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Prevalence Estimation of Dementia/Alzheimer’s Disease Using Health and Retirement Study Database in the United States 利用美国健康与退休研究数据库估算痴呆症/阿尔茨海默氏症的患病率
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-20 DOI: 10.14283/jpad.2024.114
Amir Abbas Tahami Monfared, N. Hummel, A. Chandak, A. Khachatryan, R. Zhang, Q. Zhang
<h3 data-test="abstract-sub-heading">Background</h3><p>Updated prevalence estimates along the continuum of Alzheimer’s disease (AD) can foster a more nuanced and effective approach to managing AD within the current healthcare landscape.</p><h3 data-test="abstract-sub-heading">Objectives</h3><p>This study aims to estimate the prevalence and severity distribution of dementia/AD (including mild, moderate, and severe stages) and all-cause mild cognitive impairment (MCI) in the United States using data from the Health and Retirement Study (HRS).</p><h3 data-test="abstract-sub-heading">Design</h3><p>Retrospective study.</p><h3 data-test="abstract-sub-heading">Setting</h3><p>Data from the bi-annual HRS surveys involving in-depth interviews of a representative sample of Americans aged >50 years.</p><h3 data-test="abstract-sub-heading">Participants</h3><p>Dementia/AD and all-cause MCI patients from the 4 most recent HRS surveys (2014, 2016, 2018 and 2020).</p><h3 data-test="abstract-sub-heading">Measurements</h3><p>AD was identified based on diagnosis (self-report). Cognitive performance (modified Telephone Interview of Cognitive Status [TICS-m]) scores in the dementia/AD range were also captured; all-cause MCI was similarly identified using the TICS-m. Dementia/AD and MCI prevalence, as well as the distribution by dementia/AD stage (mild, moderate, or severe), were estimated. Sampling weights developed by HRS were applied to ensure the sample’s representativeness of the target population and unbiased estimates for population parameters.</p><h3 data-test="abstract-sub-heading">Results</h3><p>Across the four HRS surveys, the total number of HRS respondents ranged from 15,000 to 21,000 (unweighted); 7,000 to 14,000 had TICS-m scores. The estimated prevalence of AD (all severity categories combined) in the 2014, 2016, 2018, and 2020 HRS surveys was 1.2%, 1.2%, 1.3% and 1.0%, respectively using the diagnosis-based approach; using the cognitive performance-based approach, 23–27% patients had scores in the dementia/AD ranges across the 4 surveys. The estimated prevalence of all-cause MCI was consistently 23% in each survey. In the 2020 survey, the distribution of mild, moderate, and severe disease stages was 34%, 45%, and 21%, respectively, in patients self-reporting an AD diagnosis, and 55%, 40%, and 5%, respectively in all patients meeting TICS-m threshold for dementia/AD.</p><h3 data-test="abstract-sub-heading">Conclusion</h3><p>The prevalence of AD diagnosis based on self-report was approximately 1% across the 4 most recent HRS surveys and may reflect the proportion of patients who have actively sought healthcare for AD. Among HRS survey respondents with cognitive scores available, over 20% were in the dementia/AD range. The distribution of disease by stage differed for self-reported AD diagnosis vs dementia/AD based on cognitive scores. Discordance in estimates of dementia/AD and stage distributions underscores a need for better understanding of clinica
背景最新的阿尔茨海默病(AD)患病率估计值可以促进在当前的医疗保健环境中采取更加细致有效的方法来管理阿尔茨海默病。目标本研究旨在利用健康与退休研究(HRS)的数据估计美国痴呆症/AD(包括轻度、中度和重度阶段)和全因轻度认知障碍(MCI)的患病率和严重程度分布。设计回顾性研究.设置数据来自一年两次的健康与退休研究调查,其中包括对具有代表性的 50 岁美国人样本进行的深度访谈.参与者来自最近 4 次健康与退休研究调查(2014、2016、2018 和 2020 年)中的痴呆/AD 和全因 MCI 患者.测量根据诊断(自我报告)确定痴呆/AD。痴呆/AD范围内的认知表现(改良的认知状态电话访谈[TICS-m])得分也被记录下来;全因MCI同样通过TICS-m来确定。对痴呆/AD 和 MCI 患病率以及痴呆/AD 阶段(轻度、中度或重度)的分布情况进行了估算。结果在四次 HRS 调查中,HRS 受访者总人数从 15,000 到 21,000 不等(未加权);7,000 到 14,000 人有 TICS-m 评分。采用基于诊断的方法,2014、2016、2018 和 2020 年 HRS 调查中,AD(合并所有严重程度类别)的估计患病率分别为 1.2%、1.2%、1.3% 和 1.0%;采用基于认知表现的方法,4 次调查中有 23-27% 的患者得分在痴呆/AD 范围内。在每次调查中,全因 MCI 的估计患病率始终为 23%。在 2020 年的调查中,自我报告 AD 诊断的患者中,轻度、中度和重度疾病分期的分布比例分别为 34%、45% 和 21%,而在所有达到 TICS-m 痴呆/AD 临界值的患者中,轻度、中度和重度疾病分期的分布比例分别为 55%、40% 和 5%。在有认知评分的 HRS 调查对象中,超过 20% 属于痴呆症/注意力缺失症范围。自我报告的注意力缺失症诊断与基于认知评分的痴呆症/注意力缺失症的疾病阶段分布不同。痴呆/AD和分期分布估计值的不一致突出表明,需要更好地了解美国在诊断AD、使用临床评估工具和严重程度分类方面的临床实践模式。需要对患者进行准确的识别,尤其是在AD疾病的早期,以便及时、适当地开始新的抗淀粉样蛋白治疗。
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引用次数: 0
A Pilot Study of BRAIN BOOTCAMP, a Low-Intensity Intervention on Diet, Exercise, Cognitive Activity, and Social Interaction to Improve Older Adults’ Dementia Risk Scores BRAIN BOOTCAMP 是一项关于饮食、运动、认知活动和社交互动的低强度干预措施,旨在提高老年人痴呆症风险评分的试点研究
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-17 DOI: 10.14283/jpad.2024.104
Joyce Siette, L. Dodds, K. Deckers, S. Köhler, I. Heger, P. Strutt, C. Johnco, V. Wuthrich, C. J. Armitage

Background

Little is known about the impact of short, low-intensity multidomain dementia risk reduction interventions in older adults.

