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Safety, Efficacy and Clinical Applications of Focused Ultrasound-Mediated Blood Brain Barrier Opening in Alzheimer’s Disease: A Systematic Review 聚焦超声介导的血脑屏障开放治疗阿尔茨海默病的安全性、有效性和临床应用:系统综述
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-22 DOI: 10.14283/jpad.2024.85
A. Patwardhan, T. Wilkinson, Y. Meng, I. Alhashyan, S. E. Black, N. Lipsman, Mario Masellis

Alzheimer’s disease is a neurodegenerative disorder marked by cognitive decline and brain pathology involving amyloid plaques and neurofibrillary tangles. Current drug development focuses on disease-modifying therapies, primarily antibodies targeting amyloid or tau. However, the blood-brain barrier (BBB) poses a challenge for drug delivery to the brain. Pre-and early clinical data suggests that Focused Ultrasound (FUS) technology safely enhances BBB permeability without damaging brain tissue, enabling drug delivery. This systematic review discusses the application of FUS to open the BBB for the treatment of Alzheimer’s disease (AD). We review the safety, efficacy, and potential biological effects of FUS-mediated BBB opening in AD patients.

阿尔茨海默病是一种神经退行性疾病,以认知能力下降和涉及淀粉样蛋白斑块和神经纤维缠结的脑部病理变化为特征。目前的药物开发主要集中在改变病情的疗法上,主要是针对淀粉样蛋白或 tau 的抗体。然而,血脑屏障(BBB)给药物进入大脑带来了挑战。前期和早期临床数据表明,聚焦超声(FUS)技术能在不损伤脑组织的情况下安全地增强血脑屏障的通透性,从而实现药物输送。本系统综述讨论了应用 FUS 打开 BBB 以治疗阿尔茨海默病(AD)的情况。我们回顾了 FUS 介导的打开阿尔茨海默病患者 BBB 的安全性、有效性和潜在生物效应。
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引用次数: 0
Biomarkers and Cognition Study, Singapore (BIOCIS): Protocol, Study Design, and Preliminary Findings 新加坡生物标志物与认知研究(BIOCIS):协议、研究设计和初步结果
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-21 DOI: 10.14283/jpad.2024.89
Y. J. Leow, J. D. J. Wang, A. Vipin, G. K. Sandhu, S. A. Soo, D. Kumar, A. A. Mohammed, F. Z. B. Zailan, F. P. H. E. Lee, S. Ghildiyal, S. Y. Liew, C. Dang, P. Tanoto, I. Y. Z. Tan, W. F. W. Chong, Nagaendran Kandiah

Background

The focus of medicine is shifting from treatment to preventive care. The expression of biomarkers of dementia and Alzheimer’s disease (AD) appear decades before the onset of observable symptoms, and evidence has emerged supporting pharmacological and non-pharmacological interventions to treat modifiable risk factors of dementia. However, there is limited research on the epidemiology, clinical phenotypes, and underlying pathobiology of cognitive diseases in Asian populations.

Objectives

The objectives of the Biomarkers and Cognition Study, Singapore(BIOCIS) are to characterize the underlying pathobiology of Cognitive Impairment through a longitudinal study incorporating fluid biomarker profiles, neuroimaging, neuropsychological and clinical outcomes in a multi-ethnic Southeast Asian population.

Design, Setting, Participants

BIOCIS is a 5-year longitudinal study where participants are assessed annually. 2500 participants aged 30 to 95 will be recruited from the community in Singapore. To investigate how pathology presents with or without minimal clinical symptoms and vice versa, CI and unimpaired individuals will be recruited. Participants will undergo assessments to characterise biomarkers of dementia through neuroimaging, fluid biomarkers, cognitive assessments, behavioural and lifestyle profiles, retinal scans and microbiome indicators.

Results

Since commencement of recruitment in February 2022, 1148 participants have been enrolled, comprising 1012 Chinese, 62 Indian, and 35 Malay individuals. Mean age and education is 61.32 years and 14.34 years respectively with 39.8% males. 47.9 % of the cohort are employed and 32.06% have a family history of dementia. The prevalence of cerebral small vessel disease is 90.2% with a mean modified Fazekas white matter hyperintensity score of 4.1.

