-1.63] in men and 1.04 (95% CI 0.90-1.24) in women. No higher risk of mortality was found for social isolation. CONCLUSIONS Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.
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Affiliation(s)
- T J Holwerda
- Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam, The Netherlands
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van den Kommer T, Dik M, Comijs H, Fassbender K, Lütjohann D, Jonker C. Erratum to “Total Cholesterol and Oxysterols: Early Markers for Cognitive Decline in Elderly?” [Neurobiol. Aging 2009;30,534–545]. Neurobiol Aging 2011. [DOI: 10.1016/j.neurobiolaging.2011.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Jonker C, Matthaei I, Schouws SNTM, Sikkens EPK. [Two subjects, each with a brain lesion and each prone to criminal behaviour: a plea for the involvement of a behavioural neurologist in the forensic psychiatric evaluation of such cases]. Tijdschr Psychiatr 2011; 53:181-187. [PMID: 21404175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Interest in the neurobiology of criminal behaviour is increasing. Recent research emphasises the important role played by the frontal lobe in the processing of emotional and social information and in the controlling of behaviour. Damage to specific frontal structures in the brain may therefore lead to antisocial and criminal behaviour. On the basis of the case histories of two suspects with brain lesions, the impact of such damage on the forensic psychiatric diagnosis is discussed. A plea is made for the more frequent involvement of a neurologist in the diagnostic evaluation usually undertaken by the forensic psychiatrist.
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de Boer ME, Dröes RM, Jonker C, Eefsting JA, Hertogh CMPM. [The lived-experiences of early-stage dementia and the feared suffering: an explorative survey]. Tijdschr Gerontol Geriatr 2010; 41:194-203. [PMID: 21114055 DOI: 10.1007/bf03096211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This qualitative explorative survey aimed at investigating the personal experiences of elderly people with early-stage dementia with regard to their illness and the extent to which they experience their situation as 'suffering'. In the Netherlands insight in this suffering is relevant with regard to ongoing debate on euthanasia and physician assisted death in early dementia. Participants in the study were 24 elderly (mean age 76.3 years) diagnosed with early-stage Alzheimer's disease. The semi-structured interviews were transcribed verbatim, and qualitatively analyzed. The elderly were found to be very capable of sharing experiences about their disease. They indicated not to experience their situation 'as a whole' as one of dreadful suffering. The gradual progression, which is distinctive of Alzheimer's disease, also allows people to adapt and adjust to their changing situation. As a result, the actual experiences of the disease can, in a positive manner, deviate from their anticipatory beliefs. The experiences of the participants appeared less negative than the ideas 'healthy' elderly often have about a life with dementia. The results from this study emphasize the importance of listening to the voices of people with dementia. Communication with elderly with Alzheimer's disease, is in the early stages quite possible and essential for advance care planning to be adjusted to their actual wishes and needs.
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Affiliation(s)
- M E de Boer
- Afdeling Verpleeghuisgeneeskunde, EMGO Instituut voor onderzoek naar gezondheid en zorg, VU Medisch Centrum, Amsterdam.
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Brandsma L, Wijers HE, Jonker C. Chemistry of acetylenic ethers 70: Preparation of 1-alkynyl thioethers and 1-alkynyl selenoethers from sodium alkynylides, sulphur or selenium and alkyl halides. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19640830215] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nielen M, Heslenfeld D, Heinen K, Van Strien J, Witter M, Jonker C, Veltman D. Distinct brain systems underlie the processing of valence and arousal of affective pictures. Brain Cogn 2009; 71:387-96. [DOI: 10.1016/j.bandc.2009.05.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 05/13/2009] [Accepted: 05/26/2009] [Indexed: 11/25/2022]
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Schoevers RA, Geerlings MI, Deeg DJH, Holwerda TJ, Jonker C, Beekman ATF. Depression and excess mortality: evidence for a dose response relation in community living elderly. Int J Geriatr Psychiatry 2009; 24:169-76. [PMID: 18642389 DOI: 10.1002/gps.2088] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Depression is associated with an increased mortality risk. It is not known to what extent depression characteristics such as severity and length of exposure to depression contribute to the association with excess mortality. OBJECTIVES To investigate the association between depression severity and duration with mortality in community-living elderly. DESIGN Two-wave prospective cohort study with 10-year follow-up of vital status. Assessment of depression at baseline and at three year follow-up (GMS-AGECAT). Cox proportional hazards analyses of mortality with depression according to severity and length of exposure, adjusted for demographic variables, physical illnesses, cognitive decline and functional disabilities. SETTING AND PARTICIPANTS Randomly selected cohort of 3 746 non-demented older community-living persons in the city of Amsterdam. MAIN OUTCOME MEASURES Excess mortality of both the baseline cohort, and of non-demented subjects participating in both assessments (n = 1989). RESULTS Both moderate (MHR 1.29, 95% CI 1.03-1.61) and severe depression (MHR 1.34, 95% CI 1.07-1.68) predicted 10-year mortality after multivariate adjustment. Chronic depression was associated with a 41% higher mortality risk in 6-year follow-up compared to subjects without depression. CONCLUSIONS Severity and chronicity of depression are associated with a higher mortality risk. In combination with other findings this is suggestive of a causal relationship and may have implications for both preventive and treatment strategies of late-life depression.
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Affiliation(s)
- R A Schoevers
- VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands.
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van den Kommer TN, Dik MG, Comijs HC, Jonker C, Deeg DJH. Homocysteine and inflammation: predictors of cognitive decline in older persons? Neurobiol Aging 2008; 31:1700-9. [PMID: 19004529 DOI: 10.1016/j.neurobiolaging.2008.09.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 09/19/2008] [Accepted: 09/25/2008] [Indexed: 01/01/2023]
Abstract
The aim of the current study was to examine the association between homocysteine and 6-year cognitive decline, and the modifying role of the inflammatory markers Interleukin-6 (IL-6), C-reactive protein (CRP) and alpha-1-antichymotrypsin (ACT). Data were collected within the Longitudinal Aging Study Amsterdam (ages >or=65 years) and analyzed using multiple longitudinal regression models (N=1257 of whom N=1076 had longitudinal data). Cognition was measured with the Mini-Mental State Examination (general cognition), Auditory Verbal Learning Test (memory), Coding Task (information processing speed) and Raven Coloured Progressive Matrices (fluid intelligence). Higher homocysteine at baseline was negatively associated with prolonged lower cognitive functioning and a faster rate of decline in information processing speed and fluid intelligence. The negative association between higher homocysteine and immediate recall was strongest in persons with a high level of IL-6. Only in the highest tertile of CRP, higher homocysteine was negatively associated with retention. In the middle tertile of ACT, higher homocysteine was associated with lower information processing speed and faster decline. Both in the lower and middle tertile of CRP, higher homocysteine was associated with a faster rate of decline in information processing speed. The results implicate that a combination of both risk factors may be used as a marker for cognitive impairment.