Objectives

To examine the effectiveness and feasibility of a low-intensity multidomain lifestyle intervention on dementia risk and dementia literacy in Australian older adults.

Design

Single-group pre-post design.

Setting

Community-dwelling.

Participants

A total of 853 older Australians (Mean age=73.3 years, SD=6.1) recruited from the community.

Intervention

A 3-month dementia risk reduction program, BRAIN BOOTCAMP, including education, personalised risk information, physical cues for healthier choices and goal setting and planning to target four modifiable risk factors of diet, exercise, cognitive activity and social interaction in older adults.

Measurements

The ‘LIfestyle for BRAin health’ (LIBRA) index was used to assess participants’ modifiable dementia risk based on 12 factors, with higher scores indicating greater risk. Dementia literacy was measured using a modified questionnaire derived from Dutch and British surveys, encompassing knowledge, risk reduction, and awareness aspects. Paired t-tests were used to compare dementia risk scores and dementia literacy before and after the program. Multivariate regressions were performed to identify sociodemographic and psychological factors associated with change in the LIBRA index.

Results

Program attrition was high (58.3%). Participants who completed the program had decreased dementia risk scores (Cohen’s d=0.59, p<0.001), increased dementia literacy and awareness (Cohen’s d=0.64, p<0.001) and increased motivation to change lifestyle behaviors (Cohen’s d=0.25–0.52, p<0.016). Participants with higher motivational beliefs had greater dementia risk reduction.

Conclusions

Improving older adults’ motivation and knowledge may help modify lifestyle behaviors to reduce dementia risk. However, program attrition remains a challenge, suggesting the need for strategies to enhance participant engagement and retention in such interventions.

背景关于短期、低强度、多领域痴呆风险降低干预措施对老年人的影响鲜为人知。目标研究低强度、多领域生活方式干预措施对澳大利亚老年人痴呆风险和痴呆知识的有效性和可行性。干预措施为期3个月的降低痴呆风险计划 "大脑训练营"(BRAIN BOOTCAMP),包括教育、个性化风险信息、更健康选择的身体提示以及目标设定和规划,针对老年人饮食、运动、认知活动和社交互动这四个可改变的风险因素。痴呆症认知度是通过一份源自荷兰和英国调查的改良问卷进行测量的,包括知识、降低风险和意识等方面。我们使用配对 t 检验来比较计划实施前后的痴呆症风险得分和痴呆症知识水平。研究还进行了多变量回归,以确定与 LIBRA 指数变化相关的社会人口和心理因素。完成计划的参与者痴呆症风险评分降低(Cohen's d=0.59,p<0.001),痴呆症知识和意识提高(Cohen's d=0.64,p<0.001),改变生活方式行为的动机增强(Cohen's d=0.25-0.52,p<0.016)。结论提高老年人的积极性和知识水平可能有助于改变生活方式以降低痴呆风险。结论提高老年人的积极性和知识水平可能有助于改变他们的生活方式,降低痴呆症的风险。然而,项目中的自然减员仍然是一个挑战,这表明需要制定策略来提高参与者的参与度和对此类干预的保留率。
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引用次数: 0
Evaluating Causal Effects of Gut Microbiome on Alzheimer’s Disease 评估肠道微生物群对阿尔茨海默病的因果效应
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-13 DOI: 10.14283/jpad.2024.113
Q. Zhao, A. Baranova, H. Cao, Fuquan Zhang

Background

The preceding evidence indicates a close correlation between imbalances in the gut microbiome and Alzheimer’s disease (AD), yet the direct causal relationship remains unclear. Our objective is to investigate this potential causal connection.

Methods

We obtained summary results from two significant genome-wide association studies (GWAS) on gut microbiota (the MibioGen consortium and the Dutch Microbiome Project), along with one GWAS summary result for AD. Using a two-sample Mendelian randomization (TSMR) analysis, we examined the potential causal effects of gut microbiota on AD.

Results

Our TSMR analysis revealed that 16 gut bacterial taxa were linked to a reduced risk of AD. These included phylum Tenericutes, classes Bacilli and Clostridia along with its order Clostridiales, family Bacteroidaceae, genus Bacteroides, and species Bifidobacterium bifidum (OR: 0.867∼0.971, P ≤ 0.045). Conversely, the presence of 12 taxa correlated with an increased risk of AD. These comprised class Actinobacteria and its family Coriobacteriaceae, as well as class Betaproteobacteria, its order Burkholderiales, and its family Sutterellaceae (OR: 1.042∼1.140, P ≤ 0.035).

Conclusion

Our research uncovered evidence suggesting certain gut bacterial species might play a causal role in AD risk, providing a fresh angle for AD treatment strategies.

