Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00033-3
Shahram Oveisgharan MD , Tianhao Wang PhD , Lisa L Barnes PhD , Julie A Schneider MD , David A Bennett MD , Aron S Buchman MD
<div><h3>Background</h3><p>Many studies have reported that impaired gait precedes cognitive impairment in older people. We aimed to characterise the time course of cognitive and motor decline in older individuals and the association of these declines with the pathologies of Alzheimer's disease and related dementias.</p></div><div><h3>Methods</h3><p>This multicohort study used data from three community-based cohort studies (Religious Orders Study, Rush Memory and Aging Project, and Minority Aging Research Study, all in the USA). The inclusion criteria for all three cohorts were no clinical dementia at the time of enrolment and consent to annual clinical assessments. Eligible participants consented to post-mortem brain donation and had post-mortem pathological assessments and three or more repeated annual measures of cognition and motor functions. Clinical and post-mortem data were analysed using functional mixed-effects models. Global cognition was based on 19 neuropsychological tests, a hand strength score was based on grip and pinch strength, and a gait score was based on the number of steps and time to walk 8 feet and turn 360°. Brain pathologies of Alzheimer's disease and related dementias were assessed at autopsy.</p></div><div><h3>Findings</h3><p>From 1994 to 2022, there were 1570 eligible cohort participants aged 65 years or older, 1303 of whom had cognitive and motor measurements and were included in the analysis. Mean age at death was 90·3 years (SD 6·3), 905 (69%) participants were female, and 398 (31%) were male. Median follow-up time was 9 years (IQR 5–11). On average, cognition was stable from 25 to 15 years before death, when cognition began to decline. By contrast, gait function and hand strength declined during the entire study. The combinations of pathologies of Alzheimer's disease and related dementias associated with cognitive and motor decline and their onsets of associations varied; only tau tangles, Parkinson's disease pathology, and macroinfarcts were associated with decline of all three phenotypes. Tau tangles were significantly associated with cognitive decline, gait function decline, and hand function decline (p<0·0001 for each); however, the association with cognitive decline persisted for more than 11 years before death, but the association with hand strength only began 3·57 years before death and the association with gait began 3·49 years before death. By contrast, the association of macroinfarcts with declining gait function began 9·25 years before death (p<0·0001) compared with 6·65 years before death (p=0·0005) for cognitive decline and 2·66 years before death (p=0·024) for decline in hand strength.</p></div><div><h3>Interpretation</h3><p>Our findings suggest that average motor decline in older adults precedes cognitive decline. Macroinfarcts but not tau tangles are associated with declining gait function that precedes cognitive decline. This suggests the need for further studies to test if gait impairment is
{"title":"The time course of motor and cognitive decline in older adults and their associations with brain pathologies: a multicohort study","authors":"Shahram Oveisgharan MD , Tianhao Wang PhD , Lisa L Barnes PhD , Julie A Schneider MD , David A Bennett MD , Aron S Buchman MD","doi":"10.1016/S2666-7568(24)00033-3","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00033-3","url":null,"abstract":"<div><h3>Background</h3><p>Many studies have reported that impaired gait precedes cognitive impairment in older people. We aimed to characterise the time course of cognitive and motor decline in older individuals and the association of these declines with the pathologies of Alzheimer's disease and related dementias.</p></div><div><h3>Methods</h3><p>This multicohort study used data from three community-based cohort studies (Religious Orders Study, Rush Memory and Aging Project, and Minority Aging Research Study, all in the USA). The inclusion criteria for all three cohorts were no clinical dementia at the time of enrolment and consent to annual clinical assessments. Eligible participants consented to post-mortem brain donation and had post-mortem pathological assessments and three or more repeated annual measures of cognition and motor functions. Clinical and post-mortem data were analysed using functional mixed-effects models. Global cognition was based on 19 neuropsychological tests, a hand strength score was based on grip and pinch strength, and a gait score was based on the number of steps and time to walk 8 feet and turn 360°. Brain pathologies of Alzheimer's disease and related dementias were assessed at autopsy.