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Affiliation(s)
- T N van den Kommer
- Longitudinal Aging Study Amsterdam and EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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van der Roest HG, Meiland FJM, Haaker T, Reitsma E, Wils H, Jonker C, Dröes RM. Finding the service you need: human centered design of a Digital Interactive Social Chart in DEMentia care (DEM-DISC). Stud Health Technol Inform 2008; 137:210-224. [PMID: 18560083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Community dwelling people with dementia and their informal carers experience a lot of problems. In the course of the disease process people with dementia become more dependent on others and professional help is often necessary. Many informal carers and people with dementia experience unmet needs with regard to information on the disease and on the available care and welfare offer, therefore they tend not to utilize the broad spectrum of available care and welfare services. This can have very negative consequences like unsafe situations, social isolation of the person with dementia and overburden of informal carers with consequent increased risk of illness for them. The development of a DEMentia specific Digital Interactive Social Chart (DEM-DISC) may counteract these problems. DEM-DISC is a demand oriented website for people with dementia and their carers, which is easy, accessible and provides users with customized information on healthcare and welfare services. DEM-DISC is developed according to the human centered design principles, this means that people with dementia, informal carers and healthcare professionals were involved throughout the development process. This paper describes the development of DEM-DISC from four perspectives, a domain specific content perspective, an ICT perspective, a user perspective and an organizational perspective. The aims and most important results from each perspective will be discussed. It is concluded that the human centered design was a valuable method for the development of the DEM-DISC.
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Affiliation(s)
- H G van der Roest
- Departement of Psychiatry/Alzheimercenter, EMGO Institute, VU University Medical Center/Stiching Buitenamstel Geestgronden, Valeriusplein 9, 1075 BG Amsterdam, The Netherlands.
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Bierman EJM, Comijs HC, Gundy CM, Sonnenberg C, Jonker C, Beekman ATF. The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent? Int J Geriatr Psychiatry 2007; 22:1194-200. [PMID: 17407168 DOI: 10.1002/gps.1811] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study investigates the effects of benzodiazepine (BZ) use on cognitive performance in elderly persons in a longitudinal design. STUDY DESIGN AND SETTING Data were obtained from the Longitudinal Aging Study Amsterdam (LASA), in the Netherlands. 2,105 respondents (>/=62 years of age) were included and had repeated measurements over a period of 9 years. For all BZs the type, dosage, frequency and duration of use was measured. The equivalent of a dose of diazepam was determined with regard to type and dosage and a cumulative dosage was calculated. General cognitive functioning was measured with the Mini-Mental State Examination, information processing speed was measured with the coding task, fluid intelligence with Raven's Coloured Progressive Matrices and episodic memory with the Auditory Verbal Learning Test. Multilevel analyses were used to investigate the relationship between BZ use and cognitive decline. RESULTS A negative effect of BZ use on cognitive performance was found. However, the effect sizes were very small. CONCLUSION This study suggests that both duration and cumulative exposure to BZ has a small negative effect on the long-term cognitive functioning of elderly people in the community.
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Affiliation(s)
- E J M Bierman
- Department of Psychiatry, Institute for Research in Extramural Medicine (EMGO Institute), VU Medical Centre, Amsterdam, The Netherlands.
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Bierman EJM, Comijs HC, Jonker C, Beekman ATF. Symptoms of anxiety and depression in the course of cognitive decline. Dement Geriatr Cogn Disord 2007; 24:213-9. [PMID: 17690554 DOI: 10.1159/000107083] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Anxiety and depression are common inpatients with cognitive decline and Alzheimer's disease (AD), and recognition and treatment of these symptoms can improve their quality of life. The present study investigates anxiety and depression in different phases of cognitive decline. METHODS The sample consisted of five groups of elderly people in different phases of cognitive decline; four from a community-based sample (Longitudinal Aging Study Amsterdam), and one group of elderly people diagnosed with AD. ANOVAs were performed to investigate group differences in the severity and prevalence of anxiety and depression, and comorbid anxiety and depressive symptoms. RESULTS The prevalence rates of anxiety, comorbid anxiety and depressive symptoms and depressive symptoms follow a pattern of an increasing prevalence as cognitive performance declines and a decrease in the prevalence when cognitive functioning is severely impaired. AD patients report fewest anxiety symptoms. CONCLUSION We found that the prevalence of anxiety symptoms, depressive symptoms and comorbid anxiety and depressive symptoms seems to increase in the early phase of cognitive decline, and decreases as cognitive functioning further declines. Elderly diagnosed with AD report less anxiety as expected, probably due to lack of insight caused by AD.
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Affiliation(s)
- E J M Bierman
- Department of Psychiatry and EMGO Institute, VU Medical Centre, Amsterdam, The Netherlands.
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van den Kommer TN, Dik MG, Comijs HC, Fassbender K, Lütjohann D, Jonker C. Total cholesterol and oxysterols: early markers for cognitive decline in elderly? Neurobiol Aging 2007; 30:534-45. [PMID: 17888546 DOI: 10.1016/j.neurobiolaging.2007.08.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 07/13/2007] [Accepted: 08/09/2007] [Indexed: 12/31/2022]
Abstract
In this prospective study we examined whether total cholesterol and the oxysterols 24S- and 27-hydroxycholesterol were related to cognitive performance and rate of cognitive decline in elderly, and whether these associations were modified by ApoE epsilon 4. Data were collected during 6 years of follow-up as part of the Longitudinal Aging Study Amsterdam (N=1181, age >or=65 years), and analyzed using generalized estimating equations. Cognitive performance was measured with the mini-mental state examination (general cognition), the auditory verbal learning test (memory) and the coding task (information processing speed). Lower cholesterol at baseline was negatively associated with both general cognition (p=.012) and information processing speed (p=.045). ApoE modified the association between cholesterol and cognitive decline, and the association between the ratio of 27-hydroxycholesterol to cholesterol and cognitive functioning. In ApoE epsilon 4 carriers, lower cholesterol was related to a higher rate of decline on information processing speed (p=.006), and a higher ratio of 27-hydroxycholesterol to cholesterol was related to a lower level of general performance (p=.002) and memory functioning (p=.045). The results implicate that lower total cholesterol may be considered as a frailty marker, predictive of lower cognitive functioning in elderly.
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Affiliation(s)
- T N van den Kommer
- Longitudinal Aging Study Amsterdam, EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Jonker C, Comijs HC. [Mild cognitive impairment: a prodromal phase of dementia?]. Tijdschr Gerontol Geriatr 2007; 38:115-21. [PMID: 17642317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Cognitive decline without dementia is common among older persons. A variety of clinical concepts have been introduced in the past 30 years, in order to describe these cognitive deficits arising in older persons. The most frequently used concept is Mild Cognitive Impairment (MCI). MCI is generally seen as a prodromal phase of Alzheimer disease (AD). Several concepts are described, with the neuropsychiatric features and predictors of conversion to dementia c.q. AD. Finally, consequences of preclinically diagnoses for health care are clarified.
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Affiliation(s)
- C Jonker
- VU medisch centrum, EMGO Instituut, Amsterdam.
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Comijs HC, Dik MG, Rijmen F, Jonker C, Van den Kommer TN, Deeg DJH. [Predictors of dementia, the construction of classification trees]. Tijdschr Gerontol Geriatr 2006; 37:237-42. [PMID: 17214420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In order to identify persons who are at risk for dementia in an early phase, two classification trees were developed. Data were used from the Longitudinal Aging Study Amsterdam (LASA). The prevalence of dementia in the whole sample was 4.0%. In the first tree age seemed to be the strongest predictor, with an increased risk for persons older than 75. In this group the positive predictive value reached a maximum of 33.3% when the persons had memory complaints and a score on the Mini Mental State Examination (MMSE) <24. In a second classification tree, age was excluded as a predictor because of high association with the other potential predictors. In this tree functional limitations seemed the strongest predictor. In the group of persons with at least one functional limitations, the positive predictive value reached a maximum of 28.8% when the persons had memory complaints and a score <24 on the MMSE. In persons without memory complaints, persons with cardiovascular diseases or diabetes were at increased risk of dementia. Further research is necessary before these classification trees can be implemented in general health care.
