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Delirium due to Anticholinergic Drug Burden in Older Persons 老年人抗胆碱能药物负担所致谵妄
Pub Date : 2020-12-28 DOI: 10.20900/agmr20210004
A. Soldati, M. Cesari
The cumulative effect of medications with anticholinergic activity (known as Anticholinergic Drug Burden, ADB) is associated with incident delirium and onset of adverse outcomes in older persons (e.g., cognitive and functional impairment). In a recent study by Egberts and colleagues, the association between delirium and ADB was demonstrated, mainly when assessed using the Anticholinergic Risk Scale (ARS). Although drugs with anticholinergic properties are often included in lists of potentially inappropriate medications, their prescription is still widespread. More efforts should be made to support deprescribing strategies and limit the prescription of potentially harmful medications.
具有抗胆碱能活性药物的累积效应(称为抗胆碱能药物负担,ADB)与老年人谵妄事件和不良后果(如认知和功能损害)的发生有关。在Egberts及其同事最近的一项研究中,谵妄和ADB之间的联系被证明,主要是通过使用抗胆碱能风险量表(ARS)进行评估。尽管具有抗胆碱能特性的药物经常被列入潜在不适当药物的清单,但它们的处方仍然很普遍。应作出更多努力,支持减少处方策略,限制潜在有害药物的处方。
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引用次数: 0
The Paradox of Precision Medicine 精准医疗的悖论
Pub Date : 2020-10-28 DOI: 10.20900/agmr20200026
L. Mosconi, Carole J. Lee, G. Vradenburg, R. Brinton
1 Center for Innovation in Brain Science; University of Arizona, 1230 N. Cherry Ave., P.O. Box 210242, Tucson, AZ 85721, USA 2 Department of Neurology, Weill Cornell Medicine, 420 East 70th St., New York, NY 10021, USA 3 Women’s Health Access Matters, 19 East Elm St, Greenwich, CT 06830, USA 4 UsAgainstAlzheimer’s, P.O. Box 34565, Washington, D.C. 20043, USA * Correspondence: Roberta Diaz Brinton, Email: rbrinton@arizona.edu.
1脑科学创新中心;亚利桑那大学,北切里大街1230号,邮政信箱210242,图森,AZ 85721,美国2,威尔康奈尔医学院,神经内科,纽约,NY 10021,美国3,妇女健康事务,东榆树街19号,格林尼治,CT 06830,美国4,美国华盛顿特区邮政信箱34565,美国20043 *通信:Roberta Diaz Brinton,电子邮件:rbrinton@arizona.edu。
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引用次数: 0
Research Survey Series Shows Effects of COVID-19 Shutdowns on Alzheimer’s Community, with Especially High Stress on Caregivers 研究调查系列显示COVID-19关闭对阿尔茨海默病社区的影响,对护理人员的压力尤其大
Pub Date : 2020-07-30 DOI: 10.20900/agmr20200020
T. Frangiosa, V. Biggar, M. Comer, Amber Roniger
The specific objective of the COVID-19 Survey series is to understand the “real time” burdens and challenges of people living with dementia in this new restrictive environment. Overall, the main purpose of the Study is to develop an understanding over time, through multiple research projects, about “what matters most” to individuals with and/or affected by Alzheimer’s disease and other dementias, including caregivers, and those concerned about brain health.
2019冠状病毒病调查系列的具体目标是了解痴呆症患者在这种新的限制性环境中面临的“实时”负担和挑战。总的来说,这项研究的主要目的是通过多个研究项目,随着时间的推移,了解对阿尔茨海默病和其他痴呆症患者和/或受其影响的人(包括护理人员和那些关心大脑健康的人)“最重要的”是什么。
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引用次数: 8
Eliminating Health Disparities Is Essential to Achieving Racial Justice—Alzheimer’s Disease, COVID-19, and Related Comorbidities Disproportionately Impact Minority Communities in the Fight for Health Equity 消除健康差距对实现种族公正至关重要——阿尔茨海默病、COVID-19和相关合并症对少数民族社区争取卫生公平的影响不成比例
Pub Date : 2020-07-27 DOI: 10.20900/agmr20200019
Stephanie Monroe, D. Satcher
At no time in recent history have the importance and necessity of fighting for health equity and access and against racial health disparities been more apparent than in the past several months.