Conclusion

The BIOCIS cohort will help identify novel biomarkers, pathological trajectories, epidemiology of dementia, and reversible risk factors in a Southeast Asian population. Completion of BIOCIS longitudinal data could provide insights into risk-stratification of Asians populations, and potentially inform public healthcare and precision medicine for better patient outcomes in the prevention of Alzheimer’s disease and dementia.

背景医学的重点正从治疗转向预防。痴呆症和阿尔茨海默病(AD)的生物标志物在可观察到的症状出现前数十年就已出现,已有证据支持药物和非药物干预治疗可改变的痴呆症风险因素。目标新加坡生物标志物与认知研究(BIOCIS)的目标是通过一项纵向研究,结合多种族东南亚人群的体液生物标志物特征、神经影像学、神经心理学和临床结果,描述认知障碍的潜在病理生物学特征。将从新加坡社区招募 2500 名年龄在 30 岁至 95 岁之间的参与者。为了调查病理表现如何与最小临床症状或无最小临床症状相反,将招募 CI 和无障碍个体。参与者将接受评估,通过神经影像学、体液生物标志物、认知评估、行为和生活方式特征、视网膜扫描和微生物组指标来确定痴呆症的生物标志物特征。结果自2022年2月开始招募以来,已有1148名参与者加入,其中包括1012名华人、62名印度人和35名马来人。平均年龄和受教育程度分别为 61.32 岁和 14.34 岁,男性占 39.8%。47.9%的人有工作,32.06%的人有痴呆症家族史。结论BIOCIS队列将有助于在东南亚人群中识别新型生物标记物、病理轨迹、痴呆症流行病学和可逆风险因素。BIOCIS 纵向数据的完成可为亚洲人群的风险分层提供见解,并有可能为公共医疗保健和精准医疗提供信息,从而在预防阿尔茨海默病和痴呆症方面为患者提供更好的治疗效果。
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引用次数: 0
Novel Blood-Based Biomarkers and Disease Modifying Therapies for Alzheimer’s Disease. Are We Ready for the New Era? 阿尔茨海默病的新型血基生物标记物和疾病改变疗法。我们准备好迎接新时代了吗?
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-21 DOI: 10.14283/jpad.2024.83
Roxanna Korologou-Linden, J. Kalsi, D. Kafetsouli, A. Olawale, D. Wingfield, D. Mummery, B. Hayhoe, O. Robinson, A. Majeed, L. T. Middleton

Recent positive trials for novel disease modifying therapies of anti-amyloid monoclonal antibodies represent a paradigm shift in the prevention and management of Alzheimer’s disease, a relentlessly progressive and debilitating disease of old age. The reported efficacy of these new agents when given early in the disease trajectory is dependent on an early and accurate disease diagnosis, which is currently based on cerebrospinal fluid tests or/and neuro-imaging studies such as positron emission tomography. These confirmatory tests provide in vivo evidence of the pathological signature of Alzheimer’s disease, of increased cerebral amyloid and tau burden and neurodegeneration. The emergence of blood-based biomarkers represents another breakthrough, offering a less invasive and scalable diagnostic tool that could be applied in both primary and specialist care settings, potentially revolutionizing Alzheimer’s disease clinical pathways. However, healthcare systems face challenges in the adoption of these new technologies and therapies due to diagnostic and treatment capacity constraints, as well as financial and infrastructure requirements.

最近,抗淀粉样蛋白单克隆抗体的新型疾病调节疗法的试验结果呈阳性,这标志着阿尔茨海默病--一种无情的进展性老年衰弱疾病--的预防和治疗模式发生了转变。据报道,这些新药在疾病早期的疗效取决于早期准确的疾病诊断,而目前的诊断主要基于脑脊液检测或/和神经影像学研究,如正电子发射断层扫描。这些确诊测试提供了阿尔茨海默病病理特征、脑淀粉样蛋白和 tau 负荷增加以及神经变性的体内证据。以血液为基础的生物标记物的出现代表了另一项突破,它提供了一种侵入性较小且可扩展的诊断工具,可应用于初级和专科护理环境,有可能彻底改变阿尔茨海默病的临床路径。然而,由于诊断和治疗能力的限制以及资金和基础设施的要求,医疗保健系统在采用这些新技术和疗法方面面临着挑战。
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引用次数: 0
Associations of Blood Pressure Trajectories with Subsequent Cognitive Decline, Dementia and Mortality 血压轨迹与后续认知能力下降、痴呆症和死亡率的关系
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-21 DOI: 10.14283/jpad.2024.91
Y. Zhu, C. Li, D. Gao, X. Huang, Y. Zhang, M. Ji, Fanfan Zheng, Wuxiang Xie

Background

Hypertension may harm cognitive performance, but the potential correlates of longitudinal patterns of blood pressure (BP), especially diastolic BP (DBP), to cognition have been unclear.