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Affiliation(s)
- H C Comijs
- EMGO institute/LASA, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam.
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Abstract
OBJECTIVE To assess whether serum levels of the inflammatory proteins alpha(1)-antichymotrypsin (ACT), C-reactive protein (CRP), interleukin-6 (IL-6), and albumin are associated with cognitive decline in older persons. METHODS The study sample consisted of 1,284 participants in the Longitudinal Aging Study Amsterdam, aged 62 to 85 years. Cognition was assessed on general cognition (Mini-Mental State Examination [MMSE]), memory (Auditory Verbal Learning Test), fluid intelligence (Raven's Colored Progressive Matrices), and information-processing speed (Coding Task) at baseline and at 3-year follow-up. RESULTS The highest tertile of ACT was associated with an increased risk of decline on the MMSE (age-, sex-, education-adjusted odds ratio [OR] 1.60; 95% CI: 1.05 to 2.43) but not on any other cognitive test score. CRP, IL-6, and albumin were not associated with cognitive decline on any cognitive test in our study. CONCLUSIONS This population-based study showed that the serum inflammatory protein alpha1-antichymotrypsin is associated with cognitive decline in older persons, whereas C-reactive protein, interleukin-6, and albumin are not.
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Affiliation(s)
- M G Dik
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Schuitemaker A, van Berckel B, Boellaard R, Kropholler M, Jonker C, Lubberink M, Scheltens P, Lammertsma A. Assessment of microglial activation in mild cognitive impairment using [11C](R)-PK11195 and PET. Neuroimage 2006. [DOI: 10.1016/j.neuroimage.2006.04.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pijnenburg YAL, Zeeman-Rebel A, van der Flier WM, Romkes RM, Gillissen F, Jonker C, Scheltens P. [Cognitive disorders appearing before the age of 65 in patients of the Alzheimer Centre of the VU Medical Centre: diagnoses and clinical characteristics]. Ned Tijdschr Geneeskd 2005; 149:2862-7. [PMID: 16398169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To obtain a profile of the causes and clinical characteristics of cognitive disorders in patients referred to a memory clinic before the age of 65 years. DESIGN Retrospective case-note study. METHOD Data were collected from 127 subjects with objective cognitive disorders who visited the Alzheimer Centre of the VU Medical Centre in Amsterdam, the Netherlands, in the period from 1 January 2001 to 31 December 2003 with an onset of complaints before the age of 65. Besides the diagnoses, we investigated the clinical presentations, the occurrence of cardiovascular risk factors, the family history, and the presence of noncognitive neurological signs. RESULTS The most common causes of cognitive decline under the age of 65 were Alzheimer's disease (46%) and frontotemporal dementia (23%). Vascular dementia was seen in 5% and dementia with Lewy bodies in 2%; 9% had mild cognitive impairment but no dementia. Hypertension and a positive family history for dementia were each present in 40% of the patients. Non-cognitive neurological abnormalities were found only in cases of non-Alzheimer dementia. During the period under investigation, the number of patients with objective cognitive disorders increased more than did the number without a cognitive disorder. CONCLUSION Within the population of a memory clinic, Alzheimer's disease was the most frequent cause of cognitive decline under the age of 65, followed by frontotemporal dementia. The distribution differed from causes of dementia at an older age, where vascular dementia had the second place.
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Abstract
OBJECTIVE The authors investigated the relationship between anxiety and cognition in older persons, taking account of comorbid depression. METHODS Data were used from the Longitudinal Aging Study Amsterdam (LASA), a large epidemiological study of 3,107 elderly citizens in The Netherlands. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale-Anxiety subscale and the Center for Epidemiologic Studies-Depression Scale. In measuring cognitive performance, general cognitive functioning was measured by means of Mini-Mental State Exam, episodic memory was measured with the Auditory Verbal Learning Test (AVLT), fluid intelligence by using the RAVEN, and information-processing speed by the coding task. Analysis of variance examined the association between anxiety symptoms and cognition in persons with and without depression. RESULTS Main effects of anxiety symptoms were found for learning and delayed recall of the AVLT. Depression symptoms showed significant main effects on almost all cognitive performance tests. Mild anxiety symptoms were associated with better cognitive performance, whereas severe anxiety symptoms were negatively associated with cognitive functioning. In contrast, depressive symptoms showed a linear association with cognition; more depression was associated with worse cognition. CONCLUSION This study suggests that anxiety has a curvilinear relationship with cognition. Depressive symptoms, however, were always negatively associated with cognitive performance.
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Affiliation(s)
- E J M Bierman
- Dept. of Psychiatry, Institute for Research in Extramural Medicine (EMGO Institute) of the Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
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Jonker C, Gerritsen DL, Bosboom PR, Van Der Steen JT. A model for quality of life measures in patients with dementia: Lawton's next step. Dement Geriatr Cogn Disord 2005; 18:159-64. [PMID: 15211071 DOI: 10.1159/000079196] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/19/2022] Open
Abstract
The introduction of drugs that are claimed to improve cognitive function and activities of daily living in patients with Alzheimer's disease raises the question of whether these drugs also influence dementia patients' quality of life (QOL). We describe a hierarchic model of QOL of dementia patients, which can guide the development of measurement instruments. After initially discussing broadly QOL research, we focus on two highly important characteristics of the concept, its broadness and subjectivity, against the background of the relevant literature on QOL in dementia. Dementia-specific dimensions and domains are presented. We identify psychological well-being as the core dimension for QOL of patients with dementia.
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Affiliation(s)
- C Jonker
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
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Vellinga A, Smit JH, Van Leeuwen E, Van Tilburg W, Jonker C. Decision-making capacity of elderly patients assessed through the vignette method: imagination or reality? Aging Ment Health 2005; 9:40-8. [PMID: 15841831 DOI: 10.1080/13607860512331334059] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article evaluates whether providing hypothetical or realistic information influences the assessment of decision-making capacity in elderly patients with (and without) cognitive impairment. Decision-making capacity was assessed by means of a clinical vignette that presented a choice about whether to undergo an endoscopic procedure. The following standards of decision-making capacity were evaluated quantitatively and qualitatively: ability to evidence a choice, to understand, to reason, and to appreciate a situation. The vignette was presented to patients in either a hypothetical or real situation. In the hypothetical situation cognitively impaired patients performed significantly poorer than cognitively non-impaired patients on all abilities associated with decision-making capacity (with the exception of evidencing a choice). The realistic situation showed the same pattern among cognitively impaired and non-impaired patients in their ability to understand and in the total vignette score. Both types of patients reasoned about and appreciated the realistic situation equally well. Qualitative analysis revealed that patients gave comparable answers in both hypothetical and realistic situations. The answers were not related to standards of decision-making capacity. Moreover, personal circumstances were taken as a reference point for making a decision, regardless of the situation. We did not find any major differences between the hypothetical and realistic situation. Our findings do raise questions about the validity of hypothetical vignettes, however, especially when used with cognitively impaired persons.