在近代史上,争取保健公平和机会以及反对种族保健差异的重要性和必要性从未像过去几个月这样明显。
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引用次数: 0
Derivation of a Frailty Index from the interRAI-HC to Assess Frailty among Older Adults Receiving Home Care and Assistance (the “fraXity” Study) 由interRAI-HC衍生出虚弱指数以评估接受家居照顾及协助的长者的虚弱程度(“虚弱”研究)
Pub Date : 2020-04-16 DOI: 10.20900/agmr20200013
C. Ludwig, C. Busnel
Background: Today, the value of screening for frailty among older adults is undisputed; to this endeavor, care at-home professionals are the “frailty whistleblowers” of choice. Yet, they need quick at-hand tools for routine use. To this aim, this study proposes a frailty index (FI) directly derived from the interRAI-HC MDS. The FI is used to assess frailty in a panel of home service recipients to document the rate of frailty among types of users. Methods: “fraXity” relies on a case-control design comparing community dwelling older adults receiving home care or assistance to peers who do not receive formal home services. The participants (N = 231) received the interRAI-HC at home from trained nurses. MDS data were used to derive a FI by following published guidelines. Regression modeling was used to assess group differences in the outcomes of interest. Results: The FI was normally distributed, with a mean of 0.19 (SD 0.10), and a value of 0.46 at the 99th percentile. The effect of age was significant (B = 0.003, 95% CI = (0.001–0.005)). As compared to the control group (FI = 0.14 ± 0.07, m ± SD), the FI was higher among individuals who received assistance (B = 0.04, 95% CI = (0.02–0.07)) and care (B = 0.11, 95% CI = (0.08–0.14)). These differences were adjusted for age. Conclusions: The results replicate demonstrations of MDS-based FI derivations and support the usefulness of a FI to distinguish different types of home service recipients. The study is a proof of concept supporting the need of a comprehensive assessment of health needs for all individuals who apply for homes services, including those admitted only for assistance. Further work is needed to evaluate the cost-benefit ratio of implementing the proposed methodology in homecare practice. Trial Registration: ClinicalTrials.gov, NCT03883425, registered on March 20, 2019.
背景:今天,在老年人中筛查虚弱的价值是无可争议的;为了实现这一目标,居家护理专业人员是“虚弱揭发者”的首选。然而,他们需要日常使用的快捷工具。为此,本研究提出了一个直接来源于interRAI-HC MDS的脆弱指数(FI)。FI用于评估家庭服务接受者小组的脆弱性,以记录不同类型用户的脆弱性率。方法:“脆弱性”依赖于病例对照设计,比较社区居住的接受家庭护理或援助的老年人与不接受正式家庭服务的同龄人。参与者(N = 231)在家中接受训练有素的护士的interRAI-HC。MDS数据被用于根据已发布的指南得出FI。回归模型用于评估各组结果的差异。结果:FI呈正态分布,均值为0.19 (SD 0.10),第99百分位值为0.46。年龄的影响显著(B = 0.003, 95% CI =(0.001 ~ 0.005))。与对照组(FI = 0.14±0.07,m±SD)相比,接受辅助(B = 0.04, 95% CI =(0.02-0.07))和护理(B = 0.11, 95% CI =(0.08-0.14))的个体FI更高。这些差异根据年龄进行了调整。结论:结果重复了基于mds的FI衍生的演示,并支持FI区分不同类型家庭服务接受者的有用性。这项研究是一项概念证明,支持需要全面评估所有申请家庭服务的个人的健康需求,包括那些仅为获得援助而入院的人。需要进一步的工作来评估在家庭护理实践中实施所提出的方法的成本效益比。试验注册:ClinicalTrials.gov, NCT03883425,注册于2019年3月20日。
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引用次数: 4
Absolute and Body Mass Index Normalized Handgrip Strength Percentiles by Gender, Ethnicity, and Hand Dominance in Americans. 美国人按性别、种族和手优势划分的绝对握力百分位数和体重指数标准化。
Pub Date : 2020-01-01 Epub Date: 2019-12-31 DOI: 10.20900/agmr20200005
Ryan McGrath, Kyle J Hackney, Nicholas A Ratamess, Brenda M Vincent, Brian C Clark, William J Kraemer