Objectives

To examine long-term BP trajectories in relation to subsequent cognitive decline, incident dementia and all-cause mortality in the general population.

Design

Population-based cohort study.

Setting

Communities in England.

Participants

The study included 7566 participants from the English Longitudinal Study of Ageing (ELSA).

Measurements

BP were measured in 1998, 2004, 2008. Group-based trajectory modeling was used to identify longterm patterns of systolic BP (SBP) and DBP. Outcomes including cognitive function, incident dementia, and all-cause mortality were followed up to 10 years.

Results

Five distinct trajectories were identified for SBP and DBP, respectively. The normal-stable trajectory was used as the reference. For cognitive decline, both SBP and DBP trajectories were independently associated with subsequent cognitive decline, with the fastest decline appeared in the high-stable SBP group of 180 mmHg and the low-stable DBP group of 60 mmHg (both P<0.005). For incident dementia, the multivariable adjusted hazard ratio (HR) was also greatest in high-stable group (4.79, 95% confidence interval: 2.84 to 8.07) across all SBP trajectories. Conversely, low (HR: 1.58) and moderate-low stable (HR: 1.56) DBP trajectories increased dementia risk (both P<0.005). Similar patterns were found in BP trajectories in relation to all-cause mortality.

Conclusion

Our study evaluates the potential health impact from different BP trajectories and suggests that controlling long-term SBP and maintaining adequate DBP may be relevant for the current practice to promote cognitive health and extend lifespan.

