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Janssen J, Châtel B, Den Heijer N, Tieben R, Deen M, Corten R, Peeters G, Olde Rikkert M. A Digital Gaming Intervention to Strengthen the Social Networks of Older Dutch Adults: Mixed Methods Process Evaluation of a Digitally Conducted Randomized Controlled Trial. JMIR Form Res 2023; 7:e45173. [PMID: 37862093 PMCID: PMC10625069 DOI: 10.2196/45173] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/19/2022] [Revised: 05/19/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Digital loneliness interventions for older adults are promising, yet conclusive evidence is lacking due to a lack of randomized controlled trials (RCTs) and difficulties with recruitment. Process evaluation of performed RCTs is essential to inform future interventions. Still, it is rarely carried out, resulting in an overly optimistic view of the impact of eHealth interventions on loneliness in older adults and options to conduct such research entirely remotely. OBJECTIVE We describe a mixed methods process evaluation of a digitally conducted RCT assessing the effectiveness of a mobile social gaming app to facilitate meaningful social interactions in older adults. METHODS We analyzed the questionnaire and game data of the RCT participants to evaluate recruitment and onboarding, intervention adherence, and intervention acceptability. The RCT participants were allocated either to the main group of older adults (aged 65 years or older) or the side group (aged between 18 and 64 years). The side group used networking to play with the older adults. We also conducted 6 post-RCT evaluation interviews and 1 focus group with a total of 4 RCT participants and 5 welfare organization representatives that aided in RCT recruitment. RESULTS In total, 371 people aged 18 years or older signed up for the RCT, of which 64% (238/371) were aged 65 years or older. Of the total sample, 20% (76/371) installed the app and signed informed consent, showing a large dropout during onboarding. The high number of questions was a relevant barrier for participants. Both questionnaire and gameplay adherence were low. Participants indicated that the games elicited contact and a feeling of togetherness and proposed challenging and competitive games with increasing difficulty levels. They suggested focusing on enjoying the games rather than administering questionnaires. CONCLUSIONS Conducting a remote digital trial of a social gaming intervention for older adults is a great challenge. Remote recruitment and informed consent acquisition may often not result in sufficient participation. Personal engagement with fellow participants and researchers might be essential for adherence and enjoyment. Future digital gaming interventions should start with small-scale studies with in-person contact, repeated instructions, and fewer questionnaires.
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Affiliation(s)
- Jeroen Janssen
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas Châtel
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nora Den Heijer
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rob Tieben
- Games for Health, Eindhoven, Netherlands
| | - Menno Deen
- Super Menno Monster, Utrecht, Netherlands
| | - Rense Corten
- Department of Sociology / Interuniversity Center for Social Science Theory and Methodology, Utrecht University, Utrecht, Netherlands
| | - Geeske Peeters
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel Olde Rikkert
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Geriatric Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Hourican C, Peeters G, Melis R, Gill TM, Rikkert MO, Quax R. Understanding multimorbidity requires sign-disease networks and higher-order interactions, a perspective. Front Syst Biol 2023; 3:1155599. [PMID: 37810371 PMCID: PMC10557993 DOI: 10.3389/fsysb.2023.1155599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background Count scores, disease clustering, and pairwise associations between diseases remain ubiquitous in multimorbidity research despite two major shortcomings: they yield no insight into plausible mechanisms underlying multimorbidity, and they ignore higher-order interactions such as effect modification. Objectives We argue that two components are currently missing but vital to develop novel multimorbidity metrics. Firstly, networks should be constructed which consists simultaneously of signs, symptoms, and diseases, since only then could they yield insight into plausible shared biological mechanisms underlying diseases.Secondly, learning pairwise associations is insufficient to fully characterize the correlations in a system. That is, synergistic (e.g., cooperative or antagonistic) effects are widespread in complex systems, where two or more elements combined give a larger or smaller effect than the sum of their individual effects. It can even occur that pairs of symptoms have no pairwise associations whatsoever, but in combination have a significant association. Therefore, higher-order interactions should be included in networks used to study multimorbidity, resulting in so-called hypergraphs. Methods We illustrate our argument using a synthetic Bayesian Network model of symptoms, signs and diseases, composed of pairwise and higher-order interactions. We simulate network interventions on both individual and population levels and compare the ground-truth outcomes with the predictions from pairwise associations. Conclusion We find that, when judged purely from the pairwise associations, interventions can have unexpected 'side-effects' or the most opportune intervention could be missed. The hypergraph uncovers links missed in pairwise networks, giving a more complete overview of sign and disease associations.
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Affiliation(s)
- Cillian Hourican
- Computational Science Lab, Institute of Informatics, University of Amsterdam, Amsterdam, The Netherlands
| | - Geeske Peeters
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Radboud university medical centre, Nijmegen, The Netherlands
| | - René Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas M. Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Radboud university medical centre, Nijmegen, The Netherlands
| | - Rick Quax
- Computational Science Lab, Institute of Informatics, University of Amsterdam, Amsterdam, The Netherlands
- Institute for Advanced Study, 1012 GC Amsterdam, The Netherlands
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Hadjisotiriou S, Marchau V, Walker W, Rikkert MO. Decision making under deep uncertainty for pandemic policy planning. Health Policy 2023; 133:104831. [PMID: 37156082 PMCID: PMC10156381 DOI: 10.1016/j.healthpol.2023.104831] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 11/15/2021] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
Policymakers around the world were generally unprepared for the global COVID-19 pandemic. As a result, the virus has led to millions of cases and hundreds of thousands of deaths. Theoretically, the number of cases and deaths did not have to happen (as demonstrated by the results in a few countries). In this pandemic, as in other great disasters, policymakers are confronted with what policy analysts call Decision Making under Deep Uncertainty (DMDU). Deep uncertainty requires policies that are not based on 'predict and act' but on 'prepare, monitor, and adapt', enabling policy adaptations over time as events occur and knowledge is gained. We discuss the potential of a DMDU-approach for pandemic decisionmaking.
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Affiliation(s)
- Sophie Hadjisotiriou
- Radboud UMC, Faculty of Medical Sciences, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands.
| | - Vincent Marchau
- Radboud University, Institute of Management Research, PO Box 9108, 6500 HK Nijmegen, the Netherlands.
| | - Warren Walker
- Delft University of Technology, Faculty of Technology, Policy and Management, PO Box 5015, 2600 GA Delft, the Netherlands.
| | - Marcel Olde Rikkert
- Radboud UMC, Faculty of Medical Sciences, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands.
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4
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Peeters G, Kok A, de Bruin SR, van Campen C, Graff M, Nieuwboer M, Huisman M, van Munster B, van der Zee EA, Kas MJ, Perry M, Gerritsen DL, Vreede-Chabot E, The AM, van Hout H, Bakker FC, Achterberg WP, van der Steen JT, Smits C, Melis R, Olde Rikkert M. Supporting Resilience of Older Adults with Cognitive Decline Requires a Multi-Level System Approach. Gerontology 2023; 69:866-874. [PMID: 36754032 DOI: 10.1159/000529337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023] Open
Abstract
The concept of resilience, i.e., the capacity of a system to bounce back after a stressor, is gaining interest across many fields of science, policy, and practice. To date, resilience research in people with cognitive decline has predominantly addressed the early stages of decline. We propose that: (1) resilience is a relevant concept in all stages of cognitive decline; and (2) a socio-ecological, multisystem perspective on resilience is required to advance understanding of, and care and support for people with cognitive decline and their support networks. We substantiate our position with literature and examples. Resilience helps understand differences in response to risk factors of (further) cognitive decline and informs personalised prevention. In a curative context, interventions to strengthen resilience aim to boost recovery from cognitive decline. In care for people with dementia, resilience-focused interventions can strengthen coping mechanisms to maintain functioning and well-being of the individual and their support network. A good example of improving resilience in the social and policy context is the introduction of age-friendly cities and dementia-friendly communities. Good care for people with cognitive decline requires a health and social care system that can adapt to changes in demand. Given the interdependency of resilience at micro-, meso- and macro-levels, an integrative socio-ecological perspective is required. Applying the concept of resilience in the field of cognitive decline opens new horizons for research to improve understanding, predicting, intervening on health and social care needs for the increasing population with cognitive decline.
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Affiliation(s)
- Geeske Peeters
- Radboud University Medical Center, Radboudumc Institute of Health Sciences, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Almar Kok
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simone R de Bruin
- Department of Health and Well-being, Research Group Living Well with Dementia, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Crétien van Campen
- Netherlands Institute for Social Research/SCP, The Hague, The Netherlands
| | - Maud Graff
- Radboud University Medical Center, Radboudumc Institute of Health Sciences, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Minke Nieuwboer
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Academy of Health and Vitality, Nijmegen, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barbara van Munster
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | - Eddy A van der Zee
- Groningen Institute for Evolutionary Life Sciences (GELIFES), Neurobiology, University of Groningen, Groningen, The Netherlands
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences (GELIFES), Neurobiology, University of Groningen, Groningen, The Netherlands
| | - Marieke Perry
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboudumc Institute of Health Sciences, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | | | - Anne-Mei The
- Tao of Care, Amsterdam, The Netherlands
- Department Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hein van Hout
- Departments of General Practice and Medicine for Older Persons, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Franka C Bakker
- Department of Health and Well-being, Research Group Living Well with Dementia, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carolien Smits
- Pharos Center of Expertise on Health Disparities, Utrecht, The Netherlands
| | - René Melis
- Radboud University Medical Center, Radboudumc Institute of Health Sciences, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Radboud University Medical Center, Donders Institute of Neuroscience, Nijmegen, The Netherlands
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5
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Janssen O, Jansen WJ, Vos SJ, Boada M, Parnetti L, Gabryelewicz T, Fladby T, Molinuevo JL, Villeneuve S, Hort J, Epelbaum S, Lleó A, Engelborghs S, van der Flier WM, Landau S, Popp J, Wallin A, Scheltens P, Rikkert MO, Snyder PJ, Rowe C, Chételat G, Ruíz A, Marquié M, Chipi E, Wolfsgruber S, Heneka M, Boecker H, Peters O, Jarholm J, Rami L, Tort‐Merino A, Binette AP, Poirier J, Rosa‐Neto P, Cerman J, Dubois B, Teichmann M, Alcolea D, Fortea J, Sánchez‐Saudinós MB, Ebenau J, Pocnet C, Eckerström M, Thompson L, Villemagne V, Buckley R, Burnham S, Delarue M, Freund‐Levi Y, Wallin ÅK, Ramakers I, Tsolaki M, Soininen H, Hampel H, Spiru L, Tijms B, Ossenkoppele R, Verhey FRJ, Jessen F, Visser PJ. Characteristics of subjective cognitive decline associated with amyloid positivity. Alzheimers Dement 2022; 18:1832-1845. [PMID: 34877782 PMCID: PMC9786747 DOI: 10.1002/alz.12512] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/21/2021] [Accepted: 09/22/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The evidence for characteristics of persons with subjective cognitive decline (SCD) associated with amyloid positivity is limited. METHODS In 1640 persons with SCD from 20 Amyloid Biomarker Study cohort, we investigated the associations of SCD-specific characteristics (informant confirmation, domain-specific complaints, concerns, feelings of worse performance) demographics, setting, apolipoprotein E gene (APOE) ε4 carriership, and neuropsychiatric symptoms with amyloid positivity. RESULTS Between cohorts, amyloid positivity in 70-year-olds varied from 10% to 76%. Only older age, clinical setting, and APOE ε4 carriership showed univariate associations with increased amyloid positivity. After adjusting for these, lower education was also associated with increased amyloid positivity. Only within a research setting, informant-confirmed complaints, memory complaints, attention/concentration complaints, and no depressive symptoms were associated with increased amyloid positivity. Feelings of worse performance were associated with less amyloid positivity at younger ages and more at older ages. DISCUSSION Next to age, setting, and APOE ε4 carriership, SCD-specific characteristics may facilitate the identification of amyloid-positive individuals.