背景 现有证据表明肠道微生物群失衡与阿尔茨海默病(AD)密切相关,但其直接因果关系仍不清楚。我们从两项关于肠道微生物群的重要全基因组关联研究(GWAS)(MibioGen 财团和荷兰微生物组项目)中获得了汇总结果,同时还获得了一项关于阿尔茨海默病的 GWAS 汇总结果。通过双样本孟德尔随机化(TSMR)分析,我们研究了肠道微生物群对注意力缺失症的潜在因果效应。结果我们的 TSMR 分析显示,16 个肠道细菌类群与注意力缺失症风险降低有关。这些分类群包括担子菌门、芽孢杆菌属和梭状芽孢杆菌属及其梭状芽孢杆菌目、类杆菌科、类杆菌属和双歧杆菌属(OR:0.867∼0.971,P≤0.045)。相反,12 个分类群的存在与 AD 风险的增加相关。结论我们的研究发现了一些证据,表明某些肠道细菌物种可能在AD风险中起着因果作用,这为AD治疗策略提供了一个新的视角。
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引用次数: 0
Clinical Meaningfulness in Alzheimer’s Disease Clinical Trials. A Report from the EU-US CTAD Task Force 阿尔茨海默病临床试验的临床意义。欧盟-美国 CTAD 工作组报告
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-13 DOI: 10.14283/jpad.2024.112
D. Angioni, J. Cummings, C. J. Lansdall, L. Middleton, C. Sampaio, S. Gauthier, S. Cohen, R. C. Petersen, D. M. Rentz, A. M. Wessels, S. B. Hendrix, F. Jessen, M. C. Carrillo, R. S. Doody, M. Irizarry, J. S. Andrews, B. Vellas, P. Aisen, Sandrine Andrieu, Randall Bateman, Richard Batrla, Joanne Bell, Oskar Bosson, Sasha Bozeat, Dawn Brooks, Samantha Budd Haeberlein, Teresa Buracchio, Min Cho, Matthew Choung, Gavin Cook, Darrin Crisitello, Fernando Dangond, Susan de Santi, Ellen Dennehy, Shobha Dhadda, Harjeet Dhillon, Billy Dunn, Michael Egan, Fiona Elwood, Sven Eriksson, Tom Fagan, Howard Fillit, Per-Ola Freskgard, Diana Gallagher, Gopi Gangi, Carlos Granda, David Greeley, Anna-Kaija Gronblad, Harald Hampel, Paul Hawthorne, David Henley, Joe Herring, Steve Hersch, Bill Holt, Takeshi Iwatsubo, Daryl Jones, Anja Kahl, Gene Kinney, Hartmuth Kolb, Lynn Kramer, Luka Kulic, Sanjay Kumar, Lars Lannfelt, John Lawson, Valérie Legrand, Rachel Lenington, Frank Longo, Brandy Matthews, D..

Recent positive results of three phase III anti-amyloid monoclonal antibody trials are transforming the landscape of disease-modifying therapeutics for Alzheimer’s disease, following several decades of failures. Indeed, all three trials have met their primary endpoints. However, the absolute size of the benefit measured in these trials has generated a debate on whether the change scores observed on clinical outcome assessments represent a clinically meaningful benefit to patients. An evidence-based conclusion is urgently required to inform decision-making related to the approval, reimbursement, and ultimately, the management of emerging therapies in clinical practice. The EU-US CTAD Task Force met in Boston to address this important question. The current state-of-the-art knowledge for interpreting clinical meaningfulness of AD clinical trial results, including the point of view of patients and study partners on what is clinically meaningful, was discussed and is summarized here. A combination of methodologies to address the challenges emerged. There remain gaps in the understanding of clinical meaningfulness that only long-term longitudinal studies will be able to address.