背景高血压可能会损害认知能力,但血压(BP)的纵向模式,尤其是舒张压(DBP)与认知能力的潜在相关性尚不清楚。目的研究普通人群中长期血压轨迹与随后的认知能力下降、痴呆症和全因死亡率的关系。采用基于群体的轨迹模型来确定收缩压 (SBP) 和 DBP 的长期模式。结果SBP和DBP分别有五种不同的轨迹。以正常稳定的轨迹为参照。在认知能力下降方面,SBP 和 DBP 轨迹均与随后的认知能力下降独立相关,其中下降最快的是 180 mmHg 的高稳定 SBP 组和 60 mmHg 的低稳定 DBP 组(P<0.005)。在所有 SBP 轨迹中,高稳定组发生痴呆的多变量调整危险比(HR)也最大(4.79,95% 置信区间:2.84 至 8.07)。相反,低(HR:1.58)和中低稳定(HR:1.56)DBP轨迹会增加痴呆风险(P<0.005)。结论我们的研究评估了不同血压轨迹对健康的潜在影响,并表明控制长期的 SBP 和保持足够的 DBP 可能与当前促进认知健康和延长寿命的实践相关。
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引用次数: 0
Meta Analysis of the Correlation between Periodontal Health and Cognitive Impairment in the Older Population 老年人牙周健康与认知障碍之间的相关性元分析
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-09 DOI: 10.14283/jpad.2024.87
Y.-D. Fu, C.-L. Li, C.-L. Hu, M.-D. Pei, W.-Y. Cai, Y.-Q. Li, Lang Xu, Yan Zeng
<h3 data-test="abstract-sub-heading">Objective</h3><p>To explore the correlation between periodontal health and cognitive impairment in the older population to provide the evidence for preventing cognitive impairment from the perspective of oral health care in older adults.</p><h3 data-test="abstract-sub-heading">Methods</h3><p>A comprehensive search was conducted in PubMed, Embase, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure, Wanfang Data, the China Science and Technology Journal Database, and the China Biomedical Literature Database, to include both cross-sectional and longitudinal cohort studies on the association between periodontal health and cognitive impairment in older adults. The search was completed in April 2023. Following quality assessment and data organization of the included studies, meta-analysis was performed using Review Manager 5.4.</p><h3 data-test="abstract-sub-heading">Results</h3><p>Twenty-two studies involving a total of 4,246,608 patients were included to comprehensively assess periodontal health from four dimensions (periodontitis, tooth loss, occlusal support, and masticatory ability), with the outcome variable of cognitive impairment (including mild cognitive impairment, Alzheimer’s disease and all-cause dementia). Meta-analysis showed that, compared to those of periodontally healthy older adults, the risk of cognitive impairment in older adults with poor periodontal health, after adjusting for confounders, was significantly greater for those with periodontitis (OR=1.45, 95% CI: 1.20–1.76, P<0.001), tooth loss (OR=1.80, 95% CI: 1.50–2.15, P<0.001), compromised occlusal support (OR=1.87, 95% CI: 1.29–2.70, P=0.001), and reduced masticatory ability (OR=1.39, 95% CI: 1.11–1.75, P=0.005). The risk of cognitive impairment was higher in older adults with low-dentition than in those with high-dentition. Subgroup analysis revealed older individuals with fewer remaining teeth were at a higher risk of developing cognitive impairment compared to those with more remaining teeth, as shown by the comparison of number of teeth lost (7–17 teeth compared to 0–6 teeth) (OR=1.64, 95% CI: 1.13–2.39, P=0.01), (9–28 teeth compared to 0–8 teeth) (OR=1.13, 95% CI: 1.06–1.20, P<0.001), (19–28 teeth compared to 0–18 teeth) (OR=2.52, 95% CI: 1.32–4.80, P=0.005), and (28 teeth compared to 0–27 teeth) (OR=2.07, 95% CI: 1.54–2.77, P<0.001). In addition, tooth loss in older adults led to a significantly increased risk of mild cognitive impairment (OR=1.66, 95% CI: 1.43–1.91, P<0.001) and all-cause dementia (OR=1.35, 95% CI: 1.11–1.65, P=0.003), although the correlation between tooth loss and the risk of Alzheimer’s disease was not significant (OR=3.89, 95% CI: 0.68–22.31, P=0.13).</p><h3 data-test="abstract-sub-heading">Conclusion</h3><p>Poor periodontal health, assessed across four dimensions (periodontitis, tooth loss, occlusal support, and masticatory ability), represents a significant risk
方法 在PubMed、Embase、Cochrane图书馆、Web of Science、中国国家知识基础设施、万方数据、中国科技期刊数据库和中国生物医学文献数据库中进行了全面检索,纳入了有关老年人牙周健康与认知障碍之间关系的横断面和纵向队列研究。检索工作于 2023 年 4 月完成。结果共纳入22项研究,涉及4246608名患者,从四个维度(牙周炎、牙齿脱落、咬合支持和咀嚼能力)全面评估牙周健康状况,结果变量为认知障碍(包括轻度认知障碍、阿尔茨海默病和全因痴呆)。元分析表明,与牙周健康的老年人相比,在调整了混杂因素后,牙周健康不良的老年人出现认知障碍的风险明显高于有牙周炎的老年人(OR=1.45,95% CI:1.20-1.76,P<0.001)、牙齿脱落(OR=1.80,95% CI:1.50-2.15,P<0.001)、咬合支持受损(OR=1.87,95% CI:1.29-2.70,P=0.001)和咀嚼能力下降(OR=1.39,95% CI:1.11-1.75,P=0.005)。低牙列老年人发生认知障碍的风险高于高牙列老年人。亚组分析显示,与剩余牙齿较多的老年人相比,剩余牙齿较少的老年人患认知障碍的风险更高,这一点可以从牙齿脱落数量(7-17 颗牙齿与 0-6 颗牙齿相比)的比较中看出(OR=1.64,95% CI:1.13-2.39,P=0.01)、(9-28颗牙齿与0-8颗牙齿相比)(OR=1.13,95% CI:1.06-1.20,P<0.001)、(19-28颗牙齿与0-18颗牙齿相比)(OR=2.52,95% CI:1.32-4.80,P=0.005)和(28颗牙齿与0-27颗牙齿相比)(OR=2.07,95% CI:1.54-2.77,P<0.001)。此外,老年人牙齿缺失导致轻度认知障碍(OR=1.66,95% CI:1.43-1.91,P<0.001)和全因痴呆(OR=1.35,95% CI:1.11-1.65,P=0.003)的风险显著增加,尽管牙齿缺失与阿尔茨海默病风险之间的相关性不显著(OR=3.结论从四个方面(牙周炎、牙齿缺失、咬合支持和咀嚼能力)评估牙周健康状况不佳是导致老年人认知障碍的重要风险因素。老年人缺牙越多,患认知障碍的风险就越高,无牙者尤其容易患认知障碍。虽然观察到阿尔茨海默病的风险有一定程度的增加,但并没有发现牙齿缺失与阿尔茨海默病的发病风险之间有明显的关联。加强牙周健康管理和为老年人提供高质量的口腔保健服务有助于预防认知障碍。
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引用次数: 0
The Relationship between History of Traumatic Brain Injury and Longitudinal Changes in Cortical Thickness among Patients with Alzheimer’s Disease 脑外伤史与阿尔茨海默病患者皮质厚度纵向变化之间的关系
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-09 DOI: 10.14283/jpad.2024.86
G. M. D’Souza, N. W. Churchill, D. X. Guan, M. A. Khoury, S. J. Graham, S. Kumar, C. E. Fischer, Tom A. Schweizer