</p></div><div><h3>Findings</h3><p>From 1994 to 2022, there were 1570 eligible cohort participants aged 65 years or older, 1303 of whom had cognitive and motor measurements and were included in the analysis. Mean age at death was 90·3 years (SD 6·3), 905 (69%) participants were female, and 398 (31%) were male. Median follow-up time was 9 years (IQR 5–11). On average, cognition was stable from 25 to 15 years before death, when cognition began to decline. By contrast, gait function and hand strength declined during the entire study. The combinations of pathologies of Alzheimer's disease and related dementias associated with cognitive and motor decline and their onsets of associations varied; only tau tangles, Parkinson's disease pathology, and macroinfarcts were associated with decline of all three phenotypes. Tau tangles were significantly associated with cognitive decline, gait function decline, and hand function decline (p<0·0001 for each); however, the association with cognitive decline persisted for more than 11 years before death, but the association with hand strength only began 3·57 years before death and the association with gait began 3·49 years before death. By contrast, the association of macroinfarcts with declining gait function began 9·25 years before death (p<0·0001) compared with 6·65 years before death (p=0·0005) for cognitive decline and 2·66 years before death (p=0·024) for decline in hand strength.</p></div><div><h3>Interpretation</h3><p>Our findings suggest that average motor decline in older adults precedes cognitive decline. Macroinfarcts but not tau tangles are associated with declining gait function that precedes cognitive decline. This suggests the need for further studies to test if gait impairment is ","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e336-e345"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000333/pdfft?md5=e34bd8bbc108b19f2ab62d243ea22f5d&pid=1-s2.0-S2666756824000333-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00045-X
Wanyang Li , Wei Chen
{"title":"10-h time-restricted eating: are there broad health benefits?","authors":"Wanyang Li , Wei Chen","doi":"10.1016/S2666-7568(24)00045-X","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00045-X","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e304-e305"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266675682400045X/pdfft?md5=b61f07f903018eb2edeeb00eb8632054&pid=1-s2.0-S266675682400045X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00065-5
Shian Ming Tan, Iris Rawtaer
{"title":"Social health and cognition: the mediating role of depression and inflammation","authors":"Shian Ming Tan, Iris Rawtaer","doi":"10.1016/S2666-7568(24)00065-5","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00065-5","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e312-e313"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000655/pdfft?md5=5777a608919fd6e5ddc427b2134b1190&pid=1-s2.0-S2666756824000655-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00028-X
Jonas Salling Quist PhD , Hanne Enghoff Pedersen PhD , Marie Møller Jensen PhD , Kim Katrine Bjerring Clemmensen PhD , Natasja Bjerre PhD , Trine Spragge Ekblond MSc , Sarah Uldal MD , Joachim Størling PhD , Nicolai J Wewer Albrechtsen PhD , Prof Jens Juul Holst DMSc , Prof Signe Sørensen Torekov PhD , Martin Erik Nyeland PhD , Dorte Vistisen PhD , Prof Marit Eika Jørgensen PhD , Prof Satchidananda Panda PhD , Prof Christina Brock PhD , Prof Graham Finlayson PhD , Martin Bæk Blond PhD , Kristine Færch PhD
<div><h3>Background</h3><p>Time-restricted eating (TRE) has been suggested to be a simple, feasible, and effective dietary strategy for individuals with overweight or obesity. We aimed to investigate the effects of 3 months of 10-h per-day TRE and 3 months of follow-up on bodyweight and cardiometabolic risk factors in individuals at high risk of type 2 diabetes.