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Affiliation(s)
- Olin Janssen
- Alzheimer Centre LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Willemijn J. Jansen
- Alzheimer Centre LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Stephanie J.B. Vos
- Alzheimer Centre LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Merce Boada
- Fundació ACEInstitut Català de Neurociències AplicadesFacultat de MedicinaUniversitat International de Catalunya‐BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Lucilla Parnetti
- Section of NeurologyCenter for Memory Disturbances – Lab. of Clinical NeurochemistryDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Tomasz Gabryelewicz
- Department of Neurodegenerative DisordersMossakowski Medical Research CentrePolish Academy of SciencesWarsawPoland
| | - Tormod Fladby
- Department of NeurologyAkershus University HospitalLorenskogNorway
| | - José Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders UnitNeurology Service, Hospital Clínic of BarcelonaAugust Pi i Sunyer Biomedical Research Institute (IDIBAPS)BarcelonaSpain
| | - Sylvia Villeneuve
- Centre for Studies on Prevention of Alzheimer's Disease (StOP‐AD) CentreMontrealQuebecCanada
| | - Jakub Hort
- Department of NeurologySecond Faculty of MedicineCharles University and Motol University HospitalPragueCzech Republic,International Clinical Research CenterSt. Anne's University HospitalBrnoCzech Republic
| | - Stéphane Epelbaum
- AP‐HPHôpital de la Pitié SalpêtrièreInstitute of Memory and Alzheimer's Disease (IM2A)Centre of excellence of neurodegenerative disease (CoEN)Department of NeurologyParisFrance,Inserm Sorbonne UniversitéInriaAramis project‐teamParis Brain Institute – Institut du Cerveau (ICM)ParisFrance
| | - Alberto Lleó
- Neurology DepartmentHospital de Sant PauBarcelonaSpain
| | | | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Susan Landau
- Helen Wills Neuroscience InstituteUniversity of CaliforniaBerkeley, CaliforniaUSA
| | - Julius Popp
- Department of Geriatric PsychiatryPsychiatric University Hospital, ZürichSwitzerland,Old Age PsychiatryUniversity Hospital of LausanneLausanneSwitzerland
| | - Anders Wallin
- CSIRO Health & BiosecurityParkvilleVictoriaAustralia,Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgMölndalSweden
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatric MedicineRadboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands
| | - Peter J. Snyder
- Institute of Clinical MedicineUniversity of OsloOsloNorway,KingstonThe University of Rhode IslandRhode IslandUSA
| | - Chris Rowe
- Department of Molecular Imaging & TherapyAustin HealthMelbourneAustralia
| | - Gaël Chételat
- Institut National de la Sant. et de la Recherche M.dicale (Inserm)CaenFrance
| | - Agustin Ruíz
- Fundació ACEInstitut Català de Neurociències AplicadesFacultat de MedicinaUniversitat International de Catalunya‐BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Marta Marquié
- Fundació ACEInstitut Català de Neurociències AplicadesFacultat de MedicinaUniversitat International de Catalunya‐BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Elena Chipi
- Section of NeurologyCenter for Memory Disturbances – Lab. of Clinical NeurochemistryDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Steffen Wolfsgruber
- German Center For Neurodegenerative Diseases/Clinical ResearchDeutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE)Zentrum für klinische Forschung/AGCologneGermany,Department of Neurodegenerative Diseases and PsychiatryUniversity Hospital BonnBonnGermany
| | - Michael Heneka
- Department of Neurodegenerative Diseases and PsychiatryUniversity Hospital BonnBonnGermany
| | - Henning Boecker
- Functional Neuroimaging GroupDepartment of RadiologyUniversity Hospital BonnBonnGermany
| | - Oliver Peters
- Klinik für Psychiatrie und PsychotherapieCharité Universitätsmedizin Berlin ‐ CBFBerlinDeutschland
| | - Jonas Jarholm
- Department of NeurologyAkershus University HospitalLorenskogNorway
| | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders UnitNeurology Service, Hospital Clínic of BarcelonaAugust Pi i Sunyer Biomedical Research Institute (IDIBAPS)BarcelonaSpain
| | - Adrià Tort‐Merino
- Alzheimer's Disease and Other Cognitive Disorders UnitNeurology Service, Hospital Clínic of BarcelonaAugust Pi i Sunyer Biomedical Research Institute (IDIBAPS)BarcelonaSpain
| | - Alexa Pichet Binette
- Centre for Studies on Prevention of Alzheimer's Disease (StOP‐AD) CentreMontrealQuebecCanada
| | - Judes Poirier
- Centre for Studies on Prevention of Alzheimer's Disease (StOP‐AD) CentreMontrealQuebecCanada
| | - Pedro Rosa‐Neto
- Centre for Studies on Prevention of Alzheimer's Disease (StOP‐AD) CentreMontrealQuebecCanada
| | - Jiri Cerman
- Department of NeurologySecond Faculty of MedicineCharles University and Motol University HospitalPragueCzech Republic,International Clinical Research CenterSt. Anne's University HospitalBrnoCzech Republic
| | - Bruno Dubois
- AP‐HPHôpital de la Pitié SalpêtrièreInstitute of Memory and Alzheimer's Disease (IM2A)Centre of excellence of neurodegenerative disease (CoEN)Department of NeurologyParisFrance
| | - Marc Teichmann
- AP‐HPHôpital de la Pitié SalpêtrièreInstitute of Memory and Alzheimer's Disease (IM2A)Centre of excellence of neurodegenerative disease (CoEN)Department of NeurologyParisFrance
| | | | - Juan Fortea
- Neurology DepartmentHospital de Sant PauBarcelonaSpain
| | | | - Jarith Ebenau
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Cornelia Pocnet
- Old Age PsychiatryUniversity Hospital of LausanneLausanneSwitzerland
| | - Marie Eckerström
- Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgMölndalSweden
| | - Louisa Thompson
- Institute of Clinical MedicineUniversity of OsloOsloNorway,KingstonThe University of Rhode IslandRhode IslandUSA
| | - Victor Villemagne
- Department of Molecular Imaging & TherapyAustin HealthMelbourneAustralia,Department of PsychiatryUniversity of PittsburghPittsburghUSA
| | - Rachel Buckley
- Brigham and Women's Hospital and Department of Neurology Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Samantha Burnham
- Section of NeurologyCenter for Memory Disturbances – Lab. of Clinical NeurochemistryDepartment of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Marion Delarue
- Institut National de la Sant. et de la Recherche M.dicale (Inserm)CaenFrance
| | - Yvonne Freund‐Levi
- Department of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Åsa K. Wallin
- Department of Clinical Sciences MalmöClinical Memory Research UnitLund UniversityLundSweden
| | - Inez Ramakers
- Alzheimer Centre LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Magda Tsolaki
- Memory and Dementia Center3rd Department of Neurology“G Papanicolau” General HospitalAristotle University of ThessalonikiThessalonikiGreece
| | - Hilkka Soininen
- Institute of Clinical MedicineNeurologyUniversity of Eastern FinlandKuopioFinland
| | - Harald Hampel
- GRC no 21, Alzheimer Precision Medicine (AMP)AP‐HPPitié‐Salpêtrière HospitalSorbonne UniversityParisFrance
| | - Luiza Spiru
- Carol DAVILA University of Medicine and PharmacyBucharestRomania,Geriatrics‐ Gerontology and Old Age PsychiatryAlzheimer UnitAna Aslan International Foundation – Memory Center and Longevity MedicineBucharestRomania
| | | | | | | | - Betty Tijms
- Alzheimer Centre LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands,Clinical Memory Research UnitDepartment of Clinical SciencesMalmöLund UniversityLundSweden,Alzheimer's Disease and Other Cognitive Disorders UnitNeurology Service, Hospital Clínic of BarcelonaAugust Pi i Sunyer Biomedical Research Institute (IDIBAPS)BarcelonaSpain
| | - Frans R. J. Verhey
- Alzheimer Centre LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Frank Jessen
- Department of PsychiatryUniversity of CologneCologneGermany,German Center For Neurodegenerative Diseases/Clinical ResearchDeutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE)Zentrum für klinische Forschung/AGCologneGermany
| | - Pieter Jelle Visser
- Alzheimer Centre LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands,Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands,Department of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
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Nieuwboer M, Van der Sande R, Olde Rikkert M, Van der Marck M, Perry M. Clinical leadership training in integrated primary care networks: a qualitative evaluation. Integ Health J 2022. [DOI: 10.1136/ihj-2021-000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo explore how a clinical leadership training programme contributes to successful implementation of integrated dementia care in local primary care networks.Methods and analysisA qualitative design was used in local primary care networks in the Netherlands. Twenty-six primary care professionals, nurses (n=22), general practitioners (n=2) and occupational therapists (n=2) followed a 2-year practice-based educational programme including individual coaching and interactive group training. Embedded leadership training created opportunities for direct application of acquired leadership skills. Reports of coaching sessions and transcripts of semi-structured interviews with 20 leadership trainees, 8 network members and a focus group interview with 9 leadership trainees were thematically analysed.ResultsThey identified 50 learning goals, mostly associated with personal leadership competences. These professionals perceived some improvement in their leadership behaviour and preferred a duo-network leadership arrangement. Individual coaching sessions and group training sessions were perceived as fruitful support. Coaching sessions were found to facilitate learning processes regarding personal competencies, collaboration issues and role clarification. Group meetings were appreciated for exercises on transformational leadership behaviour and exchange of experiences. Network leaders and members observed improved quality of care and mentioned continuity of leadership, perseverance of leaders and a sufficient time period to bring about change as important facilitating factors.ConclusionClinical leadership training to stimulate integrated primary care is promising as it was positively valued and contributed to improved perceived leadership competencies. Network leaders and members experienced improved quality of care when at least continuity in leadership was warranted.
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te Pas M, Olde Rikkert M, Bouwman A, Kessels R, Buise M. Screening for Mild Cognitive Impairment in the Preoperative Setting: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10061112. [PMID: 35742163 PMCID: PMC9223065 DOI: 10.3390/healthcare10061112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
Cognitive impairment predisposes patients to the development of delirium and postoperative cognitive dysfunction. In particular, in older patients, the adverse sequelae of cognitive decline in the perioperative period may contribute to adverse outcomes after surgical procedures. Subtle signs of cognitive impairment are often not previously diagnosed. Therefore, the aim of this review is to describe the available cognitive screeners suitable for preoperative screening and their psychometric properties for identifying mild cognitive impairment, as preoperative workup may improve perioperative care for patients at risk for postoperative cognitive dysfunction. Electronic systematic and snowball searches of PubMed, PsycInfo, ClinicalKey, and ScienceDirect were conducted for the period 2015–2020. Major inclusion criteria for articles included those that discussed a screener that included the cognitive domain ‘memory’, that had a duration time of less than 15 min, and that reported sensitivity and specificity to detect mild cognitive impairment. Studies about informant-based screeners were excluded. We provided an overview of the characteristics of the cognitive screener, such as interrater and test-retest reliability correlations, sensitivity and specificity for mild cognitive impairment and cognitive impairment, and duration of the screener and cutoff points. Of the 4775 identified titles, 3222 were excluded from further analysis because they were published prior to 2015. One thousand four hundred and forty-eight titles did not fulfill the inclusion criteria. All abstracts of 52 studies on 45 screeners were examined of which 10 met the inclusion criteria. For these 10 screeners, a further snowball search was performed to obtain related studies, resulting in 20 articles. Screeners included in this review were the Mini-Cog, MoCA, O3DY, AD8, SAGE, SLUMS, TICS(-M), QMCI, MMSE2, and Mini-ACE. The sensitivity and specificity range to detect MCI in an older population is the highest for the MoCA, with a sensitivity range of 81–93% and a specificity range of 74–89%. The MoCA, with the highest combination of sensitivity and specificity, is a feasible and valid routine screening of pre-surgical cognitive function. This warrants further implementation and validation studies in surgical pathways with a large proportion of older patients.
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Affiliation(s)
- Mariska te Pas
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
- Correspondence: ; Tel.: +31-627624857
| | - Marcel Olde Rikkert
- Radboud University Medical Center, Department of Geriatric Medicine, 6500 GL Nijmegen, The Netherlands;
| | - Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Roy Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands;
- Department of Medical Psychology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, 5803 AC Venray, The Netherlands
| | - Marc Buise
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
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8
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Schuurmans J, Crol C, Chabot B, Olde Rikkert M, Engels Y. Euthanasia in advanced dementia; the view of the general practitioners in the Netherlands on a vignette case along the juridical and ethical dispute. BMC Fam Pract 2021; 22:232. [PMID: 34789166 PMCID: PMC8600859 DOI: 10.1186/s12875-021-01580-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the Netherlands, euthanasia has been regulated by law since 2002. In the past decade, a growing number of persons with dementia requested for euthanasia, and more requests were granted. A euthanasia request from a patient with advanced dementia (PWAD) can have a major impact on a general practitioner (GP). We aimed to get insights in the views of Dutch GPs on euthanasia concerning this patient group. METHODS A postal survey was sent to 894 Dutch GPs. Questions were asked about a case vignette about a PWAD who was not able to confirm previous wishes anymore. Quantitative data were analyzed with descriptive statistics. RESULTS Of the 894 GPs approached, 422 (47.3%) completed the survey. One hundred seventy-eight GPs (42.2%) did not agree with the statement that an Advance Euthanasia Directive (AED) can replace an oral request if communication with the patient concerned has become impossible. About half of the respondents (209; 49.5%) did not agree that the family can initiate a euthanasia trajectory, 95 GPs (22.5%) would accept such a family initiative and 110 GPs (26.1%) would under certain conditions. DISCUSSION In case of a PWAD, when confirming previous wishes is not possible anymore, about half of the Dutch GPs would not accept an AED to replace verbal or non-verbal conformation nor consider performing euthanasia; a minority would. Our study shows that, probably due to the public debate and changed professional guidelines, conflicting views have arisen among Dutch GPs about interpretation of moral, ethical values considering AED and PWADs.
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Affiliation(s)
- Jaap Schuurmans
- General practice Ottenhoff, B. Ottenhoffstraat 18, 6561 CM Groesbeek, The Netherlands
| | - Chantalle Crol
- Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands
| | - Boudewijn Chabot
- General practice Ottenhoff, B. Ottenhoffstraat 18, 6561 CM Groesbeek, The Netherlands
| | - Marcel Olde Rikkert
- Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands
| | - Yvonne Engels
- Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands
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9
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Molema A, Melis R, Olde Rikkert M, Peeters G. [Do community-dwelling Dutch older adults receive the care that they need?]. Tijdschr Gerontol Geriatr 2021; 52. [PMID: 36408623 DOI: 10.36613/tgg.1875-6832/2021.04.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Aged care homes have been substituted by homecare to reduce the increasing Dutch healthcare costs. Ageing in place has led to a growing demand on formal and informal caregivers. The aim of this study was to examine: 1) the trends in formal and informal care, 2) whether care needs of community-living older adults are met, and 3) the association between care needs and quality of life (QoL). Methods Baseline data were used from 'The Older Persons and Informal Caregivers Survey - Minimum DataSet', which combines 54 studies conducted in 2008-2014. 12,735 participants met the inclusion criteria (age ≥65 years, living independently, needing assistance with washing, dressing, medication or household chores). Proportions of participants receiving formal or informal care were reported and associations with QoL were examined using ordinal (self-rated QoL) and linear (EQ-5D) regression. Results Formal care decreased from 75% to 63% and informal care increased from 16% to 28% between 2009 and 2013 (P < .001). Approximately one in four participants received no formal or informal care. Receiving no formal care was associated with a better QoL (self-rated QoL OR=1.39, CI=[1.251-1.544]; EQ-5D regression coefficient=0.038 CI=[0.023-0.053]). Conclusion The shift from formal to informal care together with the unmet care needs of community-living older adults in the Netherlands underlines the need for more support and a higher demand on informal caregivers.
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Affiliation(s)
- Anne Molema
- Afdeling geriatrie, Radboudumc, Nijmegen, Nederland
| | - René Melis
- Afdeling geriatrie, Radboudumc, Nijmegen, Nederland
| | - Marcel Olde Rikkert
- afdeling Geriatrie, Radboudumc Alzheimer Centrum, Radboud universitair medisch centrum, Nijmegen, Nederland
| | - Geeske Peeters
- Afdeling geriatrie, Radboudumc, Nijmegen, Nederland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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10
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Stolper E, Van Royen P, Jack E, Uleman J, Olde Rikkert M. Embracing complexity with systems thinking in general practitioners' clinical reasoning helps handling uncertainty. J Eval Clin Pract 2021; 27:1175-1181. [PMID: 33592677 PMCID: PMC8518614 DOI: 10.1111/jep.13549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/17/2021] [Accepted: 01/23/2021] [Indexed: 11/28/2022]
Abstract
Clinical reasoning in general practice is increasingly challenging because of the rise in the number of patients with multimorbidity. This creates uncertainty because of unpredictable interactions between the symptoms from multiple medical problems and the patient's personality, psychosocial context and life history. Case analysis may then be more appropriately managed by systems thinking than by hypothetic-deductive reasoning, the predominant paradigm in the current teaching of clinical reasoning. Application of "systems thinking" tools such as causal loop diagrams allows the patient's problems to be viewed holistically and facilitates understanding of the complex interactions. We will show how complexity levels can be graded in clinical reasoning and demonstrate where and how systems thinking can have added value by means of a case history.
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Affiliation(s)
- Erik Stolper
- Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Paul Van Royen
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Edmund Jack
- South West Peninsula National Institute for Health Research Applied Research Collaboration and University of Plymouth, Community and Primary Care Group, University of Plymouth, Plymouth, UK
| | - Jeroen Uleman
- Deptartment of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel Olde Rikkert
- Deptartment of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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11
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Olde Rikkert M, Jambroes M, Opstelten W. [Health professionals for the climate]. Ned Tijdschr Geneeskd 2021; 165:D6317. [PMID: 34542941] [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: 06/13/2023]
Abstract
More than 230 medical journals have called for worldwide action against global warming and for nature restoration. They call on health professionals to actively contribute to increasing support for the radical measures necessary to maintain the health and well-being of life on our planet. This call concerns not only making one's own living and working environment greener, but above all the use of medical knowledge, expertise and authority for measures that matter worldwide. This starts with concrete advice to patients to prevent damage from climate change at an individual level. Health workers must stand up for prevention and care outside the consultation room and across national borders. After all, medical doctors have historically been in a position to speak out about these threats and to remind political leaders of their responsibility.Health professionals can lead by example by realizing greener and more sustainable care themselves.