继数十年的失败之后,最近三项抗淀粉样蛋白单克隆抗体 III 期试验的积极结果正在改变改变阿尔茨海默病治疗方法的格局。事实上,所有三项试验都达到了主要终点。然而,在这些试验中测出的获益的绝对规模引发了一场争论,即在临床结果评估中观察到的评分变化是否代表患者获得了有临床意义的获益。目前迫切需要一个基于证据的结论,以便在临床实践中为新兴疗法的审批、报销和最终管理提供决策依据。欧盟-美国 CTAD 工作组在波士顿召开会议,以解决这一重要问题。会议讨论并总结了目前用于解释 AD 临床试验结果临床意义的最新知识,包括患者和研究合作伙伴对什么是有临床意义的观点。为应对挑战,提出了多种方法。对临床意义的理解仍存在差距,只有长期纵向研究才能解决这一问题。
{"title":"Clinical Meaningfulness in Alzheimer’s Disease Clinical Trials. A Report from the EU-US CTAD Task Force","authors":"D. Angioni, J. Cummings, C. J. Lansdall, L. Middleton, C. Sampaio, S. Gauthier, S. Cohen, R. C. Petersen, D. M. Rentz, A. M. Wessels, S. B. Hendrix, F. Jessen, M. C. Carrillo, R. S. Doody, M. Irizarry, J. S. Andrews, B. Vellas, P. Aisen, Sandrine Andrieu, Randall Bateman, Richard Batrla, Joanne Bell, Oskar Bosson, Sasha Bozeat, Dawn Brooks, Samantha Budd Haeberlein, Teresa Buracchio, Min Cho, Matthew Choung, Gavin Cook, Darrin Crisitello, Fernando Dangond, Susan de Santi, Ellen Dennehy, Shobha Dhadda, Harjeet Dhillon, Billy Dunn, Michael Egan, Fiona Elwood, Sven Eriksson, Tom Fagan, Howard Fillit, Per-Ola Freskgard, Diana Gallagher, Gopi Gangi, Carlos Granda, David Greeley, Anna-Kaija Gronblad, Harald Hampel, Paul Hawthorne, David Henley, Joe Herring, Steve Hersch, Bill Holt, Takeshi Iwatsubo, Daryl Jones, Anja Kahl, Gene Kinney, Hartmuth Kolb, Lynn Kramer, Luka Kulic, Sanjay Kumar, Lars Lannfelt, John Lawson, Valérie Legrand, Rachel Lenington, Frank Longo, Brandy Matthews, D..","doi":"10.14283/jpad.2024.112","DOIUrl":"https://doi.org/10.14283/jpad.2024.112","url":null,"abstract":"<p>Recent positive results of three phase III anti-amyloid monoclonal antibody trials are transforming the landscape of disease-modifying therapeutics for Alzheimer’s disease, following several decades of failures. Indeed, all three trials have met their primary endpoints. However, the absolute size of the benefit measured in these trials has generated a debate on whether the change scores observed on clinical outcome assessments represent a clinically meaningful benefit to patients. An evidence-based conclusion is urgently required to inform decision-making related to the approval, reimbursement, and ultimately, the management of emerging therapies in clinical practice. The EU-US CTAD Task Force met in Boston to address this important question. The current state-of-the-art knowledge for interpreting clinical meaningfulness of AD clinical trial results, including the point of view of patients and study partners on what is clinically meaningful, was discussed and is summarized here. A combination of methodologies to address the challenges emerged. There remain gaps in the understanding of clinical meaningfulness that only long-term longitudinal studies will be able to address.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"15 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141552194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multidomain Intervention for the Reversal of Cognitive Frailty Using a Personalized Approach (AGELESS Trial): Recruitment and Baseline Characteristics of Participants 采用个性化方法逆转认知功能衰弱的多领域干预(AGELESS 试验):参与者的招募和基线特征
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-13 DOI: 10.14283/jpad.2024.111
A. M. Ibrahim, D. K. A. Singh, A. F. M. Ludin, P. Subramaniam, C. Ai-Vyrn, N. Ibrahim, H. Haron, A. M. Safien, N. M. Khalid, P. Ponvel, N. H. M. Fadzil, J. M. Hanipah, F. Mangialasche, M. Kivipelto, Suzana Shahar
<h3 data-test="abstract-sub-heading">Background</h3><p>Reversal of cognitive frailty through a multidomain intervention is desirable to prevent dementia. AGELESS Trial was conducted to determine the effectiveness of a comprehensive, multidomain intervention on older adults with cognitive frailty in Malaysia. However, conducting a clinical trial, particularly during and after Covid-19, posed unique challenges.</p><h3 data-test="abstract-sub-heading">Objective</h3><p>We aimed to investigate the recruitment process and baseline characteristics of the AGELESS Trial participants to better understand an at-risk population and those who agree to participate in an intervention.</p><h3 data-test="abstract-sub-heading">Design/Setting</h3><p>24-month, randomized controlled trial.</p><h3 data-test="abstract-sub-heading">Participants</h3><p>Community-dwelling older adults with independent mobility, aged ≥ 60 years, with a mini mental state examination score of 19–25, a clinical dementia rating of 0.5 ≥ 1 Fried’s physical frailty criteria, and < 22 Beck depression inventory.</p><h3 data-test="abstract-sub-heading">Intervention</h3><p>Participants were randomized 1:1 to a structured multidomain intervention consisting of vascular management, diet, exercise, cognitive and psychosocial stimulation, or to the arm, including routine care and general health consultation.</p><h3 data-test="abstract-sub-heading">Measurement</h3><p>We analyzed the group differences between (1) cognitive frailty and non-cognitive frailty screened subjects, (2) recruited and non-recruited participants, (3) baseline characteristics of participants by arm, (4) adherence to AGELESS intervention at 12 months, and (5) preliminary findings on the effectiveness of the intervention at 12 months.</p><h3 data-test="abstract-sub-heading">Results</h3><p>A total of 957 older adults from two locations, i.e., urban (n = 764) and rural (n = 193) areas, were screened, of whom 38.9% had cognitive frailty and were eligible to participate. Those with cognitive frailty had fewer years of education (B = −0.08; 95%CI = 0.88–0.97; p = 0.002), and lower functioning cognition (B = −0.24; 95%CI = 0.74–0.84; p < 0.001). Among those from urban areas, only 33.1% (n = 106) agreed to participate, particularly those with multimorbidity (B = 0.86; 95%CI = 1.31–4.30; p = 0.01), higher physical activity (B = −1.02; 95%CI = 0.19–0.69; p = 0.002), slower walking speed (B = 1.26; 95%CI = 1.62–7.61; p = 0.001), and higher systolic blood pressure (B = 0.02; 95%CI = 1.00–1.03; p = 0.03). At baseline, participants’ mean age was 68.1±5.6, years of education was 8.3±3.9, body mass index was 27.5±5.3 kg/m<sup>2</sup>, and mini mental state examination score was 22.7±4.0. Generally, there were no significant differences between the intervention and control groups for the main outcomes, except those in the intervention group had higher body mass index, mid-upper-arm circumference, and waist circumference (p < 0.05 for all par
背景通过多领域干预扭转认知虚弱状况是预防痴呆症的理想方法。AGELESS试验旨在确定对马来西亚认知虚弱老年人进行多领域综合干预的有效性。目标我们旨在调查 AGELESS 试验参与者的招募过程和基线特征,以更好地了解高危人群和同意参与干预的人群。设计/设置为期 24 个月的随机对照试验。参与者社区居住的独立行动老年人,年龄≥ 60 岁,迷你精神状态检查评分为 19-25 分,临床痴呆评分为 0.5 ≥ 1 分,符合弗里德身体虚弱标准,以及 < 22 贝克抑郁量表。干预参与者按 1:1 随机分配到由血管管理、饮食、运动、认知和社会心理刺激组成的结构化多领域干预中,或分配到包括常规护理和一般健康咨询在内的干预组中。测量我们分析了以下方面的群体差异:(1) 认知虚弱和非认知虚弱筛查对象;(2) 已招募和未招募的参与者;(3) 各组参与者的基线特征;(4) 12 个月内坚持 AGELESS 干预的情况;(5) 12 个月内干预效果的初步结果、结果 两地共筛选出 957 名老年人,即城市地区(764 人)和农村地区(193 人),其中 38.9% 的老年人认知能力较弱,符合参与条件。认知功能虚弱者受教育年限较少(B = -0.08; 95%CI = 0.88-0.97; p = 0.002),认知功能较弱(B = -0.24; 95%CI = 0.74-0.84; p <0.001)。在来自城市地区的人群中,仅有 33.1%(n = 106)的人同意参与,尤其是那些患有多种疾病(B = 0.86; 95%CI = 1.31-4.30; p = 0.01)、体力活动较多(B = -1.02; 95%CI = 0.19-0.69; p = 0.002),步行速度较慢(B = 1.26; 95%CI = 1.62-7.61; p = 0.001),收缩压较高(B = 0.02; 95%CI = 1.00-1.03; p = 0.03)。基线时,参与者的平均年龄为(68.1±5.6)岁,受教育年限为(8.3±3.9)年,体重指数为(27.5±5.3)kg/m2,迷你精神状态检查评分为(22.7±4.0)分。总体而言,干预组和对照组在主要结果上没有明显差异,只是干预组的体重指数、中上臂围和腰围更高(所有参数的 p 均为 0.05)。12 个月时,干预组的总体坚持率为 52.8%,每个模块的坚持率从 52.8% 到 90.6% 不等。对 12 个月干预效果的初步分析表明,干预对大多数认知领域、部分营养素摄入和食物组、身体功能和血管结果都有积极作用(所有参数的 p 均为 0.05)。
{"title":"Multidomain Intervention for the Reversal of Cognitive Frailty Using a Personalized Approach (AGELESS Trial): Recruitment and Baseline Characteristics of Participants","authors":"A. M. Ibrahim, D. K. A. Singh, A. F. M. Ludin, P. Subramaniam, C. Ai-Vyrn, N. Ibrahim, H. Haron, A. M. Safien, N. M. Khalid, P. Ponvel, N. H. M. Fadzil, J. M. Hanipah, F. Mangialasche, M. Kivipelto, Suzana Shahar","doi":"10.14283/jpad.2024.111","DOIUrl":"https://doi.org/10.14283/jpad.2024.111","url":null,"abstract":"&lt;h3 data-test=\"abstract-sub-heading\"&gt;Background&lt;/h3&gt;&lt;p&gt;Reversal of cognitive frailty through a multidomain intervention is desirable to prevent dementia. AGELESS Trial was conducted to determine the effectiveness of a comprehensive, multidomain intervention on older adults with cognitive frailty in Malaysia. However, conducting a clinical trial, particularly during and after Covid-19, posed unique challenges.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Objective&lt;/h3&gt;&lt;p&gt;We aimed to investigate the recruitment process and baseline characteristics of the AGELESS Trial participants to better understand an at-risk population and those who agree to participate in an intervention.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Design/Setting&lt;/h3&gt;&lt;p&gt;24-month, randomized controlled trial.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Participants&lt;/h3&gt;&lt;p&gt;Community-dwelling older adults with independent mobility, aged ≥ 60 years, with a mini mental state examination score of 19–25, a clinical dementia rating of 0.5 ≥ 1 Fried’s physical frailty criteria, and &lt; 22 Beck depression inventory.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Intervention&lt;/h3&gt;&lt;p&gt;Participants were randomized 1:1 to a structured multidomain intervention consisting of vascular management, diet, exercise, cognitive and psychosocial stimulation, or to the arm, including routine care and general health consultation.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Measurement&lt;/h3&gt;&lt;p&gt;We analyzed the group differences between (1) cognitive frailty and non-cognitive frailty screened subjects, (2) recruited and non-recruited participants, (3) baseline characteristics of participants by arm, (4) adherence to AGELESS intervention at 12 months, and (5) preliminary findings on the effectiveness of the intervention at 12 months.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 957 older adults from two locations, i.e., urban (n = 764) and rural (n = 193) areas, were screened, of whom 38.9% had cognitive frailty and were eligible to participate. Those with cognitive frailty had fewer years of education (B = −0.08; 95%CI = 0.88–0.97; p = 0.002), and lower functioning cognition (B = −0.24; 95%CI = 0.74–0.84; p &lt; 0.001). Among those from urban areas, only 33.1% (n = 106) agreed to participate, particularly those with multimorbidity (B = 0.86; 95%CI = 1.31–4.30; p = 0.01), higher physical activity (B = −1.02; 95%CI = 0.19–0.69; p = 0.002), slower walking speed (B = 1.26; 95%CI = 1.62–7.61; p = 0.001), and higher systolic blood pressure (B = 0.02; 95%CI = 1.00–1.03; p = 0.03). At baseline, participants’ mean age was 68.1±5.6, years of education was 8.3±3.9, body mass index was 27.5±5.3 kg/m&lt;sup&gt;2&lt;/sup&gt;, and mini mental state examination score was 22.7±4.0. Generally, there were no significant differences between the intervention and control groups for the main outcomes, except those in the intervention group had higher body mass index, mid-upper-arm circumference, and waist circumference (p &lt; 0.05 for all par","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"1 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141552193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Blood Cathepsins on the Risk of Alzheimer’s Disease and Related Pathological Biomarkers: Results from Observational Cohort and Mendelian Randomization Study 血液胰蛋白酶对阿尔茨海默病风险及相关病理生物标志物的影响:观察性队列和孟德尔随机研究的结果
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-11 DOI: 10.14283/jpad.2024.107
X.-H. Qian, G.-Y. Ding, S.-Y. Chen, Xiao-li Liu, Miao Zhang, Hui-dong Tang