Background

There has been little direct examination of how traumatic brain injury (TBI) affects the rate of neurodegeneration for individuals with Alzheimer’s disease (AD).

Methods

The study examined 89 cognitively normal adults (65 with and 24 without prior TBI) and 65 with AD (16 with and 49 without prior TBI). Cortical thickness was quantified from T1-weighted MRI scans at baseline and follow-up (mean interval 33.4 months). Partial least squares analysis was used to evaluate the effects of AD and TBI history on the longitudinal change in cortical thickness.

Results

Significant group effects were identified throughout the frontal and temporal cortices. Comparison of the AD groups to their control cohorts showed greater relative atrophy for the AD cohort with prior TBI.

Conclusion

These results indicate that a history of TBI exacerbates longitudinal declines in cortical thickness among AD patients, providing new insights into the shared pathomechanisms between these neurological conditions.

背景很少有人直接研究过创伤性脑损伤(TBI)如何影响阿尔茨海默病(AD)患者的神经变性率。根据基线和随访(平均间隔 33.4 个月)时的 T1 加权磁共振成像扫描结果量化皮质厚度。结果在整个额叶和颞叶皮层中发现了显著的群体效应。结论这些结果表明,有创伤性脑损伤史会加剧 AD 患者皮质厚度的纵向下降,从而为了解这些神经疾病之间的共同病理机制提供了新的视角。
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引用次数: 0
Risk of Dementia in Korean Vietnam War Veterans 韩国越战退伍军人患痴呆症的风险
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-07 DOI: 10.14283/jpad.2024.84
Wanhyung Lee, Seunghyun Lee, S.-K. Kang, Won-Jun Choi

Background

The number of cases of all types of dementia is increasing, and a significant increase in prevalence has been noted among veterans. Evidence of an association between dementia and exposure to chemicals such as Agent Orange from the Vietnam War is still limited, and there is a reported lack of awareness.

Objective

This study aimed to investigate the risk of dementia among Vietnam War veterans in Korea.

Design

This retrospective longitudinal study compared the incidence of dementia between Vietnam War veterans and the general population.

Setting

This study used data from the nationally representative Korean Vietnam War Veterans’ Health Study Cohort, a combined dataset sourced from the Ministry of Patriots and Veterans Affairs in Korea and the National Health Insurance Sharing Service database.

Participants

There were 191,272 Vietnam War veterans and 1,000,320 people of different ages, sexes, and residences. matched control in 2002. The total number of person-years were 18,543,181.

Measurements

The dementia group included participants who had visited a medical facility with any of the following ICD-10 codes in the follow-up periods: “F00 Dementia in Alzheimer’s disease,” “F01 Vascular dementia,” “F02 Dementia in other diseases classified elsewhere,” or “F03 Unspecified dementia.”

Results

The incidence rate ratio for all types of dementia was 1.16, with higher ratios observed for vascular and unspecified dementia, particularly in the younger age groups. There was a significant increase in the risk of dementia, Alzheimer’s disease, vascular dementia, and unspecified dementia.

Conclusion

Vietnam War veterans showed an increased risk for all types of dementia. These findings are hypothesized to be due to the effects of the chemicals used during the Vietnam War, which can cause a variety of neurodegenerative diseases. Further studies are warranted to investigate the potential health determinants related to the Vietnam War, focusing on the neurodegenerative effects.