</p></div><div><h3>Methods</h3><p>This was a single-centre, parallel, superiority, open-label randomised controlled clinical trial conducted at Steno Diabetes Center Copenhagen (Denmark). The inclusion criteria were age 30–70 years with either overweight (ie, BMI ≥25 kg/m<sup>2</sup>) and concomitant prediabetes (ie, glycated haemoglobin [HbA<sub>1c</sub>] 39–47 mmol/mol) or obesity (ie, BMI ≥30 kg/m<sup>2</sup>) with or without prediabetes and a habitual self-reported eating window (eating and drinking [except for water]) of 12 h per day or more every day and of 14 h per day or more at least 1 day per week. Individuals were randomly assigned 1:1 to 3 months of habitual living (hereafter referred to as the control group) or TRE, which was a self-selected 10-h per-day eating window placed between 0600 h and 2000 h. Randomisation was done in blocks varying in size and was open for participants and research staff, but outcome assessors were masked during statistical analyses. The randomisation list was generated by an external statistician. The primary outcome was change in bodyweight, assessed after 3 months (12 weeks) of the intervention and after 3 months (13 weeks) of follow-up. Adverse events were reported and registered at study visits or if participants contacted study staff to report events between visits. This trial is registered on <span>ClinicalTrials.gov</span><svg><path></path></svg> (<span>NCT03854656</span><svg><path></path></svg>).</p></div><div><h3>Findings</h3><p>Between March 12, 2019, and March 2, 2022, 100 participants (66 [66%] were female and 34 [34%] were male; median age 59 years [IQR 52–65]) were enrolled and randomly assigned (50 to each group). Of those 100, 46 (92%) in the TRE group and 46 (92%) in the control group completed the intervention period. After 3 months of the intervention, there was no difference in bodyweight between the TRE group and the control group (–0·8 kg, 95% CI –1·7 to 0·2; p=0·099). Being in the TRE group was not associated with a lower bodyweight compared with the control group after subsequent 3-month follow-up (–0·2 kg, –1·6 to 1·2). In the per-protocol analysis, participants who completed the intervention in the TRE group lost 1·0 kg (–1·9 to –0·0; p=0·040) bodyweight compared with the control group after 3 months of intervention, which was not maintained after the 3-month follow-up period (–0·4 kg, –1·8 to 1·0). During the trial and follow-up period, one participant in the TRE group reported a severe adverse event: development of a subcutaneous nodule and pain when the arm was in use. This side-effect was evaluated to be related to the
{"title":"Effects of 3 months of 10-h per-day time-restricted eating and 3 months of follow-up on bodyweight and cardiometabolic health in Danish individuals at high risk of type 2 diabetes: the RESET single-centre, parallel, superiority, open-label, randomised controlled trial","authors":"Jonas Salling Quist PhD , Hanne Enghoff Pedersen PhD , Marie Møller Jensen PhD , Kim Katrine Bjerring Clemmensen PhD , Natasja Bjerre PhD , Trine Spragge Ekblond MSc , Sarah Uldal MD , Joachim Størling PhD , Nicolai J Wewer Albrechtsen PhD , Prof Jens Juul Holst DMSc , Prof Signe Sørensen Torekov PhD , Martin Erik Nyeland PhD , Dorte Vistisen PhD , Prof Marit Eika Jørgensen PhD , Prof Satchidananda Panda PhD , Prof Christina Brock PhD , Prof Graham Finlayson PhD , Martin Bæk Blond PhD , Kristine Færch PhD","doi":"10.1016/S2666-7568(24)00028-X","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00028-X","url":null,"abstract":"<div><h3>Background</h3><p>Time-restricted eating (TRE) has been suggested to be a simple, feasible, and effective dietary strategy for individuals with overweight or obesity. We aimed to investigate the effects of 3 months of 10-h per-day TRE and 3 months of follow-up on bodyweight and cardiometabolic risk factors in individuals at high risk of type 2 diabetes.</p></div><div><h3>Methods</h3><p>This was a single-centre, parallel, superiority, open-label randomised controlled clinical trial conducted at Steno Diabetes Center Copenhagen (Denmark). The inclusion criteria were age 30–70 years with either overweight (ie, BMI ≥25 kg/m<sup>2</sup>) and concomitant prediabetes (ie, glycated haemoglobin [HbA<sub>1c</sub>] 39–47 mmol/mol) or obesity (ie, BMI ≥30 kg/m<sup>2</sup>) with or without prediabetes and a habitual self-reported eating window (eating and drinking [except for water]) of 12 h per day or more every day and of 14 h per day or more at least 1 day per week. Individuals were randomly assigned 1:1 to 3 months of habitual living (hereafter referred to as the control group) or TRE, which was a self-selected 10-h per-day eating window placed between 0600 h and 2000 h. Randomisation was done in blocks varying in size and was open for participants and research staff, but outcome assessors were masked during statistical analyses. The randomisation list was generated by an external statistician. The primary outcome was change in bodyweight, assessed after 3 months (12 weeks) of the intervention and after 3 months (13 weeks) of follow-up. Adverse events were reported and registered at study visits or if participants contacted study staff to report events between visits. This trial is registered on <span>ClinicalTrials.gov</span><svg><path></path></svg> (<span>NCT03854656</span><svg><path></path></svg>).