Background: Gender and ethnicity are factors which influence strength, and hand dominance could be a critical component of handgrip strength (HGS) testing. Providing such HGS percentiles across the lifespan may help to identify weakness-related health concerns. We sought to generate growth charts and curves for HGS by gender and ethnicity in a nationally-representative sample of Americans aged 6-80 years.

Methods: Data from 13,617 participants in the 2011-2012 and 2013-2014 waves of the National Health and Nutrition Examination Survey were analyzed. HGS was measured with a handgrip dynamometer. Age, gender, ethnicity, and hand dominance were self-reported. Body Mass Index (BMI) was calculated from height and body mass. Measures of absolute HGS and HGS normalized to BMI were separately included in parametric quantile regression analyses for determining the 10th-90th percentiles across ages by gender and ethnicity. Similar models were also conducted by hand dominance.

Results: Differences in absolute HGS and HGS normalized to BMI quantiles across ages existed for each ethnicity regardless of gender. In men, absolute HGS generally increased until about 25 years of age, began to decline around age 30 years, and regressed into older adulthood. In women, absolute HGS appeared to rise starting at age 6 years, peaked between 20 and 30 years of age, but was maintained into mid-life before declining in older adulthood. Similar results were found for HGS normalized to BMI.

Conclusions: Our findings provide percentile charts for HGS capacity that could be utilized for comparing individual measures of HGS to those from a United States population-representative sample.

背景:性别和种族是影响握力的因素,手优势可能是握力(HGS)测试的关键组成部分。在整个生命周期中提供这样的HGS百分位数可能有助于识别与虚弱相关的健康问题。我们试图在一个具有全国代表性的6-80岁美国人样本中,按性别和种族生成HGS的增长图表和曲线。方法:对2011-2012年和2013-2014年全国健康与营养调查13617名参与者的数据进行分析。HGS的测量采用手握式测功机。年龄、性别、种族和手优势都是自我报告的。体重指数(BMI)由身高和体重计算得出。绝对HGS和归一化为BMI的HGS分别纳入参数分位数回归分析,以确定按性别和种族划分的年龄的第10 -90百分位数。类似的模型也通过手的优势进行。结果:不论性别,不同种族的绝对HGS和按BMI分位数标准化的HGS在不同年龄都存在差异。在男性中,绝对HGS通常在25岁左右增加,在30岁左右开始下降,并在成年后回归。在女性中,绝对HGS从6岁开始上升,在20到30岁之间达到顶峰,但一直保持到中年,然后在成年后下降。将HGS归一化到BMI后也发现了类似的结果。结论:我们的研究结果提供了HGS容量的百分位数图,可用于比较HGS的个人测量与美国人口代表性样本的测量。
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引用次数: 26
Situated Precision Healthcare in the Smart Medical Home: Bringing NASA's Research Strategy down to Earth. 智能医疗家庭中的精准医疗:将NASA的研究战略付诸实践。
Pub Date : 2020-01-01 Epub Date: 2020-06-29 DOI: 10.20900/agmr20200017
Gary Riccio, Rhoda Au, Richard van Emmerik, Mohammed Eslami

This special issue is ambitious in that it calls for strategic transformation in research on Alzheimer's Disease (AD) and related dementias, including innovation in both research design and value delivery, through lifestyle interventions that implicitly relate to a much broader range of comorbidities and diseases of aging. One response to this challenge is to venture beyond the boundaries of research that supports the healthcare industry. Toward this end, we introduce opportunities for research translation and knowledge transfer from NASA to the healthcare industry. Our intent is to show how NASA's approach to research can guide innovation for a smart medical home, most notably for AD and other diseases of aging. The article is organized in four major sections: (a) aggregating fragmented research communities; (b) lifestyle interventions in the medical home; (c) multiscale computational modeling and analysis; and (d) lifespan approach to precision brain health. We provide novel motivations and transformative paths to a diversity of specific lines of research, across communities, that would be difficult to discover in common methods of networking within research communities and even through sophisticated bibliographic methods. We thus reveal how knowledge transfer between the public and private sector can stimulate development of broader scientific communities and achieve a more coherent strategic approach to integration and development of a diversity of capabilities including but not limited to technology.