Background

Alzheimer’s disease (AD), the main type of dementia, involves in complex pathophysiological processes, including abnormal lysosomes function. Cathepsins are the predominant proteases responsible for the degradation of diverse substrates in the endo-lysosomal system. However, there was still a lack of systematic study on the causal association between cathepsins and AD.

Methods

This study utilized Mendelian randomization (MR) to investigate the association between blood cathepsins and the risk of AD, as well as the level of amyloid-β (Aβ) and p-Tau in cerebrospinal fluid. Furthermore, an independent dataset was employed to corroborate the above result. Importantly, this study incorporated the Alzheimer’s disease Immunization and Microbiota Initiative study Cohort to further validate the alteration of blood cathepsins expression level and examine its correlation with cognitive level and plasma AD-related pathological markers.

Results

Using MR method, we observed that high level of cathepsin L (CTSL) was associated with a lower risk of AD in both training and validation data. In observational cohort, we found there was decreased blood CTSL expression level in Aβ+ cognitive impaired (CI) group, compared with Aβ− cognitive unimpaired (CU) group. Correlation analysis revealed that blood CTSL expression level was negatively correlated with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) score, plasma Aβ42 and Aβ42/40 level in Aβ+ CI group. Mediation analysis showed that plasma Aβ42/40 level was the key mediator in the association between blood CTSL and MMSE score in Aβ+ CI participants.