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12
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Atwoli L, H Baqui A, Benfield T, Bosurgi R, Godlee F, Hancocks S, Horton R, Laybourn-Langton L, Monteiro CA, Norman I, Patrick K, Praities N, Olde Rikkert M, Rubin EJ, Sahni P, Smith R, J Talley N, Turale S, Vázquez D. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. Bosn J Basic Med Sci 2021; 22:153-155. [PMID: 34482813 PMCID: PMC8977085 DOI: 10.17305/bjbms.2021.6411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ian Norman
- International Journal of Nursing Studies
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13
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Hesselink G, Sir Ö, Koster N, Tolsma C, Munsterman M, Olde Rikkert M, Schoon Y. Teach-back of discharge instructions in the emergency department: a pre-post pilot evaluation. Emerg Med J 2021; 39:139-146. [PMID: 34140321 PMCID: PMC8788250 DOI: 10.1136/emermed-2020-210168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 05/23/2021] [Indexed: 12/30/2022]
Abstract
Objectives With the 'teach-back' method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). We aimed to determine whether teach-back would reduce ED revisits and whether it would increase patients’ retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of instructions. Methods A nonrandomised pre–post pilot evaluation in the ED of one Dutch academic hospital including patients discharged from the ED receiving standard discharge care (pre) and teach-back (post). Primary outcomes were ED-revisits within 7 days and within 8–30 days postdischarge. Secondary outcomes for a subsample of older adults were retention of instructions, self-management 72 hours after discharge and satisfaction with the provision of discharge instructions. Results A total of 648 patients were included, 154 were older adults. ED revisits within 7 days and within 8–30 days were lower in the teach-back group compared with those receiving standard discharge care: adjusted odds ratios (AORs) of 0.23 (95% CI 0.05 to 1.07) and 0.42 (95% CI 0.14 to 1.33), respectively. Participants in the teach-back group had an increased likelihood of full knowledge retention on information related to their ED diagnosis and treatment (AOR 2.19; 95% CI 1.01 to 4.75; p=0.048), medication (AOR 14.89; 95% CI 4.12 to 53.85; p>0.001) and follow-up appointments (AOR 3.86; 95% CI 1.33 to 10.19; p=0.012). Use of teach-back was not significantly associated with improved self-management and higher satisfaction with discharge instructions. Discharge conversations were generally shorter for participants receiving teach-back. Conclusions Discharging patients from the ED with a relatively simple and feasible teach-back method can contribute to safer and better transitional care from the ED to home.
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Affiliation(s)
- Gijs Hesselink
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands .,IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Özcan Sir
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nadia Koster
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Carolien Tolsma
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maartje Munsterman
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvonne Schoon
- Department of Emergency Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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14
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Linden I, Wolfs C, Perry M, Metsemakers J, van der Weijden T, de Vugt M, Verhey FR, Handels R, Olde Rikkert M, Dirksen C, Ponds RWHM. Implementation of a diagnostic decision aid for people with memory complaints and their general practitioners: a protocol of a before and after pilot trial. BMJ Open 2021; 11:e049322. [PMID: 34135053 PMCID: PMC8211080 DOI: 10.1136/bmjopen-2021-049322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Researchers, policy-makers and healthcare professionals often stress the importance of an early dementia diagnosis. Empirical evidence, however, is scarce leading to a lack of consensus on the necessity of diagnosing dementia early. We emphasise the need for a 'timely' diagnosis, that is, one that occurs at the right moment for a person with memory complaints and his/her significant other. As the optimal timing differs between individuals, the implementation of shared decision making (SDM), preferably by the general practitioner (GP), as the start of a diagnostic trajectory, could help to determine this timely moment. SDM, however, is rarely practised with respect to dementia diagnoses. Therefore, in the context of the Shared Decision-Making regarding Dementia Diagnosis project, a patient decision aid (PtDA) for 'timely' dementia diagnosis in general practice will be developed. This protocol will describe the planned before and after evaluation of its implementation. METHODS AND ANALYSIS In a mixed-methods pilot study, we will investigate decision-making processes and experiences regarding a diagnostic trajectory before and after the introduction of a PtDA for people with memory complaints, their significant others and their GPs. The 'before group' will receive diagnostics as usual from their GPs. The 'after group' will use the PtDA. We expect the PtDA to increase the level of SDM and to contribute to a timely and personalised diagnostic trajectory. Data will be collected using semistructured interviews, questionnaires and information retrieved from people with memory complaints' medical records. ETHICS AND DISSEMINATION This study protocol was approved by the Medical Review Ethics Committee of the Maastricht University Medical Centre. The findings will be published in peer-reviewed international journals and presented at conferences. This study was funded by the public funded Dutch Research Institute for Care and Medical Sciences (ZonMw). TRIAL REGISTRATION NUMBER NCT04531956.
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Affiliation(s)
- Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboudumc, Nijmegen, The Netherlands
| | - Job Metsemakers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboudumc, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Carmen Dirksen
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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15
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Burns A, Lobo A, Olde Rikkert M, Robert P, Sartorius N, Semrau M, Stoppe G. COVID-19 and dementia: experience from six European countries. Int J Geriatr Psychiatry 2021; 36:943-949. [PMID: 33462849 PMCID: PMC8014272 DOI: 10.1002/gps.5497] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022]
Abstract
The effects of coronavirus disease 2019 (COVID-19) have been well documented across the world with an appreciation that older people and in particular those with dementia have been disproportionately and negatively affected by the pandemic. This is both in terms of their health outcomes (mortality and morbidity), care decisions made by health systems and the longer-term effects such as neurological damage. The International Dementia Alliance is a group of dementia specialists from six European countries and this paper is a summary of our experience of the effects of COVID-19 on our populations. Experience from England, France, Germany, the Netherlands, Spain and Switzerland highlight the differential response from health and social care systems and the measures taken to maximise support for older people and those with dementia. The common themes include recognition of the atypical presentation of COVID-19 in older people (and those with dementia) need to pay particular attention to the care of people with dementia in care homes; the recognition of the toll that isolation can bring on older people and the complexity of the response by health and social services to minimise the negative impact of the pandemic. Potential new ways of working identified during the pandemic could serve as a positive legacy from the crisis.
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Affiliation(s)
| | - Antonio Lobo
- Instituto de Investigación Sanitaria Aragón (IIS‐Aragón)Universidad ZaragozaCIBERSAMNational Institute of Health Carlos III (ISC III)ZaragozaSpain
| | - Marcel Olde Rikkert
- Radboudumc Alzheimer CenterRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Philippe Robert
- CoBteK Lab and CHU Nice Memory CenterUniversity Cote d’AzurNiceFrance
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
| | - Maya Semrau
- Global Health and Infection DepartmentBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Gabriela Stoppe
- University of Basel and MentAge Consulting—Practice‐Research BaselBaselSwitzerland
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16
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Rombach I, Iftikhar M, Jhuti GS, Gustavsson A, Lecomte P, Belger M, Handels R, Castro Sanchez AY, Kors J, Hopper L, Olde Rikkert M, Selbæk G, Stephan A, Sikkes SAM, Woods B, Gonçalves-Pereira M, Zanetti O, Ramakers IHGB, Verhey FRJ, Gallacher J, Actifcare Consortium, LeARN Consortium, Landeiro F, Gray AM. Obtaining EQ-5D-5L utilities from the disease specific quality of life Alzheimer's disease scale: development and results from a mapping study. Qual Life Res 2021; 30:867-879. [PMID: 33068236 PMCID: PMC7952290 DOI: 10.1007/s11136-020-02670-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE The Quality of Life Alzheimer's Disease Scale (QoL-AD) is commonly used to assess disease specific health-related quality of life (HRQoL) as rated by patients and their carers. For cost-effectiveness analyses, utilities based on the EQ-5D are often required. We report a new mapping algorithm to obtain EQ-5D indices when only QoL-AD data are available. METHODS Different statistical models to estimate utility directly, or responses to individual EQ-5D questions (response mapping) from QoL-AD, were trialled for patient-rated and proxy-rated questionnaires. Model performance was assessed by root mean square error and mean absolute error. RESULTS The response model using multinomial regression including age and sex, performed best in both the estimation dataset and an independent dataset. CONCLUSIONS The recommended mapping algorithm allows researchers for the first time to estimate EQ-5D values from QoL-AD data, enabling cost-utility analyses using datasets where the QoL-AD but no utility measures were collected.
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Affiliation(s)
- Ines Rombach
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom.
| | - Marvi Iftikhar
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Gurleen S Jhuti
- Global Access, Centre of Excellence F.Hoffmann-La Roche Ltd, CH-4070, Basel, Switzerland
| | - Anders Gustavsson
- Quantify Research, Stockholm, 112 21, Sweden
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
| | - Pascal Lecomte
- Global Head Health Economic Modelling and Methodology, Novartis Pharma AG, 4002, Basel, Switzerland
| | - Mark Belger
- Global Statistical Sciences, Eli Lilly and company, Erl Wood Manor, Windlesham, GU20 6PH, United Kingdom
| | - Ron Handels
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands
| | | | - Jan Kors
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, 3015 GD, The Netherlands
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin 9, Ireland
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboudumc Alzheimer Center, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Geir Selbæk
- National Advisory Unit of Ageing and Health, Vestfold Hospital Trust, 3103, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, 0372, Norway
- Faculty of Medicine, University of Oslo, Oslo, 0372, Norway
| | - Astrid Stephan
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), 06112, Germany
| | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Amsterdam University Medical Centers/Amsterdam Neuroscience, Amsterdam, 1007 MB, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre Wales (DSDC), Bangor University, Bangor, LL57 2PZ, United Kingdom
| | - Manuel Gonçalves-Pereira
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, 1169-056, Portugal
- CHRC (Comprehensive Health Research Centre), Lisbon, Portugal
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, 25125, Italy
| | - Inez H G B Ramakers
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands
| | - Frans R J Verhey
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands
| | - John Gallacher
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | | | | | - Filipa Landeiro
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Alastair M Gray
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
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17
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Frederiksen KS, Nielsen TR, Appollonio I, Andersen BB, Riverol M, Boada M, Ceccaldi M, Dubois B, Engelborghs S, Frölich L, Hausner L, Gabelle A, Gabryelewicz T, Grimmer T, Hanseeuw B, Hort J, Hugon J, Jelic V, Koivisto A, Kramberger MG, Lebouvier T, Lleó A, de Mendonça A, Nobili F, Ousset PJ, Perneczky R, Olde Rikkert M, Robinson D, Rouaud O, Sánchez E, Santana I, Scarmeas N, Sheardova K, Sloan S, Spiru L, Stefanova E, Traykov L, Yener G, Waldemar G. Biomarker counseling, disclosure of diagnosis and follow-up in patients with mild cognitive impairment: A European Alzheimer's disease consortium survey. Int J Geriatr Psychiatry 2021; 36:324-333. [PMID: 32896040 DOI: 10.1002/gps.5427] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is associated with an increased risk of further cognitive decline, partly depending on demographics and biomarker status. The aim of the present study was to survey the clinical practices of physicians in terms of biomarker counseling, management, and follow-up in European expert centers diagnosing patients with MCI. METHODS An online email survey was distributed to physicians affiliated with European Alzheimer's disease Consortium centers (Northern Europe: 10 centers; Eastern and Central Europe: 9 centers; and Southern Europe: 15 centers) with questions on attitudes toward biomarkers and biomarker counseling in MCI and dementia. This included postbiomarker counseling and the process of diagnostic disclosure of MCI, as well as treatment and follow-up in MCI. RESULTS The response rate for the survey was 80.9% (34 of 42 centers) across 20 countries. A large majority of physicians had access to biomarkers and found them useful. Pre- and postbiomarker counseling varied across centers, as did practices for referral to support groups and advice on preventive strategies. Less than half reported discussing driving and advance care planning with patients with MCI. CONCLUSIONS The variability in clinical practices across centers calls for better biomarker counseling and better training to improve communication skills. Future initiatives should address the importance of communicating preventive strategies and advance planning.
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Affiliation(s)
- Kristian S Frederiksen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas R Nielsen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ildebrando Appollonio
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Birgitte Bo Andersen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mario Riverol
- Department of Neurology, Clinica Universidad de Navarra, University of Navarra, Madrid, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mathieu Ceccaldi
- Department of Neurology and Neuropsychology, CHU Timone, APHM and Aix Marseille University, Inserm, Institut de Neurosciences des Systèmes, Marseille, France
| | - Bruno Dubois
- Alzheimer Research Center (IM2A) and Department of Neurology, Salpêtrière University Hospital, AP-HP, Sorbonne University, Paris, France
| | - Sebastiaan Engelborghs
- Reference Center of Biological Markers of Dementia (BIODEM), Institute Born-Bunge and University of Antwerp, Antwerp, Belgium.,Department of Neurology and Center for Neurosciences, UZ Brussel and Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute for Mental Health, University of Heidelberg, Mannheim, Germany
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute for Mental Health, University of Heidelberg, Mannheim, Germany
| | - Audrey Gabelle
- Department of Neurology, Memory Resources and Research Center, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Tomasz Gabryelewicz
- Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre PAN, Warsaw, Poland
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernard Hanseeuw
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institute of Neuroscience, Brussels, Belgium
| | - Jakub Hort
- Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jacques Hugon
- Center of Cognitive Neurology, Lariboisière Hospital Paris, University of Paris, Paris, France
| | - Vesna Jelic
- Clinic for Cognitive Disorders, Theme Aging, Karolinska University Hospital - Huddinge, Stockholm, Sweden
| | - Anne Koivisto
- Department of Neurology, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland.,Department of Neurosciences and Geriatrics, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Milica G Kramberger
- Center for Cognitive Impairments, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Thibaud Lebouvier
- Lille 2 University of Health and Law, Pôle de Neurologie, Lille, France
| | - Alberto Lleó
- Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Flavio Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pierre-Jean Ousset
- Memory Clinic, Clinical Research Center, Toulouse University Hospital, Toulouse, France
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,German Center for Neurodegenerative Disorders (DZNE) Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Olivier Rouaud
- Department of Clinical Neuroscience, Vaud University Hospital, Leenaards Memory Centre, Lausanne, Switzerland
| | - Elisabet Sánchez
- Servicio de geriatria, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, Columbia University Medical Center, New York, USA
| | - Katerina Sheardova
- Memory Center ICRC, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Stephanie Sloan
- Neuroprogressive Disorders and Dementia Network, Ninewells Hospital, Dundee, Scotland
| | - Luiza Spiru
- Geriatrics-Gerontology and Old Age Psychiatry (Alzheimer Unit) Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Excellence Memory Clinic and Longevity Medicine, Ana Aslan International Foundation, Bucharest, Romania
| | - Elka Stefanova
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Görsev Yener
- Department of Neurosciences, Dokuz Eylül University Medical School, Izmir, Turkey.,Department of Neurology, Dokuz Eylül University Medical School, Izmir, Turkey
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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18
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Schuurmans J, Crol C, Olde Rikkert M, Engels Y. Dutch GPs' experience of burden by euthanasia requests from people with dementia: a quantitative survey. BJGP Open 2021; 5:bjgpopen20X101123. [PMID: 33172849 PMCID: PMC7960528 DOI: 10.3399/bjgpopen20x101123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In the Netherlands during the past decade, a growing number of people with dementia requested euthanasia, and each year more of such requests were granted. AIM To obtain quantitative insights into the problems and needs of GPs when confronted with a euthanasia request by a person with dementia. DESIGN & SETTING A concept survey was composed for GPs in the Netherlands. Expert validity of the survey was achieved through pilot testing. METHOD A postal survey was sent to a random sample of 900 Dutch GPs, regardless of their opinion on, or practical experience with, euthanasia. Collected data were analysed with descriptive statistics. RESULTS Of 894 GPs, 423 (47.3%) completed the survey, of whom 176 (41.6%) had experience with euthanasia requests from people with dementia. Emotional burden was reported most frequently (n = 86; 52.8%), as well as feeling uncertain about the mental competence of the person with dementia (n = 77; 47.2%), pressure by relatives (n = 70; 42.9%) or the person with dementia (n = 56; 34.4%), and uncertainty about handling advance euthanasia directives (AEDs) (n = 43; 26.4%). GPs would appreciate more support from the following: a support and consultation in euthanasia in the Netherlands (SCEN) physician (an independent physician for support, information, and formal consultation around euthanasia) (n = 291; 68. 8%); a geriatric consultation team (n = 185; 43.7%); the end-of-life clinic (n = 184; 43.5%); or a palliative care consultation team (n = 179; 42.3%). Surprisingly the need for moral deliberation was hardly mentioned. CONCLUSION The reported burden and the rise in numbers and complexity of euthanasia requests from people with dementia warrants primary care support. There needs to be easier access to colleagues with expertise, and training on end-of-life care needs of patients with dementia and their caregivers.