本期特刊雄心勃勃,呼吁对阿尔茨海默病和相关痴呆症的研究进行战略转变,包括在研究设计和价值交付方面进行创新,通过与更广泛的合并症和衰老疾病隐含相关的生活方式干预。应对这一挑战的一种方法是冒险超越支持医疗保健行业的研究界限。为此,我们介绍了从NASA到医疗保健行业的研究转化和知识转移的机会。我们的目的是展示NASA的研究方法如何指导智能医疗家居的创新,尤其是针对AD和其他衰老疾病。本文分为四个主要部分:(a)汇总碎片化的研究社区;(b)在疗养院进行生活方式干预;(c)多尺度计算建模和分析;(d)精确大脑健康的寿命方法。我们为跨社区的多种特定研究领域提供新颖的动机和变革的途径,这在研究社区内的常见网络方法中甚至通过复杂的书目方法都很难发现。因此,我们揭示了公共和私营部门之间的知识转移如何能够刺激更广泛的科学界的发展,并实现一种更连贯的战略方法来整合和发展包括但不限于技术的各种能力。
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引用次数: 0
Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health. 孤独干预为何不成功?呼吁精准健康。
Pub Date : 2020-01-01 Epub Date: 2020-06-17 DOI: 10.20900/agmr20200016
Samia C Akhter-Khan, Rhoda Au

Background: Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness.

Purpose: This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning.

Results: Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention.

Conclusions: We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.

背景:在过去的几十年里,由于人们日益认识到孤独与痴呆症等严重健康问题之间的密切联系,孤独越来越受到人们的关注。目的:本综述旨在阐明干预措施效果不佳的可能原因。我们提出了孤独感研究的新方向,因为它与精准健康、新兴技术、数字表型和机器学习有关:结果:目前的孤独干预措施之所以不成功,是因为(i)没有考虑到孤独是一种异质性结构,(ii)没有针对个人的需求和背景。我们提出了一个模式,说明孤独干预措施如何能够在正确的时间为正确的人找到正确的解决方案。从精准健康的角度出发,我们探讨了跨学科研究如何有助于更全面地了解孤独问题,并将干预措施从治疗转向预防:我们敦促该领域重新思考衡量标准,以考虑到个体内部不同的孤独体验和轨迹。大数据共享和不断发展的技术强调人与人之间的联系,这为我们实现应用于孤独症的精准健康模式带来了希望。我们迫切需要精确、综合、以理论为导向的干预措施,重点关注个体需求和老龄化背景下孤独感带来的主观负担。
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引用次数: 0
Centenarians as Models of Resistance and Resilience to Alzheimer's Disease and Related Dementias. 百岁老人对阿尔茨海默病和相关痴呆的抵抗力和复原力模型。
Pub Date : 2020-01-01 DOI: 10.20900/agmr20200018
Stacy L Andersen

The majority of research to understand the pathogenesis of and contributors to Alzheimer's disease (AD) pathology, dementia, and disease progression has focused on studying individuals who have the disease or are at increased risk of having the disease. Yet there may be much to learn from individuals who have a paradoxical decreased risk of AD suggesting underlying protective factors. Centenarians demonstrate exceptional longevity that for a subset of the cohort is associated with an increased health span characterized by the delay or escape of age-related diseases including dementia. Here, I give evidence of the association of exceptional longevity with resistance and resilience to AD and describe how cohorts of centenarians and their offspring may serve as models of neuroprotection from AD. Discoveries of novel genetic, environmental, and behavioral factors that are associated with a decreased risk of AD may inform the development of interventions to slow or prevent AD in the general population. Centenarian cohorts may also be instrumental in serving as controls to individuals with AD to identify additional risk factors.