背景所有类型痴呆症的病例数都在增加,退伍军人中的发病率也显著增加。痴呆症与越战期间接触橙剂等化学物质有关的证据仍然有限,而且据报道人们对此缺乏认识。本研究旨在调查韩国越战退伍军人患痴呆症的风险。背景本研究使用了具有全国代表性的韩国越战退伍军人健康研究队列的数据,该研究队列是由韩国爱国者和退伍军人事务部以及国家健康保险共享服务数据库共同提供的数据集。参与者2002年有191272名越战退伍军人和100320名不同年龄、性别和居住地的人。痴呆症组包括在随访期间曾在医疗机构就诊并带有以下任何一种 ICD-10 编码的参与者:"F00 阿尔茨海默氏症中的痴呆症"、"F00 阿尔茨海默氏症中的痴呆症 "和 "F00 阿尔茨海默氏症中的痴呆症":"结果所有类型痴呆症的发病率比为1.16,其中血管性痴呆症和不明原因痴呆症的发病率比更高,尤其是在年轻群体中。越战退伍军人患痴呆症、阿尔茨海默病、血管性痴呆症和不明痴呆症的风险明显增加。这些发现可能是由于越战期间使用的化学物质的影响,这些化学物质可导致多种神经退行性疾病。有必要开展进一步的研究,调查与越战有关的潜在健康决定因素,重点是神经退行性疾病的影响。
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引用次数: 0
Estimating Socio-Economic Status for Alzheimer’s Disease Trials 估算阿尔茨海默病试验的社会经济状况
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-07 DOI: 10.14283/jpad.2024.88
Dorene M. Rentz, J. D. Grill, D. P. Molina-Henry, G. A. Jicha, M. S. Rafii, A. Liu, R. A. Sperling, P. S. Aisen, R. Raman

Introduction

Metrics of a participant’s socioeconomic status (SES) are not routinely collected or standardized in clinical trials. This omission limits the ability to evaluate the generalizability of trial results and restricts clinicians from confidently interpreting the efficacy of new treatments across important sub-populations.

Methods

We adapted an SES measure of social disparity; the Hollingshead Two Factor Index of Social Position, which combines education and occupation into a single metric. We modernized the 1965 occupations to reflect the 2017 careers tabulated by the US Bureau of Labor Statistics. We currently use this adapted measure in Alzheimer’s Clinical Trials Consortium studies.

Results

We present the revised table of occupations. We found that the collection of SES data using the modified Hollingshead was feasible in a multi-site clinical trial and scores were distributed across all SES strata.

Discussion

The modified Hollingshead provides a standardized method for collecting SES information, enabling data aggregation, monitoring, and reporting.

引言 临床试验中没有常规收集或标准化受试者的社会经济地位(SES)指标。这种遗漏限制了评估试验结果普适性的能力,也限制了临床医生自信地解释新疗法在重要亚人群中的疗效。方法我们改编了一种社会经济地位衡量标准,即霍林斯海德社会地位双因素指数(Hollingshead Two Factor Index of Social Position),它将教育和职业结合为一个单一指标。我们对 1965 年的职业进行了更新,以反映美国劳工统计局列出的 2017 年职业。目前,我们在阿尔茨海默氏症临床试验联盟的研究中使用了这一经过调整的衡量标准。我们发现,在多地点临床试验中使用修改后的 Hollingshead 收集 SES 数据是可行的,而且得分分布于所有 SES 阶层。讨论修改后的 Hollingshead 提供了一种收集 SES 信息的标准化方法,使数据汇总、监测和报告成为可能。
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引用次数: 0
Medical Costs and Caregiver Burden of Delivering Disease-Modifying Alzheimer’s Treatments with Different Duration and Route of Administration 以不同疗程和给药途径提供可改变病情的阿尔茨海默氏症治疗的医疗成本和护理负担
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-07 DOI: 10.14283/jpad.2024.81
T. Ozawa, G. Franguridi, Soeren Mattke

Background

Multiple disease modifying treatment for Alzheimer’s disease are currently in clinical development or have been recently approved for use. They have vastly different treatment properties but so far, little work has been done to quantify the impact of treatment properties on the treatment’s value in terms of medical and social care costs and caregiver burden.

Objectives

This study aims to analyze how the mode of treatment administration, treatment frequency and duration, and monitoring requirements affect the value of disease modifying treatments. In order to isolate these effects, we compare five hypothetical disease modifying treatments with equal efficacy and safety: (1) chronic bi-weekly intravenous infusion, (2) chronic four-weekly intravenous infusion, (3) 52 weeks fixed duration four-weekly intravenous infusion, (4) chronic subcutaneous injections, and (5) chronic oral prescription on their direct medical costs, caregiver burden, and preservation of treatment value.