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Affiliation(s)
- Jaap Schuurmans
- GP, Radboud University, Groesbeek, The Netherlands
- Researcher, Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen, Netherlands
| | - Chantalle Crol
- Primary Care Physician of the Elderly, Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Professor, Department Geriatric Medicine, Radboud University, Nijmegen, The Netherlands
| | - Yvonne Engels
- Professor in Meaningful Healthcare, Anesthesiology, Radboudumc, Nijmegen, The Netherlands
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19
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Soheili-Nezhad S, van der Linden RJ, Olde Rikkert M, Sprooten E, Poelmans G. Long genes are more frequently affected by somatic mutations and show reduced expression in Alzheimer's disease: Implications for disease etiology. Alzheimers Dement 2020; 17:489-499. [PMID: 33075204 PMCID: PMC8048495 DOI: 10.1002/alz.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/11/2020] [Accepted: 10/21/2020] [Indexed: 12/17/2022]
Abstract
Aging, the greatest risk factor for Alzheimer's disease (AD), may lead to the accumulation of somatic mutations in neurons. We investigated whether somatic mutations, specifically in longer genes, are implicated in AD etiology. First, we modeled the theoretical likelihood of genes being affected by aging‐induced somatic mutations, dependent on their length. We then tested this model and found that long genes are indeed more affected by somatic mutations and that their expression is more frequently reduced in AD brains. Furthermore, using gene‐set enrichment analysis, we investigated the potential consequences of such long gene disruption. We found that long genes are involved in synaptic adhesion and other synaptic pathways that are predicted to be inhibited in the brains of AD patients. Taken together, our findings indicate that long gene–dependent synaptic impairment may contribute to AD pathogenesis.
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Affiliation(s)
- Sourena Soheili-Nezhad
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emma Sprooten
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Boumans R, van Meulen F, van Aalst W, Albers J, Janssen M, Peters-Kop M, Huisman-de Waal G, van de Poll A, Hindriks K, Neerincx M, Olde Rikkert M. Quality of Care Perceived by Older Patients and Caregivers in Integrated Care Pathways With Interviewing Assistance From a Social Robot: Noninferiority Randomized Controlled Trial. J Med Internet Res 2020; 22:e18787. [PMID: 32902387 PMCID: PMC7511864 DOI: 10.2196/18787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background Society is facing a global shortage of 17 million health care workers, along with increasing health care demands from a growing number of older adults. Social robots are being considered as solutions to part of this problem. Objective Our objective is to evaluate the quality of care perceived by patients and caregivers for an integrated care pathway in an outpatient clinic using a social robot for patient-reported outcome measure (PROM) interviews versus the currently used professional interviews. Methods A multicenter, two-parallel-group, nonblinded, randomized controlled trial was used to test for noninferiority of the quality of care delivered through robot-assisted care. The randomization was performed using a computer-generated table. The setting consisted of two outpatient clinics, and the study took place from July to December 2019. Of 419 patients who visited the participating outpatient clinics, 110 older patients met the criteria for recruitment. Inclusion criteria were the ability to speak and read Dutch and being assisted by a participating health care professional. Exclusion criteria were serious hearing or vision problems, serious cognitive problems, and paranoia or similar psychiatric problems. The intervention consisted of a social robot conducting a 36-item PROM. As the main outcome measure, the customized Consumer Quality Index (CQI) was used, as reported by patients and caregivers for the outpatient pathway of care. Results In total, 75 intermediately frail older patients were included in the study, randomly assigned to the intervention and control groups, and processed: 36 female (48%) and 39 male (52%); mean age 77.4 years (SD 7.3), range 60-91 years. There was no significant difference in the total patient CQI scores between the patients included in the robot-assisted care pathway (mean 9.27, SD 0.65, n=37) and those in the control group (mean 9.00, SD 0.70, n=38): P=.08, 95% CI –0.04 to 0.58. There was no significant difference in the total CQI scores between caregivers in the intervention group (mean 9.21, SD 0.76, n=30) and those in the control group (mean 9.09, SD 0.60, n=35): P=.47, 95% CI –0.21 to 0.46. No harm or unintended effects occurred. Conclusions Geriatric patients and their informal caregivers valued robot-assisted and nonrobot-assisted care pathways equally. Trial Registration ClinicalTrials.gov NCT03857789; https://clinicaltrials.gov/ct2/show/NCT03857789
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Affiliation(s)
- Roel Boumans
- Geriatric Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fokke van Meulen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Center for Sleep Medicine, Kempenhaege Foundation, Heeze, Netherlands
| | - William van Aalst
- Geriatric Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joyce Albers
- Geriatric Department, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - Marèse Janssen
- Geriatric Department, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - Marieke Peters-Kop
- Geriatric Department, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | | | | | - Koen Hindriks
- Social AI Group, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark Neerincx
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, Netherlands
| | - Marcel Olde Rikkert
- Geriatric Department, Radboud University Medical Center, Nijmegen, Netherlands
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21
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Hesselink G, Sir Ö, Öztürk E, Heiwegen N, Olde Rikkert M, Schoon Y. Effects of a geriatric education program for emergency physicians: a mixed-methods study. Health Educ Res 2020; 35:216-227. [PMID: 32243526 PMCID: PMC7568505 DOI: 10.1093/her/cyaa007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
Emergency physicians (EPs) often regard care for older adults as complex, while they lack sufficient geriatric skills. This study evaluates the effect of a geriatric education program on EPs' geriatric knowledge, attitude and medical practice when treating older adults. A mixed-methods study was performed on EPs from two Dutch hospitals. Effects were measured by pre-post tests of EPs' (n = 21) knowledge of geriatric syndromes and attitudes toward older adults, and by a retrospective pre-post analysis of 100 records of patients aged 70 years or more. Six EPs were purposively sampled and interviewed after completion of the education program. The program significantly improved EPs' geriatric knowledge. EPs indicated that the program improved their ability and attentiveness to recognize frailty and geriatric syndromes. The program also significantly improved EPs' attention for the older patient's social history and circumstances (P = 0.04) but did not have a significant effect on medical decision making. EPs valued especially the case-based teaching and indicated that the interactive setting helped them to better understand and retain knowledge. Combined quantitative and qualitative data suggest that EPs benefit from geriatric emergency teaching. Future enhancement and evaluation of the geriatric education program is needed to confirm benefits to clinical practice and patient outcomes.
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Affiliation(s)
- Gijs Hesselink
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Health Care, Nijmegen, The Netherlands
| | - Özcan Sir
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ekin Öztürk
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nikki Heiwegen
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Abdullah L, Crawford F, Tsolaki M, Börjesson-Hanson A, Olde Rikkert M, Pasquier F, Wallin A, Kennelly S, Ait-Ghezala G, Paris D, Hendrix S, Blennow K, Lawlor B, Mullan M. The Influence of Baseline Alzheimer's Disease Severity on Cognitive Decline and CSF Biomarkers in the NILVAD Trial. Front Neurol 2020; 11:149. [PMID: 32210906 PMCID: PMC7067750 DOI: 10.3389/fneur.2020.00149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
We examined the effects of a dihydropyridine calcium channel blocker nilvadipine with anti-inflammatory properties on cognition and cerebrospinal fluid (CSF) biomarkers by baseline Alzheimer's disease (AD) severity. Exploratory analyses were performed on the dataset (n = 497) of a phase III randomized placebo-controlled trial to examine the response to nilvadipine in AD subjects stratified by baseline AD severity into very mild (MMSE ≥ 25), mild (MMSE 20-24) and moderate AD (MMSE < 20). The outcome measures included total and subscale scores of the Alzheimer's Disease Assessment Scale Cognitive 12 (ADAS-Cog 12), the Clinical Dementia Rating Scale sum of boxes (CDR-sb) and the AD composite score (ADCOMS). Cerebrospinal fluid biomarkers Aβ38, Aβ40, Aβ42, neurofilament light chain (NFL), neurogranin, YKL-40, total tau and P181 tau (ptau) were measured in a subset of samples (n = 55). Regression analyses were adjusted for confounders to specifically examine the influence of nilvadipine and baseline AD severity on cognitive outcomes over 78-weeks. Compared to their respective placebo-controls, nilvadipine-treated, very mild AD subjects showed less decline, whereas moderate AD subjects showed a greater cognitive decline on the ADAS-Cog 12 test and the ADCOMS. A lower decline was observed after nilvadipine treatment for a composite memory trait in very mild AD subjects and a composite language trait in mild AD subjects. Cerebrospinal fluid Aβ42/Aβ40 ratios were increased in mild AD and decreased in moderate AD patients treated with nilvadipine, compared to their respective controls. Among moderate AD subjects, levels of ptau, total tau, neurogranin and YKL-40 increased in subjects treated with nilvadipine compared to placebo. These studies suggest that baseline AD severity influenced the treatment outcome in the NILVAD trial and that future clinical trials of nilvadipine should be restricted to mild and very mild AD patients. Trial Registration: NCT02017340 Registered 20 December 2013, https://clinicaltrials.gov/ct2/show/NCT02017340 EUDRACT Reference Number 2012-002764-27 Registered 04 February 2013, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-002764-27
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Affiliation(s)
| | - Fiona Crawford
- Roskamp Institute, Sarasota, FL, United States.,Archer Pharmaceuticals, Sarasota, FL, United States
| | - Magda Tsolaki
- Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anne Börjesson-Hanson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute of Medical Neurosciences, Radboudumc, Nijmegen, Netherlands
| | - Florence Pasquier
- CHU Lille, Univ. Lille, DISTALZ Laboratory of Excellence, Lille, France
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sean Kennelly
- Trinity College Dublin, College Green, Dublin, Ireland.,Department of Age Related Healthcare, Tallaght Hospital, Dublin, Ireland
| | | | | | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Clincial Neurochemistry Laboratory, Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden
| | - Brian Lawlor
- Trinity College Dublin, College Green, Dublin, Ireland
| | - Michael Mullan
- Roskamp Institute, Sarasota, FL, United States.,Archer Pharmaceuticals, Sarasota, FL, United States
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23
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Hillel I, Avanzino L, Cereatti A, Rikkert MO, Din SD, Ginis P, Mirelman A, Hausdorff JM. WEARABLES REVEAL A GAP BETWEEN GAIT PERFORMANCE IN THE LAB AND DURING 24/7 MONITORING IN OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6839987 DOI: 10.1093/geroni/igz038.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We compared in-lab usual-walking (UW) and dual-task walking (DTW) to daily-living measures of gait obtained during 24/7 monitoring. In-lab gait features (e.g., gait speed, step and stride regularity) derived from UW and DTW were compared to the same gait features during daily-living in 150 elderly fallers (age: 76.5±6.3 years, 37.6% men). Features were extracted from a lower-back accelerometer. In daily-living setting, subjects wore the device for one week and pre-processing detected 30-second walking bouts. A histogram of all walking bouts was determined for each walking feature for each subject, then each subject’s typical, worst and best values were determined. Statistics of reliability were assessed using ICC and Bland-Altman. As expected, in-lab gait speed, step regularity, and stride regularity were worse during DTW, compared to UW. Gait speed, step regularity, and stride regularity during UW were significantly higher (i.e., better) from the typical daily-living values (p<0.0001) and different (p<0.000) from the worst and best values. DTW values tended to be similar to typical daily-living values (p=0.205, p=0.053, p=0.013 respectively). ICC assessment and Bland-Altman plots indicated that in-lab values do not reliably reflect the daily-walking values. Gait values during relatively long daily-living walking bouts are more similar to the corresponding values obtained in the lab during DTW, as compared to UW. Still, gait performance during most daily-living walking bouts are worse than that measured in-lab and do not reliably reflect each other. That is, an older adult’s typical daily-living gait cannot be estimated by simply measuring walking in a structured, laboratory setting.