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Affiliation(s)
- A Vellinga
- VU University Medical Centre, Centre for Medical Ethics and Philosophy, Amsterdam, The Netherlands.
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Vellinga A, Smit JH, Van Leeuwen E, Van Tilburg W, Jonker C. Competence to consent to treatment of geriatric patients: judgements of physicians, family members and the vignette method. Int J Geriatr Psychiatry 2004; 19:645-54. [PMID: 15254921 DOI: 10.1002/gps.1139] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In absence of a gold standard of methods to assess competence, three judgements of competency of geriatric patients are evaluated: the judgements of a physician, the judgement of a family member, and the judgement of an instrument. METHODS Competence of 80 geriatric patients was judged both by a physician and a family member. Decision making capacity was assessed with a vignette. A vignette describes a treatment choice, after which the following abilities are evaluated: evidencing a choice, understanding, reasoning and appreciating a situation. Cognitive functioning was measured with the Mini-Mental State Examination. RESULTS Most of the geriatric patients were judged competent by all three methods. Disagreement between the three judgements was found for 25 patients. Agreement about incompetence was only reached for one patient. Physicians appeared to be most lenient in their incompetency judgement: only three patients were judged incompetent. These patients scored significantly lower than competent patients on cognitive functioning, the decisional ability of understanding, and the total vignette score. Family members appeared to be most stringent in their judgement: they considered 22 patients incompetent. Incompetent patients scored significantly lower than competent patients on cognitive functioning, reasoning and the total vignette score. CONCLUSIONS The disagreement between the judgements suggests a difference in factors given emphasis by the three methods. The finding that both the judgement of physicians and family members are associated with the assessment of the vignette, suggests that the vignette method has more than a legal theoretical base and is associated with daily life experience and knowledge as well. Physicians can be helped to assess competence by the vignette method to evaluate decisional abilities and by family members who can provide more information about patients' values.
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Affiliation(s)
- A Vellinga
- Center of Philosophy and Medical Ethics, VU University Medical Center, Amsterdam, The Netherlands.
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Schoevers RA, Beekman ATF, Deeg DJH, Jonker C, van Tilburg W. Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. Int J Geriatr Psychiatry 2003; 18:994-1001. [PMID: 14618550 DOI: 10.1002/gps.1001] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression and generalised anxiety disorder frequently overlap. The question remains unresolved whether these are specific disorders, or that they represent different dimensions of a single disorder. Although both are highly prevalent disorders in this age group, studies on this issue in the elderly are scarce. Research is needed that investigates patterns of comorbidity and possibly different risk profiles for pure depression, pure generalised anxiety and mixed anxiety-depression in older people. METHODS GMS-AGECAT diagnoses were obtained from 4051 community living older persons. Comorbidity was studied along a severity gradient for men and women separately. Multivariate analysis of risk factors included demographic variables, environmental vulnerability, longstanding vulnerability, physical/functional stresses and gender. RESULTS The prevalence of pure depression was 12.2%, pure generalised anxiety 2.9%, mixed anxiety-depression 1.8%. Comorbidity increased with higher severity levels of both depression and generalised anxiety. Comorbidity was twice as likely in women than in men. Different risk profiles for diagnostic categories were not demonstrated for concurrent risk factors. Longstanding vulnerability was associated significantly stronger with mixed anxiety-depression than with pure anxiety and pure depression. Mixed anxiety-depression was overrepresented in women. CONCLUSIONS Both lines of investigation suggest that, in the elderly, a dimensional classification is more appropriate than a categorical classification of depression and generalised anxiety. Mixed anxiety-depression is a more severe form of psychopathology that is almost specific to women in this age group.
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Affiliation(s)
- R A Schoevers
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
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Schoevers RA, Beekman ATF, Deeg DJH, Hooijer C, Jonker C, van Tilburg W. The natural history of late-life depression: results from the Amsterdam Study of the Elderly (AMSTEL). J Affect Disord 2003; 76:5-14. [PMID: 12943928 DOI: 10.1016/s0165-0327(02)00060-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study examines whether risk factors related to incidence of depression are also related to prognosis, and whether a vulnerability-stress model can be established for prognosis. METHODS A prospective model for prognosis of depression (chronic or remitted course) in later life was studied in 236 depressed community-living elderly. Subjects were interviewed at baseline, and at follow-up 3 years later. Bivariate and multivariate relationships between risk factors and chronic depression (GMS-AGECAT) were assessed. Effect modification was studied between stressors and two types of vulnerability: vulnerability through a personal history of depression, and gender. RESULTS A personal history of depression, baseline functional limitations and incident anxiety syndrome predicted chronic depression, whereas life-events occurring between assessments, and changes in physical, functional or cognitive status did not. In subjects without a previous history, functional disabilities, male gender and receiving instrumental support correlated with a poor prognosis. The prognosis for subjects with a personal history of depression was not affected by other factors. In women, the development of chronicity was more strongly associated with a personal history than in men, whereas in men recent psychosocial and health-related characteristics were more important than in women. LIMITATIONS Because the study consisted of two measurements with a 3-year interval, depressive episodes with a short duration may be under-represented. CONCLUSIONS In the elderly, the impact of risk factors on the course of depression is modified by longstanding vulnerability characteristics, such as a personal history of depression and gender. More recent life stresses are related to prognosis in subjects without a personal history, and in men.
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Affiliation(s)
- R A Schoevers
- Department of Psychiatry, VU University Medical Centre, LASA/AMSTEL, Faculteit GNK, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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van der Wurff FB, Beekman AT, Comijs HC, Stek ML, Hoogendijk WJ, Renes JW, Jonker C, Heeren T. [Apathy syndrome: a clinical entity?]. Tijdschr Gerontol Geriatr 2003; 34:146-50. [PMID: 14524140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Apathy is defined as a disorder of motivation that expresses itself at an emotional, cognitive and behavioural level. Apathy can occur as a symptom and a syndrome. In the recent years diagnostic criteria and a number of scales for measuring apathy in elderly with psychiatric or neurological disorders have been introduced. Two scales are specifically developed to measure apathy, the Apathy Evaluation Scale (AES) from Marin and the Apathy Scale (AS) from Starkstein. Both scales have been translated into Dutch. The AS is more convenient. The AS in addition can be used when applying the criteria for the apathy syndrome which has been introduced in 2001 by Starkstein. In addition, the Neuropsychiatric Inventory (NPI) and the 'Gedragsobservatieschaal voor de Intramurale Psychogeniatrie' (GIP) (a scale in Dutch) have an apathy domain. Conceptual problems surrounding apathy have only partly been resolved. The criteria for the apathy syndrome can only be used for assessing the extent of the problem. Apathy and depression are strongly correlated. Studies show that apathy as a syndrome can occur without concomitant depression in the elderly, but regularly occurs besides a depressive disorder, in percentages varying between 9% and 53% of the population under study. Especially the varying validity of an apathy syndrome in relation to late life depression needs further clarification.
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Affiliation(s)
- F B van der Wurff
- Academische afdeling psychiatrie GGZ-Buitenamstel/Vumc, Valeriusplein 9, 1075 BG Amsterdam.
