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.
{"title":"Safety, Efficacy and Clinical Applications of Focused Ultrasound-Mediated Blood Brain Barrier Opening in Alzheimer’s Disease: A Systematic Review","authors":"A. Patwardhan, T. Wilkinson, Y. Meng, I. Alhashyan, S. E. Black, N. Lipsman, Mario Masellis","doi":"10.14283/jpad.2024.85","DOIUrl":"https://doi.org/10.14283/jpad.2024.85","url":null,"abstract":"<p>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.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"56 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141150931","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}
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.
{"title":"Biomarkers and Cognition Study, Singapore (BIOCIS): Protocol, Study Design, and Preliminary Findings","authors":"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","doi":"10.14283/jpad.2024.89","DOIUrl":"https://doi.org/10.14283/jpad.2024.89","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Design, Setting, Participants</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>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.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"7 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141150930","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}
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。
{"title":"Novel Blood-Based Biomarkers and Disease Modifying Therapies for Alzheimer’s Disease. Are We Ready for the New Era?","authors":"Roxanna Korologou-Linden, J. Kalsi, D. Kafetsouli, A. Olawale, D. Wingfield, D. Mummery, B. Hayhoe, O. Robinson, A. Majeed, L. T. Middleton","doi":"10.14283/jpad.2024.83","DOIUrl":"https://doi.org/10.14283/jpad.2024.83","url":null,"abstract":"<p>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.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"195 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141063270","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}
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.
{"title":"Associations of Blood Pressure Trajectories with Subsequent Cognitive Decline, Dementia and Mortality","authors":"Y. Zhu, C. Li, D. Gao, X. Huang, Y. Zhang, M. Ji, Fanfan Zheng, Wuxiang Xie","doi":"10.14283/jpad.2024.91","DOIUrl":"https://doi.org/10.14283/jpad.2024.91","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>To examine long-term BP trajectories in relation to subsequent cognitive decline, incident dementia and all-cause mortality in the general population.</p><h3 data-test=\"abstract-sub-heading\">Design</h3><p>Population-based cohort study.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>Communities in England.</p><h3 data-test=\"abstract-sub-heading\">Participants</h3><p>The study included 7566 participants from the English Longitudinal Study of Ageing (ELSA).</p><h3 data-test=\"abstract-sub-heading\">Measurements</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>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.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"23 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141255699","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}
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
{"title":"Meta Analysis of the Correlation between Periodontal Health and Cognitive Impairment in the Older Population","authors":"Y.-D. Fu, C.-L. Li, C.-L. Hu, M.-D. Pei, W.-Y. Cai, Y.-Q. Li, Lang Xu, Yan Zeng","doi":"10.14283/jpad.2024.87","DOIUrl":"https://doi.org/10.14283/jpad.2024.87","url":null,"abstract":"<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","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"41 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140938936","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}
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。
{"title":"The Relationship between History of Traumatic Brain Injury and Longitudinal Changes in Cortical Thickness among Patients with Alzheimer’s Disease","authors":"G. M. D’Souza, N. W. Churchill, D. X. Guan, M. A. Khoury, S. J. Graham, S. Kumar, C. E. Fischer, Tom A. Schweizer","doi":"10.14283/jpad.2024.86","DOIUrl":"https://doi.org/10.14283/jpad.2024.86","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>There has been little direct examination of how traumatic brain injury (TBI) affects the rate of neurodegeneration for individuals with Alzheimer’s disease (AD).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>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.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"46 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140938939","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}
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.
{"title":"Risk of Dementia in Korean Vietnam War Veterans","authors":"Wanhyung Lee, Seunghyun Lee, S.-K. Kang, Won-Jun Choi","doi":"10.14283/jpad.2024.84","DOIUrl":"https://doi.org/10.14283/jpad.2024.84","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>This study aimed to investigate the risk of dementia among Vietnam War veterans in Korea.</p><h3 data-test=\"abstract-sub-heading\">Design</h3><p>This retrospective longitudinal study compared the incidence of dementia between Vietnam War veterans and the general population.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Participants</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Measurements</h3><p>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.”</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>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.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"1 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140939043","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}
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。
{"title":"Estimating Socio-Economic Status for Alzheimer’s Disease Trials","authors":"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","doi":"10.14283/jpad.2024.88","DOIUrl":"https://doi.org/10.14283/jpad.2024.88","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>The modified Hollingshead provides a standardized method for collecting SES information, enabling data aggregation, monitoring, and reporting.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"23 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140939139","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}
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.
{"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}
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.
{"title":"Predicting Cognitive Decline for Non-Demented Adults with High Burden of Tau Pathology, Independent of Amyloid Status","authors":"H.-S. Wu, L. Li, Q.-Q. Sun, C.-C. Tan, L. Tan, Wei Xu","doi":"10.14283/jpad.2024.82","DOIUrl":"https://doi.org/10.14283/jpad.2024.82","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Method</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Result</h3><p>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).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>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.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"8 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140836606","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}