</p></div><div><h3>Findings</h3><p>Between March 12, 2019, and March 2, 2022, 100 participants (66 [66%] were female and 34 [34%] were male; median age 59 years [IQR 52–65]) were enrolled and randomly assigned (50 to each group). Of those 100, 46 (92%) in the TRE group and 46 (92%) in the control group completed the intervention period. After 3 months of the intervention, there was no difference in bodyweight between the TRE group and the control group (–0·8 kg, 95% CI –1·7 to 0·2; p=0·099). Being in the TRE group was not associated with a lower bodyweight compared with the control group after subsequent 3-month follow-up (–0·2 kg, –1·6 to 1·2). In the per-protocol analysis, participants who completed the intervention in the TRE group lost 1·0 kg (–1·9 to –0·0; p=0·040) bodyweight compared with the control group after 3 months of intervention, which was not maintained after the 3-month follow-up period (–0·4 kg, –1·8 to 1·0). During the trial and follow-up period, one participant in the TRE group reported a severe adverse event: development of a subcutaneous nodule and pain when the arm was in use. This side-effect was evaluated to be related to the ","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e314-e325"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266675682400028X/pdfft?md5=2a86b774d05269156d86de416e4f9463&pid=1-s2.0-S266675682400028X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00049-7
Emma Nichols , Jennifer S Rabin
{"title":"Declining motor and cognitive functioning and the role of gait in dementia","authors":"Emma Nichols , Jennifer S Rabin","doi":"10.1016/S2666-7568(24)00049-7","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00049-7","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e308-e309"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000497/pdfft?md5=cfdadbd8c8161b994d5c5c4624b0b8f5&pid=1-s2.0-S2666756824000497-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00044-8
Anthony Attia BSc MBChB , Jamie Webb MSci , Katherine Connor PhD MRCS , Chris J C Johnston PhD FRCS , Michael Williams PhD MRCP , Tim Gordon-Walker PhD MRCP , Ian A Rowe PhD MRCP , Prof Ewen M Harrison PhD FRCS , Ben M Stutchfield PhD FRCS
<div><h3>Background</h3><p>Following the introduction of an algorithm aiming to maximise life-years gained from liver transplantation in the UK (the transplant benefit score [TBS]), donor livers were redirected from younger to older patients, mortality rate equalised across the age range and short-term waiting list mortality reduced. Understanding age-related prioritisation has been challenging, especially for younger patients and clinicians allocating non-TBS-directed livers. We aimed to assess age-related prioritisation within the TBS algorithm by modelling liver transplantation prioritisation based on data from a UK transplant unit and comparing these data with other regions.</p></div><div><h3>Methods</h3><p>In this population-based modelling study, serum parameters and age at liver transplantation assessment of patients attending the Scottish Liver Transplant Unit, Edinburgh, UK, between December, 2002, and November, 2023, were combined with representative synthetic data to model TBS survival predictions, which were compared according to age group (25–49 years <em>vs</em> ≥60 years), chronic liver disease severity, and disease cause. Models for end-stage liver disease (UKELD [UK], MELD [Eurotransplant region], and MELD 3.0 [USA]) were used as validated comparators of liver disease severity.</p></div><div><h3>Findings</h3><p>Of 2093 patients with chronic liver disease, 1808 (86%) had complete datasets and liver disease parameters consistent with eligibility for the liver transplant waiting list in the UK (UKELD ≥49). Disease severity as assessed by UKELD, MELD, and MELD 3.0 did not differ by age (median UKELD scores of 56 for patients aged ≥60 years <em>vs</em> 56 for patients aged 25–49 years; MELD scores of 16 <em>vs</em> 16; and MELD 3.0 scores of 18 <em>vs</em> 18). TBS increased with advancing age (R=0·45, p<0·0001). TBS predicted that transplantation in patients aged 60 years or older would provide a two-fold greater net benefit at 5 years than in patients aged 25–49 years (median TBS 1317 [IQR 1116–1436] in older patients <em>vs</em> 706 [411–1095] in younger patients; p<0·0001). Older patients were predicted to have shorter survival without transplantation than younger patients (263 days [IQR 144–473] in older patients <em>vs</em> 861 days [448–1164] in younger patients; p<0·0001) but similar survival after transplantation (1599 days [1563–1628] <em>vs</em> 1573 days [1525–1614]; p<0·0001). Older patients could reach a TBS for which a liver offer was likely below minimum criteria for transplantation (UKELD <49), whereas many younger patients were required to have high–urgent disease (UKELD >60). US and Eurotransplant programmes did not prioritise according to age.</p></div><div><h3>Interpretation</h3><p>The UK liver allocation algorithm prioritises older patients for transplantation by predicting that advancing age increases the benefit from liver transplantation. Restricted follow-up and biases in waiting list data m