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Jonker C, Comijs HC, Smit JH. Does aspirin or other NSAIDs reduce the risk of cognitive decline in elderly persons? Results from a population-based study. Neurobiol Aging 2003; 24:583-8. [PMID: 12714115 DOI: 10.1016/s0197-4580(02)00188-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the protective effect of NSAIDs and aspirin separately on cognitive decline in elderly subjects, controlling for consistent use of these agents over a prolonged period of time. METHODS The study sample consisted of 1007 subjects, drawn from a population-based random sample of elderly individuals, 62-85 years old, who participated in a 3-year follow-up study. From this sample subjects were selected, who did use NSAIDs and completed all cognitive tests at both measurements (n=137), and subjects who did not use NSAIDs and completed all cognitive tests (n=475). Cognitive tests included the Mini-Mental State Examination (MMSE), tests for episodic memory (Auditory Verbal Learning Test) and information processing speed (coding task). Cognitive decline was computed using Edwards-Nunnally method. Multiple logistic regression analyses were performed to examine the association between NSAID (with and without aspirin) and decline in cognitive performance. Besides, the interaction of NSAIDs with age on cognitive decline was determined. RESULTS The relative risk estimates of decline in episodic memory (immediate recall) adjusted for age, gender, education, baseline MMSE, vascular diseases, diabetes mellitus and (rheumatoid) arthritis for aspirin users only was more than three times reduced (OR: 0.30, 95% CI: 0.09-0.82). The odds ratio for decline in memory of NSAID use without aspirin, adjusted for age, gender, education, baseline MMSE, vascular diseases, diabetes mellitus and (rheumatoid) arthritis was not significant (OR: 1.00, 95% CI: 0.39-2.93). The effect of aspirin was significant only in persons of 75 years and over (OR: 0.10, 95% CI: 0.01-0.81), not in subjects younger than 75 years (OR: 0.52, 95% CI: 0.14-1.96). NSAIDs did not have benefit on information processing speed. In 92% of aspirin users a low dose of 100mg daily or less was used. CONCLUSION Low-dose aspirin might be protective for decline in memory in individuals of 75 years and over. The benefit of a low-dose aspirin does not support an anti-inflammatory effect, but suggests an antiplatelet effect. Therefore, a possible protective effect of low-dose aspirin on cognitive decline is likely only in subjects with aspirin use over a prolonged period of time.
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Affiliation(s)
- C Jonker
- Institute for Research in Extramural Medicine, Vrije Universiteit, Van der Boechorststraat 7-9, 1081 BT, Amsterdam, The Netherlands.
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Daselaar SM, Veltman DJ, Rombouts SARB, Raaijmakers JGW, Jonker C. Neuroanatomical correlates of episodic encoding and retrieval in young and elderly subjects. Brain 2003; 126:43-56. [PMID: 12477696 DOI: 10.1093/brain/awg005] [Citation(s) in RCA: 230] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lesion studies have shown convincingly that the medial temporal lobes (MTL) and frontal lobes are critical to episodic memory. Ageing generally has been found to have a generally negative effect on episodic memory performance, which might relate to neurofunctional changes in the frontal and medial temporal brain regions. In the present study, we used functional MRI (fMRI) to investigate separately the contributions of encoding and retrieval to the age-related decline in memory. To this end, we compared brain activity patterns obtained during incidental encoding (pleasant/unpleasant judgements about nouns) and subsequent retrieval (recognition) in three groups: a group of young subjects, a group of elderly subjects showing reduced memory performance (ELD-RED), and a group of elderly subjects who still performed in the normal range (ELD-NORM). This allowed us to differentiate between age-related changes in brain activity that affect memory function and those that do not have an apparent effect on memory function, because they are found in both elderly groups. Contrary to previous imaging studies on this topic, we used (self-paced) event-related fMRI to control for differences in performance level across groups by including correct responses only. Comparing the encoding of successfully remembered items with baseline (press left/press right), the young subjects showed a significant increase in brain activation in the left anterior MTL compared with the ELD-RED but not the ELD-NORM subjects. Comparing correctly rejected items (retrieval attempt) with baseline, the ELD-RED group showed much increased overall activity throughout the brain compared with the other groups. However, when correctly recognized items (retrieval attempt + success) were compared directly with correctly rejected items (retrieval attempt), these differences were greatly reduced, revealing common activity in the left parietal, retrosplenial and left anterior prefrontal regions. Therefore, we conclude that the reduced performance in the ELD-RED group is likely to be due to MTL dysfunction during encoding. The differences observed during retrieval attempts may reflect strategic differences. The lack of differences observed in relation to retrieval success suggests that ageing does not affect the processes that support the actual recovery of information.
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Affiliation(s)
- S M Daselaar
- Institute for Research in Extramural Medicine, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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Comijs HC, Deeg DJH, Dik MG, Twisk JWR, Jonker C. Memory complaints; the association with psycho-affective and health problems and the role of personality characteristics. A 6-year follow-up study. J Affect Disord 2002; 72:157-65. [PMID: 12200206 DOI: 10.1016/s0165-0327(01)00453-0] [Citation(s) in RCA: 201] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective is to investigate whether memory complaints in older persons without manifest cognitive decline are associated with depressive symptoms, anxiety symptoms, physical health and personality characteristics. Furthermore, it is investigated whether personality characteristics have a modifying effect on the association of memory complaints with depressive and anxiety symptoms and physical health. METHODS The study was carried out using the Longitudinal Aging Study Amsterdam (LASA). Participants were examined during three observation cycles covering a period of 6 years. They were asked about memory complaints, and were examined on cognitive functioning, physical health, depressive and anxiety symptoms, and the personality characteristics: mastery, perceived self-efficacy and neuroticism. The data were analysed by means of Generalised Estimating Equations (GEE). RESULTS Memory complaints were associated with physical health problems, depressive and anxiety symptoms, low feelings of mastery, low perceived self-efficacy and high neuroticism. The associations between memory complaints and physical health problems, depressive and anxiety symptoms were significantly stronger in people with high mastery, high perceived self-efficacy and low neuroticism. LIMITATIONS We used a conservative criterion for cognitive decline and therefore we might have included some people with cognitive decline during our follow-up. In order to minimise selection bias we included actual cognitive performance in our regression models. CONCLUSIONS Our findings suggest that when older persons complain about their memory and do not show actual cognitive decline, one should be aware that these complaints might reflect psycho-affective or health problems.
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Affiliation(s)
- H C Comijs
- Institute for Research in Extramural Medicine (EMGO) and the Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.