Design

Survey of Alzheimer’s disease treatment clinics and retrospective data analysis.

Setting

United States.

Measurements

Direct medical cost and caregiver burden of treatment administration and monitoring compared to gross treatment benefit.

Results

Chronic bi-weekly infusion treatment had the highest direct medical cost ($45,208) and caregiver burden ($6,095), reducing the treatment value by 44%, while oral treatment with the lowest direct medical cost ($1,983) and caregiver burden ($457) reduced the treatment value by only 2%. Substantial caregiver burden was reported from the survey, with a reported average of 2.3 hours for an office visit and infusion, 44 minutes of round-trip travel time, and 78% of patients being accompanied by a caregiver for treatment.

Conclusion

Burden of chronic intravenous treatments exceed the gross medical and social care cost savings and value of caregiver benefit. The results suggest the need for less complex treatments that require fewer clinic visits to preserve the economic value of disease modifying treatments.

背景目前有多种针对阿尔茨海默病的疾病调节疗法正在临床开发中,或已于近期获批使用。本研究旨在分析给药方式、治疗频率和持续时间以及监测要求如何影响疾病修饰治疗的价值。为了分离这些影响,我们比较了疗效和安全性相同的五种假定的疾病调整治疗方法:(1)慢性双周静脉输注;(2)慢性四周静脉输注;(3)52 周固定疗程四周静脉输注;(4)慢性皮下注射;(5)慢性口服处方,并对其直接医疗成本、护理人员负担和治疗价值进行了分析。结果 长期双周输液治疗的直接医疗成本(45208 美元)和护理人员负担(6095 美元)最高,治疗价值降低了 44%,而口服治疗的直接医疗成本(1983 美元)和护理人员负担(457 美元)最低,治疗价值仅降低了 2%。调查报告显示,护理人员负担沉重,据报告,平均每次就诊和输液时间为 2.3 小时,往返交通时间为 44 分钟,78% 的患者由护理人员陪同接受治疗。结果表明,有必要减少治疗的复杂性,减少就诊次数,以保持改变疾病治疗的经济价值。
{"title":"Medical Costs and Caregiver Burden of Delivering Disease-Modifying Alzheimer’s Treatments with Different Duration and Route of Administration","authors":"T. Ozawa, G. Franguridi, Soeren Mattke","doi":"10.14283/jpad.2024.81","DOIUrl":"https://doi.org/10.14283/jpad.2024.81","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Multiple disease modifying treatment for Alzheimer’s disease are currently in clinical development or have been recently approved for use. They have vastly different treatment properties but so far, little work has been done to quantify the impact of treatment properties on the treatment’s value in terms of medical and social care costs and caregiver burden.</p><h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>This study aims to analyze how the mode of treatment administration, treatment frequency and duration, and monitoring requirements affect the value of disease modifying treatments. In order to isolate these effects, we compare five hypothetical disease modifying treatments with equal efficacy and safety: (1) chronic bi-weekly intravenous infusion, (2) chronic four-weekly intravenous infusion, (3) 52 weeks fixed duration four-weekly intravenous infusion, (4) chronic subcutaneous injections, and (5) chronic oral prescription on their direct medical costs, caregiver burden, and preservation of treatment value.</p><h3 data-test=\"abstract-sub-heading\">Design</h3><p>Survey of Alzheimer’s disease treatment clinics and retrospective data analysis.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>United States.</p><h3 data-test=\"abstract-sub-heading\">Measurements</h3><p>Direct medical cost and caregiver burden of treatment administration and monitoring compared to gross treatment benefit.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Chronic bi-weekly infusion treatment had the highest direct medical cost ($45,208) and caregiver burden ($6,095), reducing the treatment value by 44%, while oral treatment with the lowest direct medical cost ($1,983) and caregiver burden ($457) reduced the treatment value by only 2%. Substantial caregiver burden was reported from the survey, with a reported average of 2.3 hours for an office visit and infusion, 44 minutes of round-trip travel time, and 78% of patients being accompanied by a caregiver for treatment.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Burden of chronic intravenous treatments exceed the gross medical and social care cost savings and value of caregiver benefit. The results suggest the need for less complex treatments that require fewer clinic visits to preserve the economic value of disease modifying treatments.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"2016 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140942403","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
Predicting Cognitive Decline for Non-Demented Adults with High Burden of Tau Pathology, Independent of Amyloid Status 与淀粉样蛋白状态无关,预测Tau病理学负担较重的非痴呆成人的认知能力衰退情况
IF 6.4 Q2 BUSINESS Pub Date : 2024-05-03 DOI: 10.14283/jpad.2024.82
H.-S. Wu, L. Li, Q.-Q. Sun, C.-C. Tan, L. Tan, Wei Xu

Background

Abnormal tau proteins are independent contributors to cognitive impairment. Nevertheless, not all individuals exposed to high-level tau pathology will develop cognitive dysfunction. We aimed to construct a model to predict cognitive trajectory for this high-risk population.