{"title":"Effect of recipient age on prioritisation for liver transplantation in the UK: a population-based modelling study","authors":"Anthony Attia BSc MBChB , Jamie Webb MSci , Katherine Connor PhD MRCS , Chris J C Johnston PhD FRCS , Michael Williams PhD MRCP , Tim Gordon-Walker PhD MRCP , Ian A Rowe PhD MRCP , Prof Ewen M Harrison PhD FRCS , Ben M Stutchfield PhD FRCS","doi":"10.1016/S2666-7568(24)00044-8","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00044-8","url":null,"abstract":"<div><h3>Background</h3><p>Following the introduction of an algorithm aiming to maximise life-years gained from liver transplantation in the UK (the transplant benefit score [TBS]), donor livers were redirected from younger to older patients, mortality rate equalised across the age range and short-term waiting list mortality reduced. Understanding age-related prioritisation has been challenging, especially for younger patients and clinicians allocating non-TBS-directed livers. We aimed to assess age-related prioritisation within the TBS algorithm by modelling liver transplantation prioritisation based on data from a UK transplant unit and comparing these data with other regions.</p></div><div><h3>Methods</h3><p>In this population-based modelling study, serum parameters and age at liver transplantation assessment of patients attending the Scottish Liver Transplant Unit, Edinburgh, UK, between December, 2002, and November, 2023, were combined with representative synthetic data to model TBS survival predictions, which were compared according to age group (25–49 years <em>vs</em> ≥60 years), chronic liver disease severity, and disease cause. Models for end-stage liver disease (UKELD [UK], MELD [Eurotransplant region], and MELD 3.0 [USA]) were used as validated comparators of liver disease severity.</p></div><div><h3>Findings</h3><p>Of 2093 patients with chronic liver disease, 1808 (86%) had complete datasets and liver disease parameters consistent with eligibility for the liver transplant waiting list in the UK (UKELD ≥49). Disease severity as assessed by UKELD, MELD, and MELD 3.0 did not differ by age (median UKELD scores of 56 for patients aged ≥60 years <em>vs</em> 56 for patients aged 25–49 years; MELD scores of 16 <em>vs</em> 16; and MELD 3.0 scores of 18 <em>vs</em> 18). TBS increased with advancing age (R=0·45, p<0·0001). TBS predicted that transplantation in patients aged 60 years or older would provide a two-fold greater net benefit at 5 years than in patients aged 25–49 years (median TBS 1317 [IQR 1116–1436] in older patients <em>vs</em> 706 [411–1095] in younger patients; p<0·0001). Older patients were predicted to have shorter survival without transplantation than younger patients (263 days [IQR 144–473] in older patients <em>vs</em> 861 days [448–1164] in younger patients; p<0·0001) but similar survival after transplantation (1599 days [1563–1628] <em>vs</em> 1573 days [1525–1614]; p<0·0001). Older patients could reach a TBS for which a liver offer was likely below minimum criteria for transplantation (UKELD <49), whereas many younger patients were required to have high–urgent disease (UKELD >60). US and Eurotransplant programmes did not prioritise according to age.</p></div><div><h3>Interpretation</h3><p>The UK liver allocation algorithm prioritises older patients for transplantation by predicting that advancing age increases the benefit from liver transplantation. Restricted follow-up and biases in waiting list data m","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e346-e355"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000448/pdfft?md5=acbdb963c3b53eb418988f20277b6a46&pid=1-s2.0-S2666756824000448-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00043-6
Miharu Nakanishi PhD , Sandra Martins Pereira PhD , Lieve Van den Block PhD , Deborah Parker PhD , Karen Harrison-Dening PhD , Paola Di Giulio MSc , Jürgen In der Schmitten MD , Philip J Larkin PhD , Ninoslav Mimica PhD , Rebecca L Sudore MD , Iva Holmerová PhD , Ida J Korfage PhD , Jenny T van der Steen PhD , European Association for Palliative Care
Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.