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Affiliation(s)
- Inbar Hillel
- Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel, Tel Aviv, Israel
| | - Laura Avanzino
- IRCCS San Martino Teaching Hospital, Genoa, Italy., Genoa, Italy
| | - Andrea Cereatti
- Department of Biomedical Sciences, Bioengineering unit, University of Sassari, Italy, Sassari, Italy
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Donders Centre for Medical Neuroscience, Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands, Nijmegen, Netherlands
| | - Silvia Del Din
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK, Newcastle upon Tyne, United Kingdom
| | - Pieter Ginis
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium, Leuven, Belgium
| | - Anat Mirelman
- Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel, Tel Aviv, Israel
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24
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van der Wulp K, van Wely M, van Heijningen L, van Bakel B, Schoon Y, Verkroost M, Gehlmann H, Van Garsse L, Vart P, Kievit P, Rikkert MO, Morshuis W, van Royen N. Delirium After Transcatheter Aortic Valve Implantation Under General Anesthesia: Incidence, Predictors, and Relation to Long-Term Survival. J Am Geriatr Soc 2019; 67:2325-2330. [PMID: 31342524 PMCID: PMC6899857 DOI: 10.1111/jgs.16087] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Prospectively collected data on postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) are scarce. The aim of this study was to report the incidence and risk factors of delirium after TAVI under general anesthesia and to assess the association of POD with clinical outcome and short‐ and long‐term survival. DESIGN Prospective cohort study. SETTING Academic medical center. PARTICIPANTS A total of 703 subsequent patients undergoing TAVI under general anesthesia between 2008 and 2017. MEASUREMENTS Delirium was assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV), criteria. Outcomes were postprocedural clinical outcome and short‐ and long‐term survival (30 days and 5 years, respectively). RESULTS POD was observed in 16.5% (116/703), was the strongest independent predictor of long‐term mortality (hazard ratio = 1.91; 95% confidence interval [CI] = 1.36‐2.70), and was associated with impaired 30‐day and 5‐year survival (92.2% vs 96.8% [P = .025] and 40.0% vs 50.0% [P = .007], respectively). Stroke and new onset of atrial fibrillation were more often observed in delirious patients (6.9% vs 1.9% and 12.1% vs 5.1%, respectively). Strongest independent predictors of POD were prior delirium (odds ratio [OR] = 2.56; 95% CI = 1.52‐4.31) and aortic valve area less than 0.75 cm2 (OR = 2.39; 95% CI = 1.53‐3.74). CONCLUSION One in six patients experienced POD after TAVI under general anesthesia. POD was the strongest predictor of long‐term mortality and was associated with impaired short‐ and long‐term survival. Prior delirium and a more calcified aortic valve were the strongest independent predictors of POD. J Am Geriatr Soc 67:2325–2330, 2019
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Affiliation(s)
- Kees van der Wulp
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marleen van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars van Heijningen
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram van Bakel
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Verkroost
- Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helmut Gehlmann
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leen Van Garsse
- Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Priya Vart
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Kievit
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim Morshuis
- Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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25
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Hesselink G, Demirbas M, Rikkert MO, Schoon Y. Geriatric Education Programs for Emergency Department Professionals: A Systematic Review. J Am Geriatr Soc 2019; 67:2402-2409. [PMID: 31335964 PMCID: PMC6900059 DOI: 10.1111/jgs.16067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/05/2019] [Accepted: 06/08/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate geriatric education programs for emergency department (ED) professionals based on: content and teaching methods and learning outcome effects and factors promoting or hindering program implementation. DESIGN Systematic review. SETTING ED. PARTICIPANTS Physicians, nurses, and medical residents working in the ED. METHODS AND MEASUREMENT Five major biomedical databases were searched for (quasi) experimental studies, published between 1990 and April 2018, evaluating geriatric education programs for ED professionals. Data were synthesized around study quality, learning participants, teaching content and methods, and Kirkpatrick learning outcomes. RESULTS Nine before‐after studies were included. Learners were mostly ED residents and, to a smaller extent, ED nurses and physicians. Study quality was moderate, with the lowest scores on sampling and instrument validity. Programs varied from a 1‐day workshop to a 2‐year curriculum, mostly combining didactic lectures with active and experiential learning formats. Topics commonly addressed included managing: geriatric syndromes, trauma and falls, medication, atypical presentations, and care transitions. Statistically significant improvements were mostly found in learners' knowledge acquisition (six studies). Significant improvements were also found in single studies on: self‐reported geriatric screening, documentation of geriatric care, and appropriate urinary catheter placement. Factors promoting program implementation included: solving competing educational demands and busy work schedules, embedding the program in preexisting curricula, and close collaboration between emergency and geriatric medicine faculties. CONCLUSIONS Various geriatric education programs improve the geriatric knowledge of ED professionals and seem to positively impact their clinical practice. However, more program evaluations with larger study samples, and use of valid and reliable outcome measures, are needed to provide robust evidence on the effectiveness of such programs. J Am Geriatr Soc, 1–8, 2019. J Am Geriatr Soc 67:2402–2409, 2019
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Affiliation(s)
- Gijs Hesselink
- Emergency Department, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,IQ Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Mehmet Demirbas
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Emergency Department, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Geriatric Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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26
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Vermunt L, Sikkes SAM, van den Hout A, Handels R, Bos I, van der Flier WM, Kern S, Ousset PJ, Maruff P, Skoog I, Verhey FRJ, Freund-Levi Y, Tsolaki M, Wallin ÅK, Olde Rikkert M, Soininen H, Spiru L, Zetterberg H, Blennow K, Scheltens P, Muniz-Terrera G, Visser PJ. Duration of preclinical, prodromal, and dementia stages of Alzheimer's disease in relation to age, sex, and APOE genotype. Alzheimers Dement 2019; 15:888-898. [PMID: 31164314 PMCID: PMC6646097 DOI: 10.1016/j.jalz.2019.04.001] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/28/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We estimated the age-specific duration of the preclinical, prodromal, and dementia stages of Alzheimer's disease (AD) and the influence of sex, setting, apolipoprotein E (APOE) genotype, and cerebrospinal fluid tau on disease duration. METHODS We performed multistate modeling in a combined sample of 6 cohorts (n = 3268) with death as the end stage and estimated the preclinical, prodromal, and dementia stage duration. RESULTS The overall AD duration varied between 24 years (age 60) and 15 years (age 80). For individuals presenting with preclinical AD, age 70, the estimated preclinical AD duration was 10 years, prodromal AD 4 years, and dementia 6 years. Male sex, clinical setting, APOE ε4 allele carriership, and abnormal cerebrospinal fluid tau were associated with a shorter duration, and these effects depended on disease stage. DISCUSSION Estimates of AD disease duration become more accurate if age, sex, setting, APOE, and cerebrospinal fluid tau are taken into account. This will be relevant for clinical practice and trial design.
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Affiliation(s)
- Lisa Vermunt
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Sietske A M Sikkes
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ardo van den Hout
- Department of Statistical Science, University College London, London, UK
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Isabelle Bos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Silke Kern
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Paul Maruff
- Cogstate Ltd, Florey Institute, University of Melbourne, Melbourne, Australia
| | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - Yvonne Freund-Levi
- Department of Neurobiology, Caring Sciences and Society (NVS), Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Old Age Psychiatry, Psychology and Neuroscience, King's College London, London, UK; School of Medical Sciences, Orebro University Campus USÖ, Örebro, Sweden
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Memory and Dementia Center, "G Papanicolau" General Hospital, Thessaloniki, Greece
| | - Åsa K Wallin
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Luisa Spiru
- "Carol Davila" University of Medicine and Pharmacy, Geriatrics-Gerontology and Old Age Psychiatry Clinical Department -"Elias" University Clinical Hospital, Bucarest, Romenia; "Ana Aslan" International Academy of Aging - The Memory Clinic and Longevity Medicine, Bucarest, Romenia
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Pieter Jelle Visser
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
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27
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Devenney KE, Guinan EM, Kelly ÁM, Mota BC, Walsh C, Olde Rikkert M, Schneider S, Lawlor B. Acute high-intensity aerobic exercise affects brain-derived neurotrophic factor in mild cognitive impairment: a randomised controlled study. BMJ Open Sport Exerc Med 2019; 5:e000499. [PMID: 31258928 PMCID: PMC6563898 DOI: 10.1136/bmjsem-2018-000499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the brain-derived neurotrophic factor (BDNF) and cognitive response to a short bout of high-intensity aerobic exercise in older adults with mild cognitive impairment (MCI). METHODS Participants were randomised to one of two testing schedules, completing either a standardised exercise test (group A) or a resting control condition (group B). Blood sampling and cognitive measures (visuospatial learning and memory, sustained attention and executive function) were collected at baseline (T1) and postintervention (T2). An additional measurement of study outcomes was collected after exercise (T3) in group B only. RESULTS 64 participants (female 53.2%, mean age 70.5±6.3 years) with MCI were recruited. From T1 to T2, serum BDNF (sBDNF) concentration increased in group A (n=35) (median (Md) 4564.61±IQR 5737.23 pg/mL to Md 5173.27±5997.54 pg/mL) and decreased in group B (Md 4593.74±9558.29 pg/mL to Md 3974.66±3668.22 pg/mL) (between-group difference p=0.024, effect size r=0.3). The control group made fewer errors on the sustained attention task compared with the exercise group (p=0.025). Measures of visuospatial learning and memory or executive function did not change significantly between groups. CONCLUSION This study is the first to show that a short bout of high-intensity aerobic exercise increases peripheral sBDNF in a population with MCI. However, acute exercise did not improve cognitive performance.
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Affiliation(s)
- Kate E Devenney
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Emer M Guinan
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Áine M Kelly
- Department of Physiology, Trinity College Institute of Neuroscience, Dublin, Ireland
| | - Bibiana C Mota
- Department of Physiology, Trinity College Institute of Neuroscience, Dublin, Ireland
| | - Cathal Walsh
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | | | - Stefan Schneider
- Institute of Movement and Neurosciences, German Sport University Cologne, Köln, Germany
| | - Brian Lawlor
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
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28
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Vermunt N, Elwyn G, Westert G, Harmsen M, Olde Rikkert M, Meinders M. Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis. BMC Fam Pract 2019; 20:76. [PMID: 31170920 PMCID: PMC6555756 DOI: 10.1186/s12875-019-0966-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
Background Multimorbidity poses a challenge for decision-making processes and requires that more attention is paid to patient goals, preferences and needs; however, goal setting is not yet widely recognised as a core aspect of the shared decision-making (SDM) approach. This study aims to analyse clinician perceptions of the concept of goal setting within the context of SDM with older patients with multimorbidity. Methods Semi-structured interviews with general practitioners (GPs) and clinical geriatricians (CGs) were analysed using a framework analysis. The integrative model of SDM was used to develop a categorisation matrix, including goal setting as an additional component. Results Sixteen of the 33 clinicians mentioned explicit Goal setting as an integrated component of their definition of SDM, which was comparable to the number of clinicians who listed Patient values and preferences (n = 16), Doctor knowledge and recommendations (n = 19) and Make or explicitly defer a decision (n = 19), elements which are commonly considered to be important aspects of SDM. The other 17 clinicians (6 CGs and 11 GPs) did not mention Goal setting as an explicit component of SDM. Our analysis revealed two potential reasons for this observation. Besides the use of other terminology, part of clinicians viewed collaborative goal setting and SDM as separate but related processes. Conclusions Our study on clinician perspectives highlighted goal setting as component of a SDM approach and could therefore be considered supportive of recent theoretical insights that SDM models that lack an explicit goal-setting component appear to be deficient and overlook an important aspect of engaging patients in decision-making, particularly for patients with complex multimorbidities. We therefore call for the further development of a comprehensive SDM approach for older patients with multimorbidity to include explicit and unequivocal goal setting elements to sufficiently meet the expectations and needs of clinicians and their patients. Electronic supplementary material The online version of this article (10.1186/s12875-019-0966-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neeltje Vermunt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500, HB, Nijmegen, The Netherlands. .,The Dutch Council for Health and Society, (Raad voor Volksgezondheid en Samenleving, RVS), The Hague, the Netherlands.
| | - Glyn Elwyn
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500, HB, Nijmegen, The Netherlands.,The Dartmouth Institute for Health Policy & Clinical Practice, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.,Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Gert Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Mirjam Harmsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Radboud university Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behavior, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.,Department of Geriatrics, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marjan Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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29
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Hillel I, Gazit E, Nieuwboer A, Avanzino L, Rochester L, Cereatti A, Croce UD, Rikkert MO, Bloem BR, Pelosin E, Del Din S, Ginis P, Giladi N, Mirelman A, Hausdorff JM. Is every-day walking in older adults more analogous to dual-task walking or to usual walking? Elucidating the gaps between gait performance in the lab and during 24/7 monitoring. Eur Rev Aging Phys Act 2019; 16:6. [PMID: 31073340 PMCID: PMC6498572 DOI: 10.1186/s11556-019-0214-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/11/2019] [Indexed: 01/22/2023] Open
Abstract
Background The traditional evaluation of gait in the laboratory during structured testing has provided important insights, but is limited by its “snapshot” character and observation in an unnatural environment. Wearables enable monitoring of gait in real-world environments over a week. Initial findings show that in-lab and real-world measures differ. As a step towards better understanding these gaps, we directly compared in-lab usual-walking (UW) and dual-task walking (DTW) to daily-living measures of gait. Methods In-lab gait features (e.g., gait speed, step regularity, and stride regularity) derived from UW and DTW were compared to the same gait features during daily-living in 150 elderly fallers (age: 76.5 ± 6.3 years, 37.6% men). In both settings, features were extracted from a lower-back accelerometer. In the real-world setting, subjects were asked to wear the device for 1 week and pre-processing detected 30-s daily-living walking bouts. A histogram of all walking bouts was determined for each walking feature for each subject and then each subject’s typical (percentile 50, median), worst (percentile 10) and the best (percentile 90) values over the week were determined for each feature. Statistics of reliability were assessed using Intra-Class correlations and Bland-Altman plots. Results As expected, in-lab gait speed, step regularity, and stride regularity were worse during DTW, compared to UW. In-lab gait speed, step regularity, and stride regularity during UW were significantly higher (i.e., better) than the typical daily-living values (p < 0.001) and different (p < 0.001) from the worst and best values. DTW values tended to be similar to typical daily-living values (p = 0.205, p = 0.053, p = 0.013 respectively). ICC assessment and Bland-Altman plots indicated that in-lab values do not reliably reflect the daily-walking values. Conclusions Gait values measured during relatively long (30-s) daily-living walking bouts are more similar to the corresponding values obtained in the lab during dual-task walking, as compared to usual walking. Still, gait performance during most daily-living walking bouts is worse than that measured during usual and dual-tasking in the lab. The values measured in the lab do not reliably reflect daily-living measures. That is, an older adult’s typical daily-living gait cannot be estimated by simply measuring walking in a structured, laboratory setting.
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Affiliation(s)
- Inbar Hillel
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Gazit
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Leuven, KU Belgium
| | - Laura Avanzino
- 3IRCCS San Martino Teaching Hospital, Genoa, Italy.,4Department of Experimental Medicine, Section of Human Physiology, University of Genova, Genoa, Italy
| | - Lynn Rochester
- 5Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,6The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrea Cereatti
- 7Department of Biomedical Sciences, Bioengineering unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- 7Department of Biomedical Sciences, Bioengineering unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Marcel Olde Rikkert
- 9Department of Geriatric Medicine, Donders Centre for Medical Neuroscience, Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- 10Department of Neurology, Donders Centre for Medical Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
| | - Elisa Pelosin
- 3IRCCS San Martino Teaching Hospital, Genoa, Italy.,4Department of Experimental Medicine, Section of Human Physiology, University of Genova, Genoa, Italy
| | - Silvia Del Din
- 5Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Pieter Ginis
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Leuven, KU Belgium
| | - Nir Giladi
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,11Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,12Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,11Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,12Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,11Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,13Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA.,14Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Reijs BLR, Vos SJB, Soininen H, Lötjonen J, Koikkalainen J, Pikkarainen M, Hall A, Vanninen R, Liu Y, Herukka SK, Freund-Levi Y, Frisoni GB, Frölich L, Nobili F, Rikkert MO, Spiru L, Tsolaki M, Wallin ÅK, Scheltens P, Verhey F, Visser PJ. Association Between Later Life Lifestyle Factors and Alzheimer's Disease Biomarkers in Non-Demented Individuals: A Longitudinal Descriptive Cohort Study. J Alzheimers Dis 2018; 60:1387-1395. [PMID: 29036813 DOI: 10.3233/jad-170039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/25/2023]
Abstract
BACKGROUND Lifestyle factors have been associated with the risk of dementia, but the association with Alzheimer's disease (AD) remains unclear. OBJECTIVE To examine the association between later life lifestyle factors and AD biomarkers (i.e., amyloid-β 1-42 (Aβ42) and tau in cerebrospinal fluid (CSF), and hippocampal volume) in individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). In addition, to examine the effect of later life lifestyle factors on developing AD-type dementia in individuals with MCI. METHODS We selected individuals with SCD (n = 111) and MCI (n = 353) from the DESCRIPA and Kuopio Longitudinal MCI studies. CSF Aβ42 and tau concentrations were assessed with ELISA assay and hippocampal volume with multi-atlas segmentation. Lifestyle was assessed by clinical interview at baseline for: social activity, physical activity, cognitive activity, smoking, alcohol consumption, and sleep. We performed logistic and Cox regression analyses adjusted for study site, age, gender, education, and diagnosis. Prediction for AD-type dementia was performed in individuals with MCI only. RESULTS Later life lifestyle factors were not associated with AD biomarkers or with conversion to AD-type dementia. AD biomarkers were strongly associated with conversion to AD-type dementia, but these relations were not modulated by lifestyle factors. Apolipoprotein E (APOE) genotype did not influence the results. CONCLUSIONS Later life lifestyle factors had no impact on key AD biomarkers in individuals with SCD and MCI or on conversion to AD-type dementia in MCI.