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Pluijm SMF, Dik MG, Jonker C, Deeg DJH, van Kamp GJ, Lips P. Effects of gender and age on the association of apolipoprotein E epsilon4 with bone mineral density, bone turnover and the risk of fractures in older people. Osteoporos Int 2002; 13:701-9. [PMID: 12195533 DOI: 10.1007/s001980200096] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to examine whether the presence of apolipoprotein E epsilon4 (ApoE epsilon4) is associated with a lower bone mineral density (BMD), lower quantitative ultrasound (QUS) measurements, higher bone turnover and fracture risk, and whether these relations are modified by gender and age. A total of 1406 elderly men and women (> or =65 years) of the Longitudinal Aging Study Amsterdam (LASA) participated in this study. In all participants, QUS measurements were assessed, as well as serum osteocalcin (OC) and urine deoxypyridinolin (DPD/Cr urine). Follow-up of fractures was done each three months. In a subsample ( n = 604), total body bone mineral content (BMC) and BMD of the hip and lumbar spine were measured. In addition, prevalent vertebral deformities were identified on radiographs. In women, the presence of ApoE epsilon4 was associated with significantly lower femoral neck BMD (g/cm(2); mean +/- SEM; epsilon4+, 0.64 +/- 0.01 vs. epsilon4-, 0.67 +/- 0.01; p = 0.04), lower trochanter BMD (g/cm(2); mean +/- SEM; epsilon4+, 0.58 +/- 0.01 vs. epsilon4-, 0.61 +/- 0.01; p = 0.01) and lower total body BMC (g; mean +/- SEM; epsilon4+, 1787 +/- 40.0 vs. epsilon4-, 1863 +/- 23.8; p = 0.04). Women with ApoE epsilon4 also had a higher risk of severe vertebral deformities (OR=2.78; 95%CI: 1.21-6.34). In men, the associations between ApoE status and both hip BMD and QUS depended on age. Only among the younger men (65-69 years) was the presence of ApoE epsilon4 associated with lower BMD values. Bone markers and fractures were not associated with ApoE epsilon4 in either women, or men. In conclusion, this large community-based study confirms the importance of ApoE epsilon4 as a possible genetic risk factor related to BMD and vertebral deformities and demonstrates that its effect is gender related, and depends on age in men only.
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Affiliation(s)
- S M F Pluijm
- Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Abstract
Pathological, genetic and epidemiological studies support the opinion that inflammatory mechanisms are involved in the pathogenesis of Alzheimer's disease (AD). Recent pathological and neuroradiological (PET) data show that activation of microglia is an early pathogenic event that precedes the process of severe neuropil destruction in AD brains. In this paper we review the evidence that inflammatory mediators can play a pathogenic role in some behavioural disorders frequently encountered during the clinical course in AD patients. Motivational disturbances are the most striking of the depressive symptoms in AD and can be present in a preclinical stage of the disease. Experimental animal studies and clinical trials in humans have shown that cytokines can induce similar symptoms which were described as 'sickness behaviour' or 'depressive-like' state. Delirious states are frequently observed in more advanced stages of dementia. Delirium is generally considered the result of an imbalance in neurotransmitter systems with severe deficits of the cholinergic systems. Animal studies show that pro-inflammatory cytokines, such as interleukin-1, induce a reduced activity of the cholinergic system. In AD, the release of cytokines would exacerbate any already existing disturbances in the cholinergic neurotransmission. This could explain the susceptibility of demented patients to delirium provoked by a wide variety of trivial incidents that are accompanied by an acute phase response. The data reviewed in this paper suggest that it could be worthwhile employing a neuroimmunological approach to study at molecular level the pathogenesis of a broad spectrum of behavioural disturbances common in the clinical course of AD patients.
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Affiliation(s)
- P Eikelenboom
- Graduate School Neuroscience, Amsterdam, The Netherlands.
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Abstract
BACKGROUND The visual association test (VAT) is a brief learning task based on imagery mnemonics. The test materials consist of six line drawings of pairs of interacting objects or animals-for example, an ape holding an umbrella. The person is asked to name each object and, later, is presented with one object from the pair and asked to name the other. OBJECTIVE To verify that the task induces robust incidental or effortless learning (study 1), and to study the efficiency of the test as a discriminator between early dementia of the Alzheimer type (DAT) and non-demented people (study 2) and non-DAT types of dementia (study 3). METHODS Study 1: two groups of elderly volunteers were administered the VAT. The stimuli were presented in the interactive fashion to group A-for example, a monkey carrying an umbrella (n=83)-and side by side to group B-for example, separate pictures of a monkey alone and an umbrella alone (n=79). Group B received learning instructions, but group A did not. Study 2: three groups of subjects were selected from a population based follow up study: incident DAT cases (n=24), cognitively declining subjects not diagnosed with dementia (n=21), and stable non-demented subjects (n=204). Test performance of the non-demented group at baseline was compared with that of patients with DAT at the time of their diagnosis, of patients with DAT a year before their diagnosis, and of non-demented declining subjects at baseline. Study 3: subjects were patients referred for neuropsychological assessment because of suspected dementia. They were diagnosed by consensus criteria of various dementia syndromes. RESULTS Study 1: recall was more than twice as high in group A as in group B. Thus interactive presentation, even in the absence of learning instructions, enhances learning. Study 2: at a level of 97.5% specificity, the VAT had a sensitivity of 87.5% for DAT cases at the time of diagnosis and 66.7% one year before diagnosis. The cognitively declining group scored significantly lower on the VAT at baseline than the non-demented group. The VAT discriminated more effectively than both the MMSE and the six item picture learning task from the CAMCOG. Study 3: VAT scores were significantly lower in patients with DAT (n=48) than in patients with vascular dementia (n=37), frontotemporal dementia (n=9), or subcortical dementia (n=15), but not lower than in patients with Lewy body dementia (n=7). Mean mini mental state examination scores of these groups were not significantly different. The VAT discriminated patients with DAT from patients with other types of dementia more effectively than a prose recall test. Sensitivity was 79% and specificity 69%. CONCLUSIONS The VAT detects with high specificity a sizeable proportion of patients with DAT a year before the diagnosis, and a low VAT score is relatively uncommon in patients with non-DAT dementia.
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Affiliation(s)
- J Lindeboom
- Department of Medical Psychology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
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Jelicic M, Jonker C, Deeg DJ. Effect of low levels of serum vitamin B12 and folic acid on cognitive performance in old age: a population-based study. Dev Neuropsychol 2002; 20:565-71. [PMID: 12002093 DOI: 10.1207/s15326942dn2003_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We studied the effect of low levels of vitamin B12 and folic acid, alone or combined, on cognitive performance in a population-based sample of 698 older adults (mean age = 68.7 years). No evidence was found for a vitamin-related memory deficit, but research participants with low levels of vitamin B12 exhibited reduced information processing speed relative to participants with normal vitamin B12 levels.
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Affiliation(s)
- M Jelicic
- Department of Psychiatry and Neuropsychology, University of Maastricht, The Netherlands.
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Abstract
Previous studies have shown that N-trimethyl chitosan chloride (TMC) is a potent absorption enhancer for hydrophilic and macromolecular compounds across mucosal surfaces. TMC proved to be effective in neutral and basic pH environments where the absorption enhancing ability of chitosan is severely hampered by its insolubility in these environments. The absorption enhancing characteristics of TMC polymers with different degrees of quaternisation were investigated in vitro and in situ to identify the most effective polymer in a neutral pH environment. Different degrees of quaternisation were obtained by varying the number and duration of the reaction steps in the synthesis process of TMC. The TMC polymers were characterised with 1H-NMR spectroscopy and the degrees of quaternisation were between 22.1 and 48.8%. Everted intestinal sacs (rats) were used to determine the effect of the polymers (0.0625-0.5% w/v) on the permeation of the hydrophilic model compound, [14C]mannitol, at a pH value of 7.4. A single pass intestinal perfusion method was also used to evaluate the permeation enhancing properties of the TMC polymers under the same conditions. The results obtained from both methods clearly showed a pronounced enhancement of [14C]mannitol permeation when administered with the different TMC polymers. It was shown that the permeation enhancing effects depend on the degree of quaternisation of TMC. In both models the best permeation enhancing results were obtained with the highest degree of quaternisation of TMC (48.8%) at a concentration of 0.5% w/v.