{"title":"Future policy and research for advance care planning in dementia: consensus recommendations from an international Delphi panel of the European Association for Palliative Care","authors":"Miharu Nakanishi PhD , Sandra Martins Pereira PhD , Lieve Van den Block PhD , Deborah Parker PhD , Karen Harrison-Dening PhD , Paola Di Giulio MSc , Jürgen In der Schmitten MD , Philip J Larkin PhD , Ninoslav Mimica PhD , Rebecca L Sudore MD , Iva Holmerová PhD , Ida J Korfage PhD , Jenny T van der Steen PhD , European Association for Palliative Care","doi":"10.1016/S2666-7568(24)00043-6","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00043-6","url":null,"abstract":"<div><p>Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.</p></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e370-e378"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000436/pdfft?md5=9a2904f9de4562236a4221ffe1b97a26&pid=1-s2.0-S2666756824000436-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00064-3
Kazunari Sasaki , Marc L Melcher
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Pub Date : 2024-05-01DOI: 10.1016/S2666-7568(24)00046-1
Jean Stafford PhD , Serhiy Dekhtyar PhD , Anna-Karin Welmer PhD , Davide L Vetrano PhD , Giulia Grande PhD , Erika J Laukka PhD , Anna Marseglia PhD , Vanessa Moulton PhD , Rosie Mansfield PhD , Yiwen Liu PhD , Ke Ning PhD , Prof Karin Wolf-Ostermann PhD , Prof Henry Brodaty DSc , Suraj Samtani PhD , Prof Mohammad Arfan Ikram PhD , René Melis PhD , Prof Joanna Rymaszewska PhD , Dorota Szcześniak PhD , Giorgio Di Gessa PhD , Prof Marcus Richards PhD , Jane Maddock PhD
<div><h3>Background</h3><p>Social health markers, including marital status, contact frequency, network size, and social support, have been shown to be associated with cognition. However, the mechanisms underlying these associations remain poorly understood. We investigated whether depressive symptoms and inflammation mediated associations between social health and subsequent cognition.</p></div><div><h3>Methods</h3><p>In the English Longitudinal Study of Ageing (ELSA), a nationally representative longitudinal study in England, UK, we sampled 7136 individuals aged 50 years or older living in private households without dementia at baseline or at the intermediate mediator assessment timepoint, who had recorded information on at least one social health marker and potential mediator. We used four-way decomposition to examine to what extent depressive symptoms, C-reactive protein, and fibrinogen mediated associations between social health and subsequent standardised cognition (verbal fluency and delayed and immediate recall), including cognitive change, with slopes derived from multilevel models (12-year slope). We examined whether findings were replicated in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), a population-based longitudinal study in Sweden, in a sample of 2604 individuals aged 60 years or older living at home or in institutions in Kungsholmen (central Stockholm) without dementia at baseline or at the intermediate mediator assessment timepoint (6-year slope). Social health exposures were assessed at baseline, potential mediators were assessed at an intermediate timepoint (wave 2 in ELSA and 6-year follow-up in SNAC-K); cognitive outcomes were assessed at a single timepoint (wave 3 in ELSA and 12-year follow-up in SNAC-K), and cognitive change (between waves 3 and 9 in ELSA and between 6-year and 12-year follow-ups in SNAC-K).</p></div><div><h3>Findings</h3><p>The study sample included 7136 participants from ELSA, of whom 3962 (55·5%) were women and 6934 (97·2%) were White; the mean baseline age was 63·8 years (SD 9·4). Replication analyses included 2604 participants from SNAC-K, of whom 1604 (61·6%) were women (SNAC-K did not collect ethnicity data); the mean baseline age was 72·3 years (SD 10·1). In ELSA, we found indirect effects via depressive symptoms of network size, positive support, and less negative support on subsequent verbal fluency, and of positive support on subsequent immediate recall (pure indirect effect [PIE] 0·002 [95% CI 0·001–0·003]). Depressive symptoms also partially mediated associations between less negative support and slower decline in immediate recall (PIE 0·001 [0·000–0·002]) and in delayed recall (PIE 0·001 [0·000–0·002]), and between positive support and slower decline in immediate recall (PIE 0·001 [0·000–0·001]). We did not observe mediation by inflammatory biomarkers. Findings of mediation by depressive symptoms in the association between positive support and verbal fluency and between