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Affiliation(s)
- Babette L R Reijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Stephanie J B Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Jyrki Lötjonen
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Oy, Tampere, Finland
| | - Juha Koikkalainen
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Oy, Tampere, Finland
| | - Maria Pikkarainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anette Hall
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Yawu Liu
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Yvonne Freund-Levi
- Department of NVS, Section of Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | | | - Lutz Frölich
- Department of Geriatric Psychiatry, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Flavio Nobili
- Department of Neuroscience (DINOGMI), Clinical Neurology, University of Genoa and IRCCS AOU San Martino-IST Genoa, Italy
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luiza Spiru
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Memory and Dementia Centre, G. Papanicolaore General Hospital, Thessaloniki, Greece
| | - Åsa K Wallin
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Sweden
| | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
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31
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Bos I, Verhey FR, Ramakers IHGB, Jacobs HIL, Soininen H, Freund-Levi Y, Hampel H, Tsolaki M, Wallin ÅK, van Buchem MA, Oleksik A, Verbeek MM, Rikkert MO, van der Flier WM, Scheltens P, Aalten P, Visser PJ, Vos SJB. Correction to: Cerebrovascular and amyloid pathology in predementia stages: the relationship with neurodegeneration and cognitive decline. Alzheimers Res Ther 2018; 10:56. [PMID: 29925412 PMCID: PMC6011342 DOI: 10.1186/s13195-018-0391-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Isabelle Bos
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Heidi I L Jacobs
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Yvonne Freund-Levi
- Department of Neurobiology, Caring Sciences and Society (NVS), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Harald Hampel
- AXA Research Fund and UPMC Chair Sorbonne Universités, Université Pierre et Marie Curie (UPMC), Paris, France.,Institut du cerveau et de la moelle (ICM), Hôpital Pitié-Salpêtrière, Paris, France
| | - Magda Tsolaki
- Memory and Dementia Center, 3rd Department of Neurology, Aristotle University of Thessaloniki, G Papanicolau" General Hospital, Thessaloniki, Greece
| | - Åsa K Wallin
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ania Oleksik
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Centre, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Centre, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Alzheimer Centre, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Stephanie J B Vos
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
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32
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Rüdiger S, Stuckenschneider T, Vogt T, Abeln V, Lawlor B, Olde Rikkert M, Schneider S. Cognitive Impairment Is Reflected by an Increased Difference between Real and Imagined Timed Up and Go Test Performance. Dement Geriatr Cogn Disord 2018; 44:55-62. [PMID: 28738338 DOI: 10.1159/000477760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent research suggests using an imaginary version of the Timed Up and Go test (TUG) for a first assessment of cognitive impairment. By using the time difference between a real (TUGr) and an imagined (TUGi) TUG task, the objective of this study was to examine the effect of cognitive impairment on motor imagery ability. METHODS Fifty-two participants (mean age 69.3 ± 4.0 years) with mild cognitive impairment or subjective cognitive impairment were included in this study. The time difference between the TUGr and the TUGi was used as the main outcome. The Trail Making Test part B (TMT B), the ratio between TMT A and TMT B, and the Montreal Cognitive Assessment (MoCA) battery were the main independent variables. RESULTS The difference between TUGr and TUGi performance time and the TMT B performance time increased with decreasing cognitive function (p < 0.01). There was no relationship between TUGr and TUGi performance time and TMT B/A ratio. There were significant correlations between TUG time differences and the MoCA score (r = -0.489, p < 0.01), the TMT B (r = 0.364, p < 0.01), and the TMT B/A ratio (r = 0.377, p < 0.01). CONCLUSION The combination of TUGr and TUGi may have added value in assessing cognitive impairment, which is a possible pre-stage of dementia.
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Affiliation(s)
- Stefanie Rüdiger
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany
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33
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Stuckenschneider T, Askew CD, Rüdiger S, Polidori MC, Abeln V, Vogt T, Krome A, Olde Rikkert M, Lawlor B, Schneider S. Cardiorespiratory Fitness and Cognitive Function are Positively Related Among Participants with Mild and Subjective Cognitive Impairment. J Alzheimers Dis 2018; 62:1865-1875. [DOI: 10.3233/jad-170996] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Tim Stuckenschneider
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany
- Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, QLD, Australia
| | - Christopher David Askew
- Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, QLD, Australia
| | - Stefanie Rüdiger
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department Medicine II, University Hospital of Cologne, Cologne, Germany
| | - Vera Abeln
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany
| | - Tobias Vogt
- Institute for Professional Sport Education and Sport Qualifications, German Sport University, Cologne, Germany
| | - Andreas Krome
- Gemeinschaftspraxis für Kardiologie, Innere Medizin, Sportmedizin, St. Elisabeth-Krankenhaus Hohenlind, Cologne, Germany
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Centre, Radboud University Medical Center, Donders Institute for Cognitive Medical Sciences, Nijmegen, The Netherlands
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Dublin, Ireland
| | - Stefan Schneider
- Institute of Movement and Neurosciences, German Sport University, Cologne, Germany
- Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, QLD, Australia
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34
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Jansen WJ, Handels RLH, Visser PJ, Aalten P, Bouwman F, Claassen J, van Domburg P, Hoff E, Hoogmoed J, Leentjens AFG, Rikkert MO, Oleksik AM, Smid M, Scheltens P, Wolfs C, Verhey F, Ramakers IHGB. The Diagnostic and Prognostic Value of Neuropsychological Assessment in Memory Clinic Patients. J Alzheimers Dis 2018; 55:679-689. [PMID: 27716658 DOI: 10.3233/jad-160126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 11/15/2022]
Abstract
BACKGROUND Neuropsychological testing has long been embedded in daily clinical practice at memory clinics but the added value of a complete neuropsychological assessment (NPA) to standard clinical evaluation is unknown. OBJECTIVE To evaluate the added diagnostic and prognostic value of NPA to clinical evaluation only in memory clinic patients. METHODS In 221 memory clinic patients of a prospective cohort study, clinical experts diagnosed clinical syndrome (subjective cognitive impairment (SCI), mild cognitive impairment (MCI), or dementia) and etiology (Alzheimer's disease (AD) or no AD), and provided a prognosis of disease course (decline or no decline) before and after results of NPA were made available. The reference standard was a panel consensus based on all clinical information at baseline and up to 2 follow-up assessments. RESULTS With NPA data available, clinicians changed their initial syndromal diagnosis in 22% of patients, and the etiological diagnosis as well as the prognosis in 15%. This led to an increase in correctly classified cases of 18% for syndromal diagnosis, 5% for etiological diagnosis, and 1% for prognosis. NPA data resulted in the largest improvement in patients initially classified as SCI (syndrome: 93.3% (n = 14) correctly reclassified, etiology: net reclassification improvement [NRI] = 0.61, prognosis: NRI = 0.13) or MCI (syndrome: 89.3% (n = 23) correctly reclassified, etiology: NRI = 0.17, prognosis: NRI = 0.14), while there was no improvement in patients with dementia (syndrome: 100% (n = 1) correctly reclassified, etiology: NRI = -0.05, prognosis: NRI = -0.06). Overall, inclusion of NPA in the diagnostic process increased confidence in all diagnoses with 6-7%. CONCLUSION Administration of a complete NPA after standard clinical evaluation has added value for diagnosing cognitive syndrome and its underlying etiology in patients regarded as non-demented based on the first clinical impression.
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Affiliation(s)
- Willemijn J Jansen
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ron L H Handels
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Femke Bouwman
- Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Jurgen Claassen
- Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter van Domburg
- Department of Neurology, Zuyderland Medical Center, Sittard, The Netherlands
| | - Erik Hoff
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jan Hoogmoed
- Department of Geriatrics, Laurentius Hospital, Roermond, The Netherlands.,Department of Geriatrics, St. Jans Gasthuis, Weert, The Netherlands
| | - Albert F G Leentjens
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboud Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ania M Oleksik
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Machiel Smid
- Department of Geriatrics, Zuyderland Medical Center, Sittard, The Netherlands
| | - Philip Scheltens
- Department of Neurology, VUmc Alzheimer Center, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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35
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Freeze WM, Jacobs HIL, Gronenschild EH, Jansen JFA, Burgmans S, Aalten P, Clerx L, Vos SJ, van Buchem MA, Barkhof F, van der Flier WM, Verbeek MM, Rikkert MO, Backes WH, Verhey FR. White Matter Hyperintensities Potentiate Hippocampal Volume Reduction in Non-Demented Older Individuals with Abnormal Amyloid-β. J Alzheimers Dis 2018; 55:333-342. [PMID: 27662299 DOI: 10.3233/jad-160474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/01/2023]
Abstract
Cerebral small vessel disease (cSVD) and amyloid-β (Aβ) deposition often co-exist in (prodromal) dementia, and both types of pathology have been associated with neurodegeneration. We examined whether cSVD and Aβ have independent or interactive effects on hippocampal volume (HV) in a memory clinic population. We included 87 individuals with clinical diagnoses of Alzheimer's disease (AD) (n = 24), mild cognitive impairment (MCI) (n = 26), and subjective cognitive complaints (SCC) (n = 37). cSVD magnetic resonance imaging markers included white matter hyperintensity (WMH) volume, lacunar infarct presence, and microbleed presence. Aβ pathology was assessed as cerebrospinal fluid-derived Aβ1 - 42 levels and dichotomized into normal or abnormal, and HV was determined by manual volumetric measurements. A linear hierarchical regression approach was applied for the detection of additive or interaction effects between cSVD and Aβ on HV in the total participant group (n = 87) and in the non-demented group (including SCC and MCI individuals only, n = 63). The results revealed that abnormal Aβ and lacunar infarct presence were independently associated with lower HV in the non-demented individuals. Interestingly, Aβ and WMH pathology interacted in the non-demented individuals, such that WMH had a negative effect on HV in individuals with abnormal CSF Aβ42 levels, but not in individuals with normal CSF Aβ42 levels. These associations were not present when individuals with AD were included in the analyses. Our observations suggest that relatively early on in the disease process older individuals with abnormal Aβ levels are at an increased risk of accelerated disease progression when concomitant cSVD is present.
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Affiliation(s)
- Whitney M Freeze
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Heidi I L Jacobs
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Ed H Gronenschild
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Jacobus F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Saartje Burgmans
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Lies Clerx
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Stephanie J Vos
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College Lodon, London, UK
| | | | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Radboud University Medical Center Nijmegen, Donders Institute for Brain, Cognition and Behaviour, and Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center Nijmegen, Donders Institute for Brain, Cognition and Behaviour, and Radboud UMC, Alzheimer Center, Nijmegen, The Netherlands
| | - Walter H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands
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36
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Bos I, Verhey FR, Ramakers IHGB, Jacobs HIL, Soininen H, Freund-Levi Y, Hampel H, Tsolaki M, Wallin ÅK, van Buchem MA, Oleksik A, Verbeek MM, Olde Rikkert M, van der Flier WM, Scheltens P, Aalten P, Visser PJ, Vos SJB. Cerebrovascular and amyloid pathology in predementia stages: the relationship with neurodegeneration and cognitive decline. Alzheimers Res Ther 2017; 9:101. [PMID: 29284531 PMCID: PMC5747152 DOI: 10.1186/s13195-017-0328-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cerebrovascular disease (CVD) and amyloid-β (Aβ) often coexist, but their influence on neurodegeneration and cognition in predementia stages remains unclear. We investigated the association between CVD and Aβ on neurodegenerative markers and cognition in patients without dementia. METHODS We included 271 memory clinic patients with subjective or objective cognitive deficits but without dementia from the BioBank Alzheimer Center Limburg cohort (n = 99) and the LeARN (n = 50) and DESCRIPA (n = 122) multicenter studies. CSF Aβ1-42 and white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) scans were used as measures of Aβ and CVD, respectively. Individuals were classified into four groups based on the presence (+) or absence (-) of Aβ and WMH. We investigated differences in phosphorylated tau, total tau (t-tau), and medial temporal lobe atrophy (MTA) between groups using general linear models. We examined cognitive decline and progression to dementia using linear mixed models and Cox proportional hazards models. All analyses were adjusted for study and demographics. RESULTS MTA and t-tau were elevated in the Aβ - WMH+, Aβ + WMH-, and Aβ + WMH+ groups. MTA was most severe in the Aβ + WMH+ group compared with the groups with a single pathology. Both WMH and Aβ were associated with cognitive decline, but having both pathologies simultaneously was not associated with faster decline. CONCLUSIONS In the present study, we found an additive association of Aβ and CVD pathology with baseline MTA but not with cognitive decline. Because our findings may have implications for diagnosis and prognosis of memory clinic patients and for future scientific research, they should be validated in a larger sample with longer follow-up.
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Affiliation(s)
- Isabelle Bos
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Heidi I L Jacobs
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter & Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Yvonne Freund-Levi
- Department of Neurobiology, Caring Sciences and Society (NVS), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Harald Hampel
- AXA Research Fund and UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie (UPMC), Paris, France.,Institut du cerveau et de la moelle (ICM), Hôpital Pitié-Salpêtrière, Paris, France
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Memory and Dementia Center, 3rd Department of Neurology, "G Papanicolau" General Hospital, Thessaloniki, Greece
| | - Åsa K Wallin
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ania Oleksik
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Centre, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Centre, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Alzheimer Centre, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Stephanie J B Vos
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
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Jacobs A, Benraad C, Wetzels J, Rikkert MO, Kramers C. Clinical Relevance of Differences in Glomerular Filtration Rate Estimations in Frail Older People by Creatinine- vs. Cystatin C-Based Formulae. Drugs Aging 2017; 34:445-452. [PMID: 28405944 DOI: 10.1007/s40266-017-0460-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The risk of incorrect medication dosing is high in frail older people. Therefore, accurate assessment of the glomerular filtration rate is important. OBJECTIVE The objective of this study was to compare the estimated glomerular filtration rate using creatinine- and cystatin C-based formulae, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, in frail older people. We hypothesized that frailty determines the difference between the creatinine- and cystatin C-based formulae. METHODS The mean difference between CKD-EPI creatinine and cystatin C was determined using (cross-sectional) data of 55 patients (mean age 73 years) admitted to a psychiatric ward for older adults. The level of agreement of these estimations was assessed by a Bland-Altman analysis. In all patients, the Rockwood's Frailty Index was derived and correlated with the mean difference between CKD-EPI creatinine and cystatin C. RESULTS The mean difference between CKD-EPI creatinine (mean 71.2 mL/min/1.73 m2) and CKD-EPI cystatin C (mean 57.6 mL/min/1.73 m2) was 13.6 mL/min/1.73 m2 (p < 0.0001). The two standard deviation limit in the Bland-Altman plot was large (43.2 mL/min/1.73 m2), which represents a low level of agreement. The Frailty Index did not correlate with the mean difference between the creatinine- and cystatin C-based glomerular filtration rate (Pearson correlation coefficient 0.182, p = 0.184). CONCLUSIONS There was a significant gap between a creatinine- and cystatin C-based estimation of glomerular filtration rate, irrespective of frailty. The range of differences between the commonly used estimated glomerular filtration rate formulae might result in clinically relevant differences in drug prescription and differences in chronic kidney disease staging.
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Affiliation(s)
- Anne Jacobs
- Department of Geriatrics, Radboudumc, Nijmegen, The Netherlands. .,Department of Geriatric Psychiatry, Pro Persona Mental Health Care, Nijmegen/Arnhem, The Netherlands. .,Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands. .,Heilige Geeststraat 14, 5664 AV, Geldrop, The Netherlands.
| | - Carolien Benraad
- Department of Geriatrics, Radboudumc, Nijmegen, The Netherlands.,Department of Geriatric Psychiatry, Pro Persona Mental Health Care, Nijmegen/Arnhem, The Netherlands
| | - Jack Wetzels
- Department of Nephrology, Radboudumc, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboudumc, Nijmegen, The Netherlands.,Radboudumc Alzheimer Centre, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
| | - Cornelis Kramers
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands.,Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Manera V, Ben-Sadoun G, Aalbers T, Agopyan H, Askenazy F, Benoit M, Bensamoun D, Bourgeois J, Bredin J, Bremond F, Crispim-Junior C, David R, De Schutter B, Ettore E, Fairchild J, Foulon P, Gazzaley A, Gros A, Hun S, Knoefel F, Olde Rikkert M, Phan Tran MK, Politis A, Rigaud AS, Sacco G, Serret S, Thümmler S, Welter ML, Robert P. Recommendations for the Use of Serious Games in Neurodegenerative Disorders: 2016 Delphi Panel. Front Psychol 2017; 8:1243. [PMID: 28790945 PMCID: PMC5524915 DOI: 10.3389/fpsyg.2017.01243] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/07/2017] [Indexed: 11/21/2022] Open
Abstract
The use of Serious Games (SG) in the health domain is expanding. In the field of neurodegenerative disorders (ND) such as Alzheimer’s disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients’ treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014). The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI) and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI). SG are more adapted for use with trained caregivers (both at home and in clinical settings), with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game), and should be personalized with the help of a clinician.