Conclusion

This study revealed that blood CTSL was an important factor affecting the risk of AD, and it affected the cognitive level of AD patients through plasma Aβ42/40 level.

背景阿尔茨海默病(AD)是痴呆症的主要类型,涉及复杂的病理生理过程,包括溶酶体功能异常。胰蛋白酶是内溶酶体系统中负责降解各种底物的主要蛋白酶。本研究采用孟德尔随机法(Mendelian randomization,MR)研究血液中的胰蛋白酶与AD发病风险之间的关系,以及脑脊液中淀粉样蛋白-β(Aβ)和p-Tau的水平。此外,一项独立的数据集也证实了上述结果。重要的是,本研究纳入了阿尔茨海默病免疫和微生物群倡议研究队列,以进一步验证血液中猫蛋白酶表达水平的变化,并研究其与认知水平和血浆中AD相关病理标记物的相关性。结果使用MR方法,我们观察到在训练和验证数据中,高水平的猫蛋白酶L(CTSL)与较低的AD风险相关。在观察队列中,我们发现与 Aβ- 认知功能未受损(CU)组相比,Aβ+ 认知功能受损(CI)组血液中 CTSL 表达水平降低。相关性分析显示,Aβ+ CI 组血液 CTSL 表达水平与迷你精神状态检查(MMSE)和蒙特利尔认知评估(MoCA)评分、血浆 Aβ42 和 Aβ42/40 水平呈负相关。中介分析表明,血浆Aβ42/40水平是Aβ+ CI参与者血液CTSL与MMSE评分之间关系的关键中介因素。
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引用次数: 0
The AlzMatch Pilot Study - Feasibility of Remote Blood Collection of Plasma Biomarkers for Preclinical Alzheimer’s Disease Trials AlzMatch 试点研究--为阿尔茨海默病临床前试验远程采集血浆生物标志物的可行性
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-07 DOI: 10.14283/jpad.2024.101
Sarah Walter, O. Langford, G. A. Jimenez-Maggiora, S. Abdel-Latif, R. A. Rissman, J. D. Grill, J. Karlawish, A. Atri, S. Bruschi, K. Hussen, M. C. Donohue, G. A. Marshall, G. Jicha, M. Racke, R. S. Turner, C. H. van Dyck, V. Venkatesh, K. E. Yarasheski, R. Sperling, J. Cummings, P. S. Aisen, R. Raman
<h3 data-test="abstract-sub-heading">Background</h3><p>Advances in plasma biomarkers to detect Alzheimer’s disease (AD) biology allows researchers to improve the efficiency of participant recruitment into preclinical trials. Recently, protein levels of plasma amyloid-beta and tau proteins have been shown to be predictive of elevated amyloid in brain. Online registries, such as the Alzheimer’s Prevention Trials (APT) Webstudy, include and follow participants using remote assessments to facilitate efficient screening and enrollment of large numbers of individuals who may be at higher risk for AD.</p><h3 data-test="abstract-sub-heading">Objectives</h3><p>The AlzMatch Pilot Study investigated the feasibility of recruiting individuals from an online registry for blood sample collection at community-based phlebotomy centers and plasma biomarker quantification to assess an individual’s eligibility for AD preclinical trials.</p><h3 data-test="abstract-sub-heading">Design</h3><p>Pilot feasibility study with co-primary outcomes.</p><h3 data-test="abstract-sub-heading">Setting</h3><p>This pilot feasibility study included participants from the APT Webstudy, the remote assessment arm of the Trial-ready cohort for Preclinical and Prodromal AD (TRC-PAD) Platform. Novel design included collection of electronic consent, use of community laboratories for plasma collection, mass spectrometry-based biomarker assay, and telephone communication of plasma biomarker screening eligibility.</p><h3 data-test="abstract-sub-heading">Participants</h3><p>Participants invited to the AlzMatch pilot feasibility study were active in the APT Webstudy, 50 years of age or older, resided within 50 miles of both a Quest Diagnostics Patient Services Center (a national diagnostic laboratory with convenient locations for sample collection and processing) and one of six TRC-PAD vanguard clinical trial sites, had no self-reported dementia diagnosis, were able to communicate in English and engaged with the APT Webstudy within the prior 6 months.</p><h3 data-test="abstract-sub-heading">Measurements</h3><p>Primary feasibility outcomes were completion of electronic consent (e-consent) for invited participants and collection of usable blood samples. Additional feasibility outcomes included invitation response rate, plasma biomarker eligibility status (based on amyloid beta-42/40 [Aβ42/40] concentration ratio), ApoE proteotype, and trial inclusion criterion), and completion of telephone contact to learn eligibility to screen for a study.</p><h3 data-test="abstract-sub-heading">Results</h3><p>300 APT Webstudy participants were invited to consent to the AlzMatch study. The AlzMatch e-consent rate was 39% (n=117) (95% CI of 33.5%–44.5%) overall, which was higher than the expected rate of 25%. Similar consent rates were observed across participants based on self-defined sex (41% Female (n=75), 37% Male (n=42)) and race and ethnicity (37% from underrepresented groups (URG) (n=36), 40% not from URG (n=
背景检测阿尔茨海默病(AD)生物学的血浆生物标志物的进步使研究人员能够提高临床前试验招募参与者的效率。最近,血浆中淀粉样蛋白-beta 和 tau 蛋白的水平被证明可预测大脑中淀粉样蛋白的升高。阿尔茨海默氏症预防试验(APT)网络研究等在线注册机构通过远程评估纳入并跟踪参与者,以促进高效筛查和招募大量可能有较高阿尔茨海默氏症风险的个体。目标AlzMatch试验研究调查了从在线登记处招募个体,在社区抽血中心采集血样并进行血浆生物标记物定量,以评估个体是否有资格参与AD临床前试验的可行性。设置这项试验可行性研究纳入了APT Webstudy的参与者,APT Webstudy是临床前和前驱AD试验就绪队列(TRC-PAD)平台的远程评估部分。新颖的设计包括收集电子同意书、使用社区实验室收集血浆、基于质谱的生物标志物检测以及电话通知血浆生物标志物筛选资格。参与者受邀参加 AlzMatch 试点可行性研究的参与者必须积极参与 APT 网络研究,年龄在 50 岁或以上,居住地距离 Quest 诊断公司患者服务中心(一家全国性诊断实验室,样本采集和处理地点方便)和六个 TRC-PAD 先驱临床试验点之一均在 50 英里以内,没有自我报告的痴呆诊断,能够用英语交流,并在之前 6 个月内参与过 APT 网络研究。测量主要可行性结果是受邀参与者完成电子同意书(e-consent)的填写和可用血样的采集。其他可行性结果包括邀请回复率、血浆生物标志物资格状态(基于淀粉样β-42/40 [Aβ42/40]浓度比值)、载脂蛋白E蛋白型和试验纳入标准),以及完成电话联系以了解是否有资格参加研究筛选。结果300名APT Webstudy参与者受邀同意参加AlzMatch研究。AlzMatch 电子同意率总体为 39%(n=117)(95% CI 为 33.5%-44.5%),高于预期的 25%。根据参与者自我定义的性别(41% 女性(n=75),37% 男性(n=42))、种族和民族(37% 来自代表不足群体(URG)(n=36),40% 非来自代表不足群体(URG)(n=79)),观察到了相似的同意率。在同意者(n=117)中,74%(n=87)(95% CI 为 66%-82%)的人成功采集了血浆,不同性别(76% 女性(n=57),71% 男性(n=30))、不同种族和族裔(75% URG(n=27),75% 非 URG(n=59))的采集率相似。60%(n=51)有血浆生物标志物结果的参与者符合未来临床前AD试验的筛选条件。结论通过在线注册表获得参与者的电子同意、在社区中心采集血样、血浆生物标志物量化和报告以及生物标志物评估研究资格都是可行的,不同人口群体的参与率相似。尽管该试验的样本较少且具有选择性,但参与者的参与率和同意率均高于预期。我们的结论是,在社区实验室收集血液进行生物标志物分析可能会提高研究以外的可及性,并可能促进更广泛地将 AD 血浆生物标志物用于临床。基于我们的研究结果,AlzMatch 研究的扩展版正在进行中,其中包括向更多的 APT 网络研究参与者和临床试验机构发出邀请。
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引用次数: 0
Potentially Modifiable Dementia Risk Factors in Canada: An Analysis of Canadian Longitudinal Study on Aging with a Multi-Country Comparison 加拿大潜在的可改变的痴呆症风险因素:加拿大老龄化纵向研究分析与多国比较
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-07 DOI: 10.14283/jpad.2024.105
S. Son, M. Speechley, G. Y. Zou, M. Kivipelto, F. Mangialasche, H. H. Feldman, H. Chertkow, S. Belleville, H. Nygaard, V. Hachinski, F. Pieruccini-Faria, Manuel Montero-Odasso