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Affiliation(s)
- C Jonker
- Faculty of Health Sciences, School of Pharmacy, Department of Pharmaceutics, Potchefstroom University for Christian Higher Education, Potchefstroom 2520, South Africa
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Schoevers R, Beekman A, Deeg D, Hooije C, Jonker C, Van Tilburg W. The natural history of late-life depression. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Dik MG, Jonker C, Comijs HC, Bouter LM, Twisk JW, van Kamp GJ, Deeg DJ. Memory complaints and APOE-epsilon4 accelerate cognitive decline in cognitively normal elderly. Neurology 2001; 57:2217-22. [PMID: 11756600 DOI: 10.1212/wnl.57.12.2217] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate to what extent subjective memory complaints and APOE-epsilon4 allele carriage predict future cognitive decline in cognitively intact elderly persons, by evaluating both their separate and combined effects. METHODS We selected 1,168 subjects from the population-based Longitudinal Aging Study Amsterdam who were 62 to 85 years of age and had no obvious cognitive impairment at baseline (Mini-Mental State Examination [MMSE] score, > or =27). Memory complaints and APOE phenotypes were assessed at baseline. MMSE, the Auditory Verbal Learning Test (memory: immediate recall and delayed recall), and the Alphabet Coding Task-15 (information processing speed) were used to study cognitive decline. Follow-up data were collected after 3 and 6 years. Data were analyzed with generalized estimating equations, adjusted for age, sex, education, and depression. RESULTS Baseline memory complaints were reported by 25.5% of the cognitively intact elderly persons. Overall, 25.3% of the subjects were carriers of at least one APOE-epsilon4 allele. Memory complaints were associated with a greater rate of decline in all cognitive measures, except immediate recall. In addition, APOE-epsilon4 allele carriers had a greater rate of cognitive decline shown by MMSE scores and slower information processing speeds after 6 years. The effects of both memory complaints and APOE-epsilon4 allele carriage were additive: subjects with both factors had a two times higher cognitive decline than did subjects without both factors. CONCLUSIONS Both memory complaints and APOE-epsilon4 allele carriage predict cognitive decline at an early stage. This finding highlights the importance of subjective memory complaints, which are important even at an early stage when objective tests are still unable to detect cognitive deficits and are especially important for elderly carriers of the APOE-epsilon4 allele because they have an additional risk.
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Affiliation(s)
- M G Dik
- Institute for Research in Extramural Medicine (EMGO Institute), Academic Hospital, Vrije Universiteit, Amsterdam, the Netherlands.
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Jonker C, Gerritsen DL, van der Steen JT, Bosboom PR, van Campen C, Kleemans AH, Schrijver TL. [Quality of life and dementia. I. Model of assessment of wellbeing in dementia patients]. Tijdschr Gerontol Geriatr 2001; 32:252-8. [PMID: 11789414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
The introduction of cholinesterase inhibitors to improve the cognitive function and activities of daily living in patients with Alzheimer disease, raises the question whether these drugs also have the potential to improve the quality of life of these patients. In this article a model is presented to measure quality of life in patients with dementia, in which psychological well-being is chosen as the central measure. The presented model might be the starting point to develop instruments to measure quality of life in dementia. After a short introduction concerning the developments in quality of life research, the two most important characteristics of the concept--multidimensionality and subjectivity--are discussed against the background of the relevant literature on dementia. The dementia-specific dimensions--individual characteristics, psychological, social and physical dimension, and environment--and domains are presented, and put in a hierarchical model.
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Affiliation(s)
- C Jonker
- Afdeling Psychiatrie en EMGO-instituut, VUmc Amsterdam.
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van der Steen JT, van Campen C, Bosboom PR, Gerritsen DL, Kleemans AH, Schrijver TL, Jonker C. [Quality of life and dementia. II. Selection of a measurement instrument for wellbeing appropriate for the reference model]. Tijdschr Gerontol Geriatr 2001; 32:259-64. [PMID: 11789415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Measuring demented patients' 'quality of life' is an important issue in the Netherlands. Due to diminished cognition and other characteristics of dementia, general instruments are not suitable. A conceptual model for quality of life in dementia should guide instrument choice. We used a recently developed model, in which 'well-being' is indicated as the standard for quality of life. Appropriateness of fit in the model is shown of three important instruments developed in the '90s. Eventually, the 'Dementia Quality of Life instrument' (DQoL or D-QoL) of Brod et al., 1999 was selected as exhibiting the best fit. The DQoL measures well-being as a balance of positive and negative aspects. Other instruments consider, for example, either positive or negative aspects or include determinants of well-being, such as the general health condition. In contrast to the other instruments, the DQoL requires only the patient's own opinion. We plan further validation of the DQoL in Dutch demented patients.
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Affiliation(s)
- J T van der Steen
- Instituut voor Extramuraal Geneeskundig Onderzoek, afdeling Sociale Geneeskunde en Verpleeghuisgeneeskunde, VUmc, Amsterdam.
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Daselaar SM, Rombouts SA, Veltman DJ, Raaijmakers JG, Lazeron RH, Jonker C. Parahippocampal Activation during Successful Recognition of Words: A Self-Paced Event-Related fMRI Study. Neuroimage 2001; 13:1113-20. [PMID: 11352616 DOI: 10.1006/nimg.2001.0758] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, we investigated retrieval from verbal episodic memory using a self-paced event-related fMRI paradigm, similar to the designs typically used in behavioral studies of memory function. We tested the hypothesis that the medial temporal lobe (MTL) is involved in the actual recovery of verbal information (retrieval success) rather than in the attempt to retrieve information (retrieval attempt). To this end, we used a verbal recognition task, distinguishing correctly recognized words, correctly rejected words, and a low-level baseline condition. Directly contrasting correct recognition with correct rejection of words, we found activation in the left fusiform/parahippocampal gyrus, indicating that this region has a distinct role in the successful retrieval of verbal information. Furthermore, our results were in agreement with those of previous imaging studies that compared a fixed-paced verbal recognition task to a baseline condition, showing activation in bilateral inferior frontal cortex, left dorsolateral prefrontal cortex, left anterior insular cortex, and anterior cingulate. This demonstrates the applicability of a self-paced event-related design within imaging studies of memory function.