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Affiliation(s)
- Valeria Manera
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,Université Côte d'Azur, INRIA, STARSSophia Antipolis, France
| | - Grégory Ben-Sadoun
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France
| | - Teun Aalbers
- Radboudumc Alzheimer Center, Donders Institute for Medical NeuroSciences, RadboudumcNijmegen, Netherlands
| | | | - Florence Askenazy
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,Centre Ressources Autisme, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Children's Hospitals of Nice CHU-LenvalNice, France.,IA AssociationNice, France
| | - Michel Benoit
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,IA AssociationNice, France.,Université Côte d'Azur, Centre Hospitalier Universitaire, Hôpital PasteurNice, France
| | - David Bensamoun
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,Université Côte d'Azur, Centre Hospitalier Universitaire, Hôpital PasteurNice, France
| | - Jérémy Bourgeois
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,Centre Ressources Autisme, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Children's Hospitals of Nice CHU-LenvalNice, France
| | | | | | | | - Renaud David
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,IA AssociationNice, France.,Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressource et de RechercheNice, France
| | - Bob De Schutter
- College for Education, Health and Society, Miami University, OxfordOH, United States
| | - Eric Ettore
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressource et de RechercheNice, France
| | - Jennifer Fairchild
- Department of Veterans Affairs, VA Palo Alto Health Care System, LivermoreCA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, StanfordCA, United States
| | | | - Adam Gazzaley
- Departments of Neurology and Psychiatry and Department of Physiology, University of California, San Francisco, San FranciscoCA, United States
| | - Auriane Gros
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressource et de RechercheNice, France
| | - Stéphanie Hun
- Centre Ressources Autisme, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Children's Hospitals of Nice CHU-LenvalNice, France
| | - Frank Knoefel
- Bruyère Memory Program, Bruyère Research InstituteOttawa, ON, Canada.,Department of Family Medicine, University of OttawaOttawa, ON, Canada.,Department of Systems and Computer Engineering, Carleton UniversityOttawa, ON, Canada
| | - Marcel Olde Rikkert
- Department of Geriatrics and Radboudumc Alzheimer Center, Radboud University Medical CenterNijmegen, Netherlands
| | | | - Antonios Politis
- 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of AthensAthens, Greece
| | - Anne S Rigaud
- Hopital Broca, Assistance Publique-Hôpitaux de ParisParis, France.,Faculty of Medicine, Université Paris DescartesParis, France
| | - Guillaume Sacco
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressource et de RechercheNice, France
| | - Sylvie Serret
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,Centre Ressources Autisme, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Children's Hospitals of Nice CHU-LenvalNice, France
| | - Susanne Thümmler
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,IEM Rossetti des PEP 06Nice, France.,Centre Ressources Autisme, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Children's Hospitals of Nice CHU-LenvalNice, France
| | - Marie L Welter
- UMR-S975, Institut du Cerveau et de la Moelle épiniere, Université Pierre et Marie CurieParis, France.,U975, INSERMParis, France.,UMR 7225, CNRSParis, France.,Département de Neurologie, Hôpitaux Universitaires Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisParis, France
| | - Philippe Robert
- Université Côte d'Azur, Cognition, Behaviour, Technology - CoBTeKNice, France.,IA AssociationNice, France.,Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressource et de RechercheNice, France
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Handels RL, Vos SJ, Kramberger MG, Jelic V, Blennow K, Buchem M, Flier W, Freund‐Levi Y, Hampel H, Olde Rikkert M, Oleksik A, Pirtosek Z, Scheltens P, Soininen H, Teunissen C, Tsolaki M, Wallin AK, Winblad B, Verhey FR, Visser PJ. Predicting progression to dementia in persons with mild cognitive impairment using cerebrospinal fluid markers. Alzheimers Dement 2017; 13:903-912. [DOI: 10.1016/j.jalz.2016.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/26/2016] [Accepted: 12/28/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Ron L.H. Handels
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences Maastricht University Maastricht The Netherlands
| | - Stephanie J.B. Vos
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences Maastricht University Maastricht The Netherlands
| | | | - Vesna Jelic
- Division of Clinical Geriatrics, Department of NVS, Karolinska Institutet Center for Alzheimer Research Division of Neurogeriatrics Huddinge Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital Mölndal Sweden
| | - Mark Buchem
- Department of Radiology Leiden University Medical Centre Leiden The Netherlands
| | - Wiesje Flier
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam VU University Medical Centre Amsterdam The Netherlands
- Department of Epidemiology and Biostatistics VU University Medical Center Amsterdam The Netherlands
| | - Yvonne Freund‐Levi
- Division of Clinical Geriatrics, Department of NVS, Karolinska Institutet Center for Alzheimer Research Division of Neurogeriatrics Huddinge Sweden
- Department of Psychiatry Tiohundra AB Norrtälje Hospital Stockholm Sweden
| | - Harald Hampel
- AXA Research Fund & UPMC Chair Paris France
- Sorbonne Universités Pierre et Marie Curie (UPMC) Paris 06, Inserm, CNRS, Institut du cerveau et de la moelle (ICM), Département de Neurologie Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Hôpital Pitié‐Salpêtrière, Boulevard de l'hôpital Paris France
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboudumc Alzheimer Centre, Donders Institute for Brain Cognition and Behavior Radboud University Medical Centre Nijmegen The Netherlands
| | - Ania Oleksik
- Department of Radiology Leiden University Medical Centre Leiden The Netherlands
| | - Zvezdan Pirtosek
- Department of Neurology Ljubljana University Medical Centre Ljubljana Slovenia
| | - Philip Scheltens
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam VU University Medical Centre Amsterdam The Netherlands
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine , University of Eastern Finland, Neurocenter–Neurology, Kuopio University Hospital Kuopio Finland
| | - Charlotte Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry VU University Medical Centre Amsterdam The Netherlands
| | - Magda Tsolaki
- Memory and Dementia Outpatient Clinic, 3rd Department of Neurology, Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Asa K. Wallin
- Clinical Memory Research Unit, Department of Clinical Sciences Lund University Malmö Sweden
| | - Bengt Winblad
- Division of Clinical Geriatrics, Department of NVS, Karolinska Institutet Center for Alzheimer Research Division of Neurogeriatrics Huddinge Sweden
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences Maastricht University Maastricht The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences Maastricht University Maastricht The Netherlands
- Alzheimer Centre and Department of Neurology, Neuroscience Campus Amsterdam VU University Medical Centre Amsterdam The Netherlands
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40
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Oeseburg B, Schols J, Olde Rikkert M, van der Horst H, Smilde-van den Doel D, de Rooij S, Buurman-van Es B, Schuurmans M, Gussekloo J. [Education within the Dutch National Care for the Elderly Programme]. Tijdschr Gerontol Geriatr 2016; 47:272-281. [PMID: 27844200 DOI: 10.1007/s12439-016-0194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Netherlands Organisation of Health Research and Development started in 2008 the Dutch National Care for the Elderly Programme (in Dutch abbreviated as NPO) with the aim to improve the quality of life for the frail older people through better quality of care (health, social, community) which is tailored to the needs and wants of older people. The delivery of good care is related with competent professional behaviour which is inextricably linked to the education of professionals. This article presents an overview of 32 educational programmes developed within the NPO. Within the NPO different educational programmes were developed on relevant themes to improve elderly care. However, the programmes focused mainly on professionals in health care, especially those working in primary care. For nurses and nursing assistants and more or less for physicians also different educational programmes were developed. Educational programmes for paramedics or professionals working in social care, housing or in the municipalities were scarce. This is also the case for specific themes in elderly care like loneliness or (domestic) violence. Moreover, none of the experiments focused on older people or informal care givers. Although 22 of the 32 projects developed educational programmes for different groups, multi - or interdisciplinary education is rare in these programmes. Based on the overview we advise the development of more educational programmes on: target groups which were less or not addressed in the NPO, like professionals in social care and paramedics; multi- or interdisciplinary collaboration; and themes, like loneliness in older people and elder abuse.
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Affiliation(s)
- Barth Oeseburg
- Universitair Medisch Centrum Groningen, Groningen, Nederland.
| | - Jos Schols
- Universiteit Maastricht, Maastricht, Nederland
| | | | | | | | - Sophia de Rooij
- Universitair Medisch Centrum Groningen, Groningen, Nederland
| | - Bianca Buurman-van Es
- Academisch Medisch Centrum Amsterdam, Amsterdam, Nederland
- Transmurale Ouderenzorg Academisch Medisch Centrum, Amsterdam, Nederland
- Hogeschool van Amsterdam, Amsterdam, Nederland
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41
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van Bruggen-Kuijt G, Olde Rikkert M. [Suggestions to guide elderly patients on safe cycling]. Tijdschr Gerontol Geriatr 2016; 47:211-215. [PMID: 27629149 DOI: 10.1007/s12439-016-0190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Elderly cyclists are at high risk for a cycling accident, often followed by severe morbidity or mortality. Therefore, there is a chance that they discontinue a major form of autonomous and healthy mobility or have a cycling incident. By means of this case description, it is illustrated which steps should be taken by the doctor in guiding elderly, in order to remain safe cycling as long as possible.
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Affiliation(s)
- Gerdien van Bruggen-Kuijt
- Radboudumc, afd. Klinische Geriatrie, Nijmegen, Nederland.
- , Zuideinderhof 4, 8278BH, Kamperveen, Nederland.
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42
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Mirelman A, Rochester L, Maidan I, Del Din S, Alcock L, Nieuwhof F, Rikkert MO, Bloem BR, Pelosin E, Avanzino L, Abbruzzese G, Dockx K, Bekkers E, Giladi N, Nieuwboer A, Hausdorff JM. Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet 2016; 388:1170-82. [PMID: 27524393 DOI: 10.1016/s0140-6736(16)31325-3] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [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] [Received: 07/19/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Age-associated motor and cognitive deficits increase the risk of falls, a major cause of morbidity and mortality. Because of the significant ramifications of falls, many interventions have been proposed, but few have aimed to prevent falls via an integrated approach targeting both motor and cognitive function. We aimed to test the hypothesis that an intervention combining treadmill training with non-immersive virtual reality (VR) to target both cognitive aspects of safe ambulation and mobility would lead to fewer falls than would treadmill training alone. METHODS We carried out this randomised controlled trial at five clinical centres across five countries (Belgium, Israel, Italy, the Netherlands, and the UK). Adults aged 60-90 years with a high risk of falls based on a history of two or more falls in the 6 months before the study and with varied motor and cognitive deficits were randomly assigned by use of computer-based allocation to receive 6 weeks of either treadmill training plus VR or treadmill training alone. Randomisation was stratified by subgroups of patients (those with a history of idiopathic falls, those with mild cognitive impairment, and those with Parkinson's disease) and sex, with stratification per clinical site. Group allocation was done by a third party not involved in onsite study procedures. Both groups aimed to train three times per week for 6 weeks, with each session lasting about 45 min and structured training progression individualised to the participant's level of performance. The VR system consisted of a motion-capture camera and a computer-generated simulation projected on to a large screen, which was specifically designed to reduce fall risk in older adults by including real-life challenges such as obstacles, multiple pathways, and distracters that required continual adjustment of steps. The primary outcome was the incident rate of falls during the 6 months after the end of training, which was assessed in a modified intention-to-treat population. Safety was assessed in all patients who were assigned a treatment. This study is registered with ClinicalTrials.gov, NCT01732653. FINDINGS Between Jan 6, 2013, and April 3, 2015, 302 adults were randomly assigned to either the treadmill training plus VR group (n=154) or treadmill training alone group (n=148). Data from 282 (93%) participants were included in the prespecified, modified intention-to-treat analysis. Before training, the incident rate of falls was similar in both groups (10·7 [SD 35·6] falls per 6 months for treadmill training alone vs 11·9 [39·5] falls per 6 months for treadmill training plus VR). In the 6 months after training, the incident rate was significantly lower in the treadmill training plus VR group than it had been before training (6·00 [95% CI 4·36-8·25] falls per 6 months; p<0·0001 vs before training), whereas the incident rate did not decrease significantly in the treadmill training alone group (8·27 [5·55-12·31] falls per 6 months; p=0·49). 6 months after the end of training, the incident rate of falls was also significantly lower in the treadmill training plus VR group than in the treadmill training group (incident rate ratio 0·58, 95% CI 0·36-0·96; p=0·033). No serious training-related adverse events occurred. INTERPRETATION In a diverse group of older adults at high risk for falls, treadmill training plus VR led to reduced fall rates compared with treadmill training alone. FUNDING European Commission.
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Affiliation(s)
- Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Neurology, Tel Aviv University, Tel Aviv, Israel.
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Inbal Maidan
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Silvia Del Din
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Lisa Alcock
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Freek Nieuwhof
- Department of Geriatrics Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands; Radboud Alzheimers Center, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands; Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands; Radboud Alzheimers Center, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands
| | - Elisa Pelosin
- Department of Neurosciences, University of Genoa, Genoa, Italy
| | - Laura Avanzino
- Department of Neurosciences, University of Genoa, Genoa, Italy; Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | | | - Kim Dockx
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Esther Bekkers
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nir Giladi
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Neurology, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Meulenbroek O, O'Dwyer S, de Jong D, van Spijker G, Kennelly S, Cregg F, Olde Rikkert M, Abdullah L, Wallin A, Walsh C, Coen R, Kenny RA, Daly L, Segurado R, Borjesson-Hanson A, Crawford F, Mullan M, Lucca U, Banzi R, Pasquier F, Breuilh L, Riepe M, Kalman J, Molloy W, Tsolaki M, Howard R, Adams J, Gaynor S, Lawlor B. European multicentre double-blind placebo-controlled trial of Nilvadipine in mild-to-moderate Alzheimer's disease-the substudy protocols: NILVAD frailty; NILVAD blood and genetic biomarkers; NILVAD cerebrospinal fluid biomarkers; NILVAD cerebral blood flow. BMJ Open 2016; 6:e011584. [PMID: 27436668 PMCID: PMC4964180 DOI: 10.1136/bmjopen-2016-011584] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In conjunction with the NILVAD trial, a European Multicentre Double-Blind Placebo Controlled trial of Nilvadipine in Mild-to-Moderate Alzheimer's disease (AD), there are four NILVAD substudies in which eligible NILVAD patients are also invited to participate. The main NILVAD protocol was previously published in BMJ Open (2014). The objectives of the NILVAD substudies are to determine whether frailty, cerebrospinal fluid (CSF), blood biomarker profile and Apolipoprotein E (APOE) status predict response to Nilvadipine, and to investigate the effect of Nilvadipine on cerebral blood flow and blood biomarkers. METHODS AND ANALYSIS All participants who fulfil criteria for the main NILVAD study are eligible for participation in the NILVAD substudies. Participation is subject to informed consent and whether the substudy is available at a particular NILVAD study site. Each substudy entails extra measurements during the course of the main NILVAD study. For example, in the blood and genetic biomarkers substudy, extra blood (30 mL) will be collected at week 0, week 13, week 52 and week 78, while in the cerebral blood flow substudy, participants will receive an MRI and transcranial Doppler measurements at week 0, week 26 and week 78. In the CSF substudy, 10 mL CSF is collected at week 0 and week 78. ETHICS AND DISSEMINATION All NILVAD substudies and all subsequent amendments have received ethical approval within each participating country, according to national regulations. Each participant provides written consent to participate. All participants remain anonymised throughout and the results of each substudy will be published in an international peer reviewed journal. TRIAL REGISTRATION NUMBER EUDRACT 2012-002764-27; Pre-results.