Method

Longitudinal data of 181 non-demented adults (mean age= 73.1; female= 45%), who were determined to have high cerebral burden of abnormal tau by cerebrospinal fluid (CSF) measurements of phosphorylated tau (ptau181) or total tau, were derived from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Cognitive decline was defined as Mini-Mental State Examination scores decline ≥ 3 over three years. A predictive nomogram was constructed using stepwise backward regression method. The discrimination, calibration, and clinical usefulness of the nomogram were evaluated. The model was validated in another 189 non-demented adults via a cross-sectional set (n=149, mean age = 73.9, female = 51%) and a longitudinal set (n= 40, mean age = 75, female = 48%). Finally, the relationships of the calculated risk scores with cognitive decline and risk of Alzheimer’s disease were examined during an extended 8-year follow-up.

Result

Lower volume of hippocampus (odds ratio [OR] = 0.37, p< 0.001), lower levels of CSF sTREM2 (OR = 0.76, p = 0.003), higher scores of Alzheimer’s Disease Assessment Scale-Cognitive (OR = 1.15, p = 0.001) and Functional Activities Questionnaire (OR = 1.16, p = 0.016), and number of APOE ε4 (OR = 1.88, p = 0.039) were associated with higher risk of cognitive decline independent of the amyloid status and were included in the final model. The nomogram had an area of under curve (AUC) value of 0.91 for training set, 0.93 for cross-sectional validation set, and 0.91 for longitudinal validation set. Over the 8-year follow-up, the high-risk group exhibited faster cognitive decline (p< 0.001) and a higher risk of developing Alzheimer’s dementia (HR= 6.21, 95% CI= 3.61–10.66, p< 0.001).

Conclusion

APOE ε4 status, brain reserve capability, neuroinflammatory marker, and neuropsychological scores can help predict cognitive decline in non-demented adults with high burden of tau pathology, independent of the presence of amyloid pathology.

背景异常的 tau 蛋白是造成认知障碍的独立因素。然而,并非所有暴露于高水平 tau 病理学的人都会出现认知功能障碍。我们从阿尔茨海默病神经影像学倡议(ADNI)数据库中获得了181名非痴呆成年人(平均年龄=73.1岁;女性=45%)的纵向数据,这些人通过脑脊液(CSF)中磷酸化tau(ptau181)或总tau的测量结果被确定为大脑中存在大量异常tau。认知能力下降的定义是三年内迷你精神状态检查评分下降≥3分。采用逐步回归法构建了预测提名图。对提名图的区分度、校准和临床实用性进行了评估。该模型在另外 189 名非痴呆成人中进行了验证,包括横断面组(n=149,平均年龄=73.9,女性=51%)和纵断面组(n=40,平均年龄=75,女性=48%)。最后,在长达 8 年的随访过程中,对计算出的风险评分与认知能力下降和阿尔茨海默病风险之间的关系进行了研究。结果 海马体积较小(几率比 [OR] = 0.37,p< 0.001),CSF sTREM2 水平较低(OR = 0.76,p = 0.003)、较高的阿尔茨海默病评估量表-认知评分(OR = 1.15,p = 0.001)和功能活动问卷(OR = 1.16,p = 0.016)以及 APOE ε4(OR = 1.88,p = 0.039)与较高的认知能力下降风险相关,且与淀粉样蛋白状态无关,并被纳入最终模型。训练集的提名图曲线下面积(AUC)值为0.91,横断面验证集为0.93,纵向验证集为0.91。结论APOE ε4状态、脑储备能力、神经炎症标志物和神经心理学评分有助于预测具有高tau病理负担的非痴呆成人的认知能力下降,而与是否存在淀粉样病理无关。
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引用次数: 0
期刊
The Journal of Prevention of Alzheimer's Disease
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