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Affiliation(s)
- S M Daselaar
- Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, vd Boechorstraat 7, 1081 BT Amsterdam, The Netherlands
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Hopman-Rock M, Tak EC, Staats PG, Jonker C, Wind AW. [Indicators of early Alzheimer dementia in family practice. Development and validation of the Observation List of Early Symptoms of Dementia (OLD)]. Tijdschr Gerontol Geriatr 2001; 32:74-81. [PMID: 11370580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
UNLABELLED Aim of the study was the development and validation of a short observation list of possible early signs of dementia (OLD) for use in general practice. A stepwise development was carried out using reviews of publications and expert consensus. Experimental observations were carried out by 22 general practitioners in 19 Dutch practices. A field study (with interviews and family forms) was conducted out afterwards, to evaluate reliability and validity. Data reduction techniques were used to construct a short version. The first two patients seen on 15 working days (N = 470) were observed. INCLUSION CRITERIA age > 75, without a known diagnosis of dementia. Exclusion: psychiatric treatment, severe depression, acute illness with confusion. The patients were divided into three groups with no, intermediate, and the most signs (total of interviewed patients n = 60; family forms n = 39). Cronbach's alpha and factor-analysis were used to evaluate the reliability. The Cognitive Screening Test (CST), the Word Learning Test (WLT; total and retention), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Groningen Activities Restriction Scale (GARS), and an IADL scale were used to evaluate convergent validity. The Geriatric Depression Scale (GDS) was used to evaluate discriminant validity. Construct validity was evaluated using PRINCALS. Incremental validity was evaluated using the intuitive opinion of the GP (McNemar test). The reliability in the total group was 0.88, the first factor explained 42.5% of the variance. Convergent validity (2-side ANOVA) results: CST (p = 0.00), WLT-total (p = 0.001), WLT retention (p = 0.00), IQCODE (p = 0.09). No statistically significant differences were found for GARS and IADL. The GDS (p = 0.30) showed no difference. The first factor of PRINCALS explained 48% of the variance. The OLD added to the GP opinion (McNemar p = 0.00). Reliability of the short version (12 items) was 0.89 (interviewed group), and 0.86 (total group). The conclusion is that the OLD is a valid and reliable method to detect early signs of dementia in general practice. (Partly adapted from: Hopman-Rock M, Tak ECPM, Staats PGM. Development and validation of the Observation List for early signs of Dementia (OLD). Int J Geriatr Psychiatry 2001 (in press)).
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Affiliation(s)
- M Hopman-Rock
- TNO Preventie en Gezondheid, Postbus 2215, 2301 CE Leiden.
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Comijs HC, Jonker C, Beekman AT, Deeg DJ. The association between depressive symptoms and cognitive decline in community-dwelling elderly persons. Int J Geriatr Psychiatry 2001; 16:361-7. [PMID: 11333422 DOI: 10.1002/gps.343] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate whether depressive symptoms predict specific types of cognitive decline in order to elucidate the association between late life depression and cognitive decline. BACKGROUND Mechanisms underlying the association between late life depression and cognitive decline are still unclear. METHOD Six hundred and forty-one elderly persons of the Longitudinal Aging Study Amsterdam (LASA) aged 70-85 were examined by means of two measurement occasions over a period of 3 years. Depressive symptoms were assessed by means of the CES-D. Various cognitive functions were examined using neuropsychological tests. RESULTS Depressive symptoms were associated with decline in speed of information processing over a 3-year period, whereas there was no association between depression and increasing memory impairment or global mental deterioration. CONCLUSION These findings suggest that depressive symptoms are associated with subcortical pathology, most probable white matter lesions.
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Affiliation(s)
- H C Comijs
- Institute for Research in Extramural Medicine, Vrije Universiteit, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands.
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Abstract
OBJECTIVES To review studies that have reported on the prevalence of memory complaints and the relationship between memory complaints and impairment or decline (dementia) in elderly individuals. DATA SOURCES AND STUDY SELECTION All publications in the English language relating to memory complaints, memory impairment, cognitive disorder and dementia in MEDLINE, PSYCHLIT and EMBASE computerized databases, together with a search of relevant citations. DATA SYNTHESIS The prevalence of memory complaints, defined as everyday memory problems, shows a large variation of approximately 25 - 50%. A high age, female gender and a low level of education are generally associated with a high prevalence of memory complaints. In community-based samples of elderly subjects an association has been found between memory complaints and memory impairment, after adjustment for depressive symptomatology. Memory complaints predict dementia after a follow-up of at least 2 years, in particular in those with mild cognitive impairment, defined as Mini Mental State Examination (MMSE) > 23. Memory complaints in highly educated elderly subjects may be predictive of dementia even when there is no indication of cognitive impairment on short cognitive screen tests. The shift in methodology which is noticeable in the recently published major studies is discussed as a possible explanation for the established association between memory complaints and decline in memory (or dementia) in elderly subjects. Three methodological factors, in particular, are responsible for the results: community-based sampling, longitudinal design and the treatment of variables such as depression, cognitive impairment and level of education. CONCLUSION Memory complaints in elderly people should no longer be considered merely as an innocent age-related phenomenon or a symptom of depression. Instead, these complaints deserve to be taken seriously, at least as a possible early sign of dementia.
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Affiliation(s)
- C Jonker
- Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit, Amsterdam, The Netherlands.
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Jonker C, Dik MG, van Kamp GJ, Deeg DJ. [Apolipoprotein E4 and memory decline in the elderly]. Tijdschr Gerontol Geriatr 2000; 31:198-202. [PMID: 11064931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The objective of this study was to investigate whether the association between Apolipoprotein E4 (ApoE4) and memory decline is modified by baseline general cognitive impairment and age in a population-based elderly sample. Subjects were participants in the Longitudinal Aging Study Amsterdam (LASA). The study sample consisted of 1,243 subjects, 62-85 years old, with a Mini-Mental State Examination (MMSE) score between 21-30 and known ApoE phenotypes. Memory performance was measured with a short version of the Auditory Verbal Learning Test (AVLT) at baseline and repeated after three years (N = 854). Memory decline was defined as a decrease of at least one standard deviation from the mean change score on immediate recall, delayed recall and retention. ApoE4 was associated with memory decline in cognitively impaired subjects (MMSE 21-26), but not in cognitively normal subjects (MMSE 27-30). In particular cognitively impaired E4 carriers older than 75 years were at high risk of memory decline. Contrary to AD studies, our study suggests that the risk of ApoE4 on memory decline does not decrease with ageing.
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Affiliation(s)
- C Jonker
- Vrije Universiteit, afdeling Psychiatrie, Amsterdam.
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Schoevers RA, Geerlings MI, Beekman AT, Penninx BW, Deeg DJ, Jonker C, Van Tilburg W. Association of depression and gender with mortality in old age. Results from the Amsterdam Study of the Elderly (AMSTEL). Br J Psychiatry 2000; 177:336-42. [PMID: 11116775 DOI: 10.1192/bjp.177.4.336] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association between depression and increased mortality risk in older persons may depend on the severity of the depressive disorder and gender. AIMS To investigate the association between major and mild depressive syndromes and excess mortality in community-living elderly men and women. METHOD Depression (Geriatric Mental State AGECAT) was assessed in 4051 older persons, with a 6-year follow-up of community death registers. The mortality risk of neurotic and psychotic depression was calculated after adjustment for demographic variables, physical illness, cognitive decline and functional disabilities. RESULTS A total of 75% of men and 41% of women with psychotic depression had diet at follow-up. Psychotic depression was associated with significant excess mortality in both men and women. Neurotic depression was associated with a 1.67-fold higher mortality risk in men only. CONCLUSIONS In the elderly, major depressive syndromes increase the risk of death in both men and women, but mild depression increases the risk of death only in men.
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Affiliation(s)
- R A Schoevers
- Department of Psychiatry, Vrije Universiteit Amsterdam, Valeriusplein 9, 1075 BG Amsterdam, The Netherlands.
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