Background

It has been suggested that up to 40% of dementia cases worldwide are associated with modifiable risk factors; however, these estimates are not known in Canada. Furthermore, sleep disturbances, an emerging factor, has not been incorporated into the life-course model of dementia prevention.

Objective

To estimate the population impact of 12 modifiable risk factors in Canadian adults including sleep disturbances, by sex and age groups, and to compare with other countries.

Design

Cross-sectional analysis of Canadian Longitudinal Study on Aging baseline data.

Setting

Community.

Participants

30,097 adults aged 45 years and older.

Measuremments

Prevalence and Population Attributable

Fractions (PAFs) associated with less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and sleep disturbances

Results

The risk factors with the largest PAF were later life physical inactivity (10.2%; 95% CI, 6.8% to 13%), midlife hearing loss (6.5%; 3.7% to 9.3%), midlife obesity (6.4%; 4.1% to 7.7%), and midlife hypertension (6.2%; 2.7% to 9.3%). The PAF of later life sleep disturbances was 3.0% (95% CI, 1.8% to 3.8%). The 12 risk factors accounted for 51.9% (32.2% to 68.0%) of dementia among men and 52.4% (32.5% to 68.7%) among women. Overall, the combined PAF of all risk factors was 49.2% (31.1% to 64.9%), and it increased with age.

Conclusion

Nearly up to 50% of dementia cases in Canada are attributable to 12 modifiable risk factors across the lifespan. Canadian risk reduction strategies should prioritize targeting physical inactivity, hearing loss, obesity, and hypertension.

背景有研究表明,全球多达 40% 的痴呆症病例与可改变的风险因素有关;然而,这些估计数字在加拿大并不为人所知。目标按性别和年龄组估算包括睡眠障碍在内的12个可改变的风险因素对加拿大成年人的人口影响,并与其他国家进行比较。设计对加拿大老龄化纵向研究的基线数据进行横断面分析。测量与教育程度较低、听力损失、脑外伤、高血压、过量饮酒、肥胖、吸烟、抑郁、社会隔离、缺乏运动、糖尿病和睡眠障碍相关的患病率和人口可归因分数(PAFs)结果PAFs最大的风险因素是晚年缺乏运动(10.2%;95% CI,6.8% 至 13%)、中年听力损失(6.5%;3.7% 至 9.3%)、中年肥胖(6.4%;4.1% 至 7.7%)和中年高血压(6.2%;2.7% 至 9.3%)。晚年睡眠障碍的 PAF 为 3.0%(95% CI,1.8% 至 3.8%)。在男性痴呆症患者中,这12个风险因素占51.9%(32.2%至68.0%),在女性痴呆症患者中,这12个风险因素占52.4%(32.5%至68.7%)。总体而言,所有风险因素的综合PAF为49.2%(31.1%至64.9%),并且随着年龄的增长而增加。加拿大的降低风险战略应优先针对缺乏运动、听力损失、肥胖和高血压。
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引用次数: 0
Does Playing Mahjong Benefit Older Individuals? A Scoping Review 打麻将对老年人有益吗?范围审查
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-07 DOI: 10.14283/jpad.2024.102
Z. C. K. Tse, Y. Cao, B. K. H. Chau, M. K. Yeung, C. Leung, David H. K. Shum