大多数了解阿尔茨海默病(AD)病理、痴呆和疾病进展的发病机制和因素的研究都集中在研究患有该疾病或患病风险增加的个体上。然而,从那些患阿尔茨海默病风险似是而非的降低表明潜在的保护因素的个体身上,我们可能会学到很多东西。百岁老人表现出超常的长寿,这一群体的一个子集与健康寿命的延长有关,其特征是延迟或避免与年龄有关的疾病,包括痴呆症。在这里,我给出了异常长寿与对阿尔茨海默病的抵抗力和恢复力之间的联系的证据,并描述了百岁老人及其后代如何可能作为阿尔茨海默病神经保护的模型。新的基因、环境和行为因素的发现与阿尔茨海默病的风险降低有关,这可能会影响到干预措施的发展,以减缓或预防普通人群的阿尔茨海默病。百岁老人队列也可能有助于作为AD患者的对照,以确定其他风险因素。
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引用次数: 9
Can Patient Frailty Be Estimated from Inpatient Records? A Prospective Cohort Study 从住院病历中可以估计病人的虚弱程度吗?一项前瞻性队列研究
Pub Date : 2019-12-26 DOI: 10.20900/agmr20200004
C. Marincowitz, V. Turner, V. Allgar, Jodie Bellwood, Alice Wheeler, M. Hale, Harriet Callaghan, A. Clegg, T. Sheldon
Background: Frailty is a common condition in older people affecting around 1.8 million people in the UK and is independently associated with adverse outcomes. Frailty is commonly measured with the Clinical Frailty Scale (CFS) which involves a face to face assessment. There is evidence the CFS can be assigned retrospectively from information in patient records, but no research has assessed whether scores can be assigned using routine inpatient records. We aimed to assess whether a CFS could be accurately assigned using hospital inpatient records in a UK setting. Methods: Forty newly admitted patients aged 65 and over were prospectively recruited at Bradford Royal Infirmary. A CFS score was assigned to each patient using a face to face assessment. A CFS score was independently assigned to each patient solely using information in the inpatient records. A quadratically weighted Cohen’s Kappa was used to estimate inter-rater reliability (IRR) between the assessments. Results: A Kappa of 0.84 was estimated for the IRR between the scores derived from a face to face assessment and those based solely on inpatient records, indicating good agreement. The Kappa score fell to 0.7 when a 4 category collapsed version of the CFS was used. The IRR appeared unaffected by the number of times a patient had been admitted recently. Conclusion: The CSF may accurately be determined from data routinely recorded in inpatient records. Retrospectively derived scores can, therefore, be used in analysis of patient outcomes of older people in research and service improvement.
背景:虚弱是老年人的一种常见疾病,在英国约有180万人受到影响,并且与不良后果独立相关。虚弱通常用临床虚弱量表(CFS)来衡量,其中包括面对面的评估。有证据表明,可以根据患者记录中的信息对CFS进行回顾性评分,但没有研究评估是否可以使用常规住院记录进行评分。我们的目的是评估在英国是否可以使用医院住院记录准确地分配CFS。方法:前瞻性招募40例65岁及以上新入院的布拉德福德皇家医院患者。通过面对面评估给每位患者分配CFS评分。单独使用住院记录中的信息为每位患者分配CFS评分。使用二次加权的Cohen’s Kappa来估计评估之间的评级间信度(IRR)。结果:面对面评估所得的IRR与仅基于住院记录所得的IRR之间的Kappa估计为0.84,表明一致性良好。当使用4类压缩版的CFS时,Kappa评分降至0.7。IRR似乎不受患者最近入院次数的影响。结论:脑脊液可根据住院病历中常规记录的数据准确测定。因此,回顾性得出的评分可以用于分析老年人的研究和服务改进中的患者结果。
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引用次数: 10
期刊
Advances in geriatric medicine and research
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