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Affiliation(s)
- Olga Meulenbroek
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sarah O'Dwyer
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Daan de Jong
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerrita van Spijker
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Fiona Cregg
- Trinity College Dublin (TCD), Dublin, Ireland
| | - Marcel Olde Rikkert
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Cathal Walsh
- University College Dublin (UCD), Dublin, Ireland
| | - Robert Coen
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Leslie Daly
- University College Dublin (UCD), Dublin, Ireland
| | | | | | | | | | - Ugo Lucca
- Department of Laboratory of Geriatric Neuropsychiatry, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Rita Banzi
- Department of Laboratory of Geriatric Neuropsychiatry, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Florence Pasquier
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | - Laetitia Breuilh
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | | | - Janos Kalman
- Szegedi Tudomanyegyetem (SZEGED), Szeged, Hungary
| | - William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork (UCC), Cork, Ireland
| | - Magda Tsolaki
- Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | | | | | | | - Brian Lawlor
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
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Handels RL, Joore MA, Vos SJ, Aalten P, Ramakers IH, Rikkert MO, Scheltens P, Jansen WJ, Visser PJ, van Berckel BM, van Domburg P, Smid M, Hoff E, Hoogmoed J, Bouwman F, Claassen J, Leentjens AF, Wolfs CA, Severens JL, Verhey FR. Added Prognostic Value of Cerebrospinal Fluid Biomarkers in Predicting Decline in Memory Clinic Patients in a Prospective Cohort. J Alzheimers Dis 2016; 52:875-85. [DOI: 10.3233/jad-151120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ron L.H. Handels
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
- CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Department of Health Organization, Policy and Economics, Maastricht University, Maastricht, the Netherlands
| | - Manuela A. Joore
- CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Department of Health Organization, Policy and Economics, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Stephanie J.B. Vos
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Pauline Aalten
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Marcel Olde Rikkert
- Radboudumc Alzheimer Centre, Department of Geriatrics, Donders Centre for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Philip Scheltens
- Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - Willemijn J. Jansen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Pieter-Jelle Visser
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
- Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - Bart M.N. van Berckel
- Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - Peter van Domburg
- Department of Neurology, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Machiel Smid
- Department of Geriatrics, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Erik Hoff
- Department of Neurology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jan Hoogmoed
- Department of Geriatrics, Laurentius Hospital Roermond, Roermond, The Netherlands
- Department of Geriatrics, St. Jans Gasthuis Weert, Weert, The Netherlands
| | - Femke Bouwman
- Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jurgen Claassen
- Radboudumc Alzheimer Centre, Department of Geriatrics, Donders Centre for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Albert F.G. Leentjens
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Claire A.G. Wolfs
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Johan L. Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frans R.J. Verhey
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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Semrau M, Burns A, Djukic-Dejanovic S, Eraslan D, Han C, Lecic-Tosevski D, Lobo A, Mihai A, Morris J, Palumbo C, Robert P, Stiens G, Stoppe G, Volpe U, Rikkert MO, Sartorius N. Development of an international schedule for the assessment and staging of care for dementia. J Alzheimers Dis 2015; 44:139-51. [PMID: 25182744 DOI: 10.3233/jad-141599] [Citation(s) in RCA: 9] [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: 11/15/2022]
Abstract
BACKGROUND A reliable and valid global staging scale has been lacking within dementia care. OBJECTIVE To develop an easy-to-use multi-dimensional clinical staging schedule for dementia. METHODS The schedule was developed through: i) Two series of focus groups (40 and 48 participants, respectively) in Denmark, France, Germany, Netherlands, Spain, Switzerland, and UK with a multi-disciplinary group of professionals working within dementia care, to assess the need for a dementia-staging tool and to obtain suggestions on its design and characteristics; ii) A pilot-study over three rounds to test inter-rater reliability of the newly developed schedule using written case histories, with five members of the project's steering committee and 27 of their colleagues from Netherlands, France, and Spain as participants; and iii) A field-study to test the schedule's inter-rater reliability in clinical practice in France, Germany, Netherlands, Spain, Italy, Turkey, South Korea, Romania, and Serbia, which included 209 dementia patients and 217 of their caregivers as participants. RESULTS Focus group participants indicated a clear need for a culture-fair international dementia staging scale and reached consensus on face validity and content validity. Accordingly, the schedule has been composed of seven dimensions including behavioral, cognitive, physical, functional, social, and care aspects. Overall, the schedule showed adequate face validity, content validity, and inter-rater reliability; in the nine field-sites, intraclass correlation coefficients (ICCs; absolute agreement) for individual dimensions ranged between 0.38 and 1.0, with 84.4% of ICCs over 0.7. ICCs for total sum scores ranged between 0.89 and 0.99 in the nine field-sites. CONCLUSION The IDEAL schedule looks promising as tool for the clinical and social management of people with dementia globally, though further reliability and validity testing is needed.
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Affiliation(s)
- Maya Semrau
- King's College London, Institute of Psychiatry, London, UK
| | - Alistair Burns
- University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | | | | | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Dusica Lecic-Tosevski
- School of Medicine, University of Belgrade, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Antonio Lobo
- Department of Psychiatry, Universidad Zaragoza and Instituto de Investigación Sanitaria de Aragón, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - Adriana Mihai
- Department of Psychiatry, University of Medicine and Pharmacy, Tg Mures, Romania
| | - Julie Morris
- University Hospital of South Manchester, Manchester, United Kingdom
| | - Claudia Palumbo
- Department of Medical Basic Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Philippe Robert
- Memory CenterCHU - CoBTeK Research, University of Nice Sophia Antipolis, Nice, France
| | - Gerthild Stiens
- Center for Old Age Psychiatry, LVR Hospitals Bonn, Bonn, Germany
| | | | - Umberto Volpe
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Marcel Olde Rikkert
- Radboud Alzheimer Centre/Department Geriatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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Chouliaras L, Kenis G, Visser PJ, Scheltens P, Tsolaki M, Jones RW, Kehoe PG, Graff C, Girtler NG, Wallin ÅK, Rikkert MO, Spiru L, Elias-Sonnenschein LS, Ramakers IHGB, Pishva E, Os JV, Steinbusch HWM, Verhey FRJ, van den Hove DLA, Rutten BPF. DNMT3A moderates cognitive decline in subjects with mild cognitive impairment: replicated evidence from two mild cognitive impairment cohorts. Epigenomics 2015; 7:533-7. [DOI: 10.2217/epi.15.22] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Epigenetic dysregulation has been associated with cognitive decline and Alzheimer's disease. The present study investigated associations between common SNPs in genes regulating DNA methylation and age-related changes in cognitive decline in two independent prospective cohorts of patients suffering from mild cognitive impairment. An association between the rs1187120 SNP in DNMT3A and annual decline in cognitive functioning was discovered and replicated, suggesting that DNMT3A moderates cognitive decline in subjects with mild cognitive impairment.
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Affiliation(s)
- Leonidas Chouliaras
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Memory & Dementia Center, 3rd Department of Neurology, G Papanicolaou General Hospital, Thessaloniki, Greece
| | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Patrick G Kehoe
- School of Clinical Sciences, Dementia Research Group, University of Bristol Frenchay Hospital, Bristol, UK
| | - Caroline Graff
- Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Huddinge, Sweden
| | - Nicola G Girtler
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
| | - Åsa K Wallin
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Marcel Olde Rikkert
- Radboud Alzheimer Center, Department of Geriatrics, Donders Institute for Cognitive Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luiza Spiru
- “Carol Davila” University of Medicine & Pharmacy, Bucharest, Romania
| | - Lyzel S Elias-Sonnenschein
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Inez HGB Ramakers
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ehsan Pishva
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Harry WM Steinbusch
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frans RJ Verhey
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Daniel LA van den Hove
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bart PF Rutten
- Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry & Psychology, Faculty of Health, Medicine & Life Sciences, School for Mental Health & Neuroscience (MHeNS), European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER, PO Box 616 6200 MD, Maastricht, The Netherlands
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Olde Rikkert M, Claassen J. [Anticoagulants after intracerebral haemorrhage in frail elderly]. Ned Tijdschr Geneeskd 2015; 159:A8765. [PMID: 25873225] [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: 06/04/2023]
Abstract
Restarting anticoagulants in frail older patients who have had an intracerebral haemorrhage as an adverse reaction to anticoagulant therapy is a major dilemma, and one which is not specifically addressed in the state-of-the-art paper on restarting anticoagulants elsewhere in this issue. Frail older persons have the highest risk of recurrent bleeding, but, in theory, also have the most benefit from anticoagulants due to the high absolute risk for ischemic events in atrial fibrillation, which is the major indication. However, frail older persons are largely excluded from trials with anticoagulants, which makes it impossible to solve this dilemma in an evidence-based way. Therefore, we argue that sound decision making cannot only be based on neurological or cardiological expertise, as proposed by others, but should include an overall comprehensive geriatric assessment, and, most importantly, patients and caregivers should be included in shared goal setting and shared decision making.
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Ooms S, Overeem S, Besse K, Rikkert MO, Verbeek M, Claassen JAHR. Effect of 1 night of total sleep deprivation on cerebrospinal fluid β-amyloid 42 in healthy middle-aged men: a randomized clinical trial. JAMA Neurol 2014; 71:971-7. [PMID: 24887018 DOI: 10.1001/jamaneurol.2014.1173] [Citation(s) in RCA: 265] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Increasing evidence suggests a relationship between poor sleep and the risk of developing Alzheimer disease. A previous study found an effect of sleep on β-amyloid (Aβ), which is a key protein in Alzheimer disease pathology. OBJECTIVE To determine the effect of 1 night of total sleep deprivation on cerebrospinal fluid Aβ42 protein levels in healthy middle-aged men. DESIGN, SETTING, AND PARTICIPANTS The Alzheimer, Wakefulness, and Amyloid Kinetics (AWAKE) study at the Radboud Alzheimer Center, a randomized clinical trial that took place between June 1, 2012, and October 1, 2012. Participants were cognitively normal middle-aged men (40-60 years of age) with normal sleep (n = 26) recruited from the local population. INTERVENTIONS Participants were randomized to 1 night with unrestricted sleep (n = 13) or 1 night of total sleep deprivation (24 hours of wakefulness) (n = 13). MAIN OUTCOMES AND MEASURES Sleep was monitored using continuous polysomnographic recording from 3 pm until 10 am. Cerebrospinal fluid samples were collected using an intrathecal catheter at defined times to compare cerebral Aβ42 concentrations between evening and morning. RESULTS A night of unrestricted sleep led to a 6% decrease in Aβ42 levels of 25.3 pg/mL (95% CI [0.94, 49.6], P = .04), whereas sleep deprivation counteracted this decrease. When accounting for the individual trajectories of Aβ42 over time, a difference of 75.8 pg/mL of Aβ42 was shown between the unrestricted sleep and sleep deprivation group (95% CI [3.4, 148.4], P = .04). The individual trajectories of evening and morning Aβ42 concentrations differed between the unrestricted sleep and sleep deprivation groups (P = .04) in contrast to stable Aβ40, tau, and total protein levels. CONCLUSIONS AND RELEVANCE Sleep deprivation, or prolonged wakefulness, interferes with a physiological morning decrease in Aβ42. We hypothesize that chronic sleep deprivation increases cerebral Aβ42 levels, which elevates the risk of Alzheimer disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01194713.
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Affiliation(s)
- Sharon Ooms
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands2Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands3Department of Geriatric Medicine, Radboud University
| | - Sebastiaan Overeem
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands4Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kees Besse
- Department of Anaesthesiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel Olde Rikkert
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands2Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands3Department of Geriatric Medicine, Radboud University
| | - Marcel Verbeek
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands2Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands4Department of Neurology, Radboud University Medical
| | - Jurgen A H R Claassen
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands2Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands3Department of Geriatric Medicine, Radboud University
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Lawlor B, Kennelly S, O'Dwyer S, Cregg F, Walsh C, Coen R, Kenny RA, Howard R, Murphy C, Adams J, Daly L, Segurado R, Gaynor S, Crawford F, Mullan M, Lucca U, Banzi R, Pasquier F, Breuilh L, Riepe M, Kalman J, Wallin A, Borjesson A, Molloy W, Tsolaki M, Olde Rikkert M. NILVAD protocol: a European multicentre double-blind placebo-controlled trial of nilvadipine in mild-to-moderate Alzheimer's disease. BMJ Open 2014; 4:e006364. [PMID: 25300460 PMCID: PMC4194801 DOI: 10.1136/bmjopen-2014-006364] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION This study is a European multicentre, randomised, double-blind, placebo-controlled trial investigating the efficacy and safety of nilvadipine as a disease course modifying treatment for mild-to-moderate Alzheimer's disease (AD) in a phase III study that will run for a period of 82 weeks with a treatment period of 78 weeks. METHODS AND ANALYSIS Adult patients, males and females over 50 years with mild-to-moderate AD as defined by the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's disease and Related Disorders Association (NINCDS-ADRDA) criteria, will be included in the study. It aims to recruit a total of 500 patients with AD; 250 in the nilvadipine group and 250 in the placebo group. Participants will be randomised to receive nilvadipine, an 8 mg overencapsulated, sustained release capsule, or a matching overencapsulated placebo (sugar pill) for a period of 78 weeks of treatment. The primary efficacy outcome measure in this study is the change in cognitive function as assessed by the Alzheimer's disease Assessment Scale (ADAS-Cog 12) from baseline to the end of treatment duration (78 weeks). There are two key secondary outcome measures, the Clinical Dementia Rating Scale Sum of Boxes (CDR-sb) and the Disability Assessment for Dementia (DAD). If a statistically significant effect is seen in the primary outcome, CDR-sb will be considered to be a coprimary end point and only the DAD will contribute to the secondary outcome analysis. ETHICS AND DISSEMINATION The study and all subsequent amendments have received ethical approval within each participating country according to national regulations. Each participant will provide written consent to participate in the study. All participants will remain anonymised throughout and the results of the study will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER EUDRACT Reference Number: 2012-002764-27.
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Affiliation(s)
- Brian Lawlor
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Sean Kennelly
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Sarah O'Dwyer
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Fiona Cregg
- Trinity College Dublin (TCD), Dublin, Ireland
| | | | - Robert Coen
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | | | | | | | - Leslie Daly
- University College Dublin (UCD), Dublin, Ireland
| | | | | | - Fiona Crawford
- Archer Pharmaceuticals Inc, 2040 Whitefield Avenue, Sarasota, Florida, USA
| | - Michael Mullan
- Archer Pharmaceuticals Inc, 2040 Whitefield Avenue, Sarasota, Florida, USA
| | - Ugo Lucca
- IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Rita Banzi
- IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Florence Pasquier
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | - Laetitia Breuilh
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | | | - Janos Kalman
- Szegedi Tudomanyegyetem (SZEGED), Szeged, Hungary
| | | | | | | | | | - Marcel Olde Rikkert
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
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