Playing mahjong is a popular intellectual and social leisure activity in Asian countries. It is culturally believed that this activity is beneficial to cognitive and psychological functioning in older adults. However, empirical evidence of the benefits of playing mahjong is scant and scattered across the Western and Asian literature. This scoping review comprehensively examined previous studies of the relationships between playing mahjong and cognitive, psychological, and functional abilities in older adults, highlighted gaps in the literature, and identified directions for future research. A systematic search of the literature was conducted across thirteen Western and Asian databases. Fifty-three studies, including forty-seven observational and six intervention studies, were identified. Overall, the results of the observational studies suggested that more mahjong-playing experience was associated with better cognitive, psychological, and functional abilities. As an intervention, playing mahjong was found to enhance general cognitive abilities and short-term memory and relieve depressive symptoms. However, because most of the reviewed studies adopted a correlational methodology, the neural mechanism underlying the benefits of playing mahjong awaits further elucidation. The findings of this review suggest that more randomized controlled trials should be conducted to explore the effects of playing mahjong on higher-level cognitive functioning in older populations.

打麻将是亚洲国家流行的智力和社交休闲活动。在文化上,人们认为这种活动有益于老年人的认知和心理功能。然而,有关打麻将益处的实证证据却很少,而且散见于西方和亚洲的文献中。本综述全面考察了以往关于打麻将与老年人认知、心理和功能能力之间关系的研究,强调了文献中的空白,并确定了未来研究的方向。我们在 13 个西方和亚洲数据库中进行了系统的文献检索。共发现 53 项研究,包括 47 项观察性研究和 6 项干预性研究。总体而言,观察性研究的结果表明,更多的打麻将经验与更好的认知、心理和功能能力相关。作为一种干预措施,打麻将被发现可以提高一般认知能力和短期记忆力,缓解抑郁症状。然而,由于大多数综述研究采用的是相关性方法,打麻将的益处背后的神经机制还有待进一步阐明。本综述的研究结果表明,应该进行更多的随机对照试验,以探索打麻将对老年人群高层次认知功能的影响。
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引用次数: 0
Digital Health Technologies for Alzheimer’s Disease and Related Dementias: Initial Results from a Landscape Analysis and Community Collaborative Effort 针对阿尔茨海默病和相关痴呆症的数字健康技术:前景分析和社区合作努力的初步成果
IF 6.4 Q2 BUSINESS Pub Date : 2024-06-06 DOI: 10.14283/jpad.2024.103
Sarah Averill Lott, E. Streel, S. L. Bachman, K. Bode, J. Dyer, C. Fitzer-Attas, J. C. Goldsack, A. Hake, A. Jannati, R. S. Fuertes, P. Fromy

Digital health technologies offer valuable advantages to dementia researchers and clinicians as screening tools, diagnostic aids, and monitoring instruments. To support the use and advancement of these resources, a comprehensive overview of the current technological landscape is essential. A multi-stakeholder working group, convened by the Digital Medicine Society (DiMe), conducted a landscape review to identify digital health technologies for Alzheimer’s disease and related dementia populations. We searched studies indexed in PubMed, Embase, and APA PsycInfo to identify manuscripts published between May 2003 to May 2023 reporting analytical validation, clinical validation, or usability/feasibility results for relevant digital health technologies. Additional technologies were identified through community outreach. We collated peer-reviewed manuscripts, poster presentations, or regulatory documents for 106 different technologies for Alzheimer’s disease and related dementia assessment covering diverse populations such as Lewy Body, vascular dementias, frontotemporal dementias, and all severities of Alzheimer’s disease. Wearable sensors represent 32% of included technologies, non-wearables 61%, and technologies with components of both account for the remaining 7%. Neurocognition is the most prevalent concept of interest, followed by physical activity and sleep. Clinical validation is reported in 69% of evidence, analytical validation in 34%, and usability/feasibility in 20% (not mutually exclusive). These findings provide clinicians and researchers a landscape overview describing the range of technologies for assessing Alzheimer’s disease and related dementias. A living library of technologies is presented for the clinical and research communities which will keep findings up-to-date as the field develops.

数字健康技术作为筛查工具、诊断辅助工具和监测仪器,为痴呆症研究人员和临床医生提供了宝贵的优势。为了支持这些资源的使用和发展,全面了解当前的技术状况至关重要。由数字医学协会(DiMe)召集的多方利益相关者工作组进行了一次前景回顾,以确定阿尔茨海默病和相关痴呆症人群的数字健康技术。我们检索了 PubMed、Embase 和 APA PsycInfo 索引中的研究,以确定 2003 年 5 月至 2023 年 5 月间发表的报告相关数字医疗技术的分析验证、临床验证或可用性/可行性结果的手稿。此外,我们还通过社区外联活动确定了其他技术。我们整理了经同行评审的手稿、海报展示或监管文件,涉及 106 种不同的阿尔茨海默病和相关痴呆症评估技术,涵盖路易体、血管性痴呆症、额颞叶痴呆症和所有严重程度的阿尔茨海默病等不同人群。可穿戴式传感器占所含技术的 32%,非可穿戴式传感器占 61%,其余 7% 的技术包含了两者的组成部分。神经认知是最受关注的概念,其次是身体活动和睡眠。69%的证据报告了临床验证,34%的证据报告了分析验证,20%的证据报告了可用性/可行性(不相互排斥)。这些发现为临床医生和研究人员提供了一个概览,描述了评估阿尔茨海默病和相关痴呆症的技术范围。我们为临床和研究界提供了一个活的技术图书馆,它将随着该领域的发展不断更新研究结果。
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The Journal of Prevention of Alzheimer's Disease
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