{"title":"Social health and subsequent cognitive functioning in people aged 50 years and older: examining the mediating roles of depressive symptoms and inflammatory biomarkers in two European longitudinal studies","authors":"Jean Stafford PhD , Serhiy Dekhtyar PhD , Anna-Karin Welmer PhD , Davide L Vetrano PhD , Giulia Grande PhD , Erika J Laukka PhD , Anna Marseglia PhD , Vanessa Moulton PhD , Rosie Mansfield PhD , Yiwen Liu PhD , Ke Ning PhD , Prof Karin Wolf-Ostermann PhD , Prof Henry Brodaty DSc , Suraj Samtani PhD , Prof Mohammad Arfan Ikram PhD , René Melis PhD , Prof Joanna Rymaszewska PhD , Dorota Szcześniak PhD , Giorgio Di Gessa PhD , Prof Marcus Richards PhD , Jane Maddock PhD","doi":"10.1016/S2666-7568(24)00046-1","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00046-1","url":null,"abstract":"<div><h3>Background</h3><p>Social health markers, including marital status, contact frequency, network size, and social support, have been shown to be associated with cognition. However, the mechanisms underlying these associations remain poorly understood. We investigated whether depressive symptoms and inflammation mediated associations between social health and subsequent cognition.</p></div><div><h3>Methods</h3><p>In the English Longitudinal Study of Ageing (ELSA), a nationally representative longitudinal study in England, UK, we sampled 7136 individuals aged 50 years or older living in private households without dementia at baseline or at the intermediate mediator assessment timepoint, who had recorded information on at least one social health marker and potential mediator. We used four-way decomposition to examine to what extent depressive symptoms, C-reactive protein, and fibrinogen mediated associations between social health and subsequent standardised cognition (verbal fluency and delayed and immediate recall), including cognitive change, with slopes derived from multilevel models (12-year slope). We examined whether findings were replicated in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), a population-based longitudinal study in Sweden, in a sample of 2604 individuals aged 60 years or older living at home or in institutions in Kungsholmen (central Stockholm) without dementia at baseline or at the intermediate mediator assessment timepoint (6-year slope). Social health exposures were assessed at baseline, potential mediators were assessed at an intermediate timepoint (wave 2 in ELSA and 6-year follow-up in SNAC-K); cognitive outcomes were assessed at a single timepoint (wave 3 in ELSA and 12-year follow-up in SNAC-K), and cognitive change (between waves 3 and 9 in ELSA and between 6-year and 12-year follow-ups in SNAC-K).</p></div><div><h3>Findings</h3><p>The study sample included 7136 participants from ELSA, of whom 3962 (55·5%) were women and 6934 (97·2%) were White; the mean baseline age was 63·8 years (SD 9·4). Replication analyses included 2604 participants from SNAC-K, of whom 1604 (61·6%) were women (SNAC-K did not collect ethnicity data); the mean baseline age was 72·3 years (SD 10·1). In ELSA, we found indirect effects via depressive symptoms of network size, positive support, and less negative support on subsequent verbal fluency, and of positive support on subsequent immediate recall (pure indirect effect [PIE] 0·002 [95% CI 0·001–0·003]). Depressive symptoms also partially mediated associations between less negative support and slower decline in immediate recall (PIE 0·001 [0·000–0·002]) and in delayed recall (PIE 0·001 [0·000–0·002]), and between positive support and slower decline in immediate recall (PIE 0·001 [0·000–0·001]). We did not observe mediation by inflammatory biomarkers. Findings of mediation by depressive symptoms in the association between positive support and verbal fluency and between","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e356-e369"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000461/pdfft?md5=4d7163a6c39e22e92bc32235385197ba&pid=1-s2.0-S2666756824000461-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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