JAR life最新文献

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Background: Rapid advancements in diagnostic biomarkers and criteria have created a complex and evolving environment for clinicians managing patients with cognitive complaints. Real-world data on current diagnostic processes used among diverse populations remains limited.

Objectives: This study aimed to investigate diagnostic patterns and use of diagnostic tests among U.S. adults with mild cognitive impairment, Alzheimer's disease, and/or dementia, stratified by gender, age, and race/ethnicity before clinical availability of blood-based biomarkers and the most recent diagnostic updates.

Design: Retrospective, observational cohort study.

Setting: The Optum® Market Clarity database from January 1, 2017, to September 30, 2021, was utilized.

Participants: 338,739 patients diagnosed with dementia, 81,267 with AD, and 179,419 with MCI were included in the analysis.

Measurements: Demographics information identified from electronic health records at the time of diagnosis was utilized. Occurrence and timing of diagnostic tests was pulled from insurance claims and electronic health records.

Results: Mean age at diagnosis was 69.3 years for MCI, 78.9 years for AD, and 78.6 years for dementia. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used infrequently (MCI: MRI 16.6%, CT 17.5%; AD: MRI 9.0%, CT 18.4%; dementia: MRI 9.5%, CT 25.9%). Cerebrospinal fluid (CSF) biomarker tests and positron emission tomography (PET) were rarely used (MCI: PET 0.6%, CSF 1.6%; AD: PET 0.5%, CSF 0.9%; dementia: PET 0.2%, CSF 1.6%).

Conclusions: During the study period, diagnosis of MCI, AD, and dementia involved low use of brain imaging or CSF biomarkers, despite recommendations from guidelines. By better understanding how patients navigate their diagnostic journey in real-world settings, diagnostic practices can improve and faster support can be provided.

Introduction: Given the accelerated aging processes and elevated fall risk associated with functional decline in correctional settings, developing effective exercise programs for older inmates is increasingly important.

Methods: This study examined the potential effects of a six‑week balance‑training program on static and dynamic balance performance, well‑being, and enjoyment of physical activity among older inmates in an open German prison. Ten male inmates (mean age = 62.1 ± 4.4 years) participated, with five assigned to an intervention group and five to a control group. The intervention comprised three 60‑minute sessions per week. based on a standardized balance‑training protocol for older adults. A repeated‑measures design assessed pre‑ and post‑intervention changes in anthropometric data, static balance, static balance on unstable surfaces, dynamic balance, well‑being, and physical activity enjoyment.

Results: The training group showed significant improvements in static balance and static balance on unstable surfaces, corresponding to functional gains of approximately 26% and 33%, respectively. Dynamic balance, well‑being, and enjoyment of physical activity did not change significantly.

Discussion: The observed improvements in static balance suggest that even limited interventions may yield meaningful physical benefits in older inmates. However, the absence of effects on dynamic balance and psychosocial outcomes may reflect the short intervention duration, small sample size, and ongoing stressors inherent to incarceration. Future studies should extend program length and include follow‑up assessments to evaluate long‑term benefits.

Conclusion: A short, resource‑efficient balance‑training program was associated with improved balance performance in older inmates and may help preserve mobility, autonomy, and quality of life in aging prison populations.

Background: Social determinants of health and biological processes are shaped by the exposome, which provides a framework for understanding how social adversity drives molecular and cellular mechanisms underlying Alzheimer's disease risk. Individuals with low premorbid intellectual ability (pIQ ≤70) may be particularly vulnerable to adverse social determinants of health due to reduced cognitive reserve, yet this relationship is understudied.

Methods: Data from the Health and Aging Brain Study-Health Disparities (n = 2691) were analyzed. Participants were classified as low pIQ (IQ ≤70) or average pIQ (IQ 90-100) via word reading scores. Using a machine learning approach, an XGBoost model evaluated education, income, Area Deprivation Index (ADI), social support, stress, health status, and worry in prediction of pIQ grouping.

Results: The model achieved and AUC of 0.72 [0.64, 0.81]. Top predictors included worry, ADI, income, high school completion, and tangible support. Low pIQ was associated with greater neighborhood deprivation, lower income, and reduced support resources.

Conclusion: Low pIQ, when combined with SDoH factors reflects a vulnerable psychosocial-cognitive phenotype that may accelerate pathways to cognitive decline potentially through inflammatory mechanisms.

Older individuals generally have decreased food intake owing to physical, social, psychological, and behavioral limitations. However, the characteristics of food and nutrient intake resulting from these limitations are poorly organized. Organizing knowledge for practical application in older adults is necessary when considering nutrition care strategies. This review aimed to characterize food and nutrient intake according to these exposure factors in older individuals. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PROSPERO, CRD42024582151). MEDLINE and Web of Science were searched in September 2024 using the following inclusion criteria: community-dwelling older adults aged ≥65 years (participants); factors contributing to physical, social, psychological, or behavioral limitations affecting food and nutrient intake (exposure); food and/or nutrient intake, dietary patterns, and overall diet quality (outcomes); and cross-sectional and cohort studies (study design). Among the 2,354 studies screened, 29 studies were analyzed. These included studies addressed the following exposure factors: oral function and physical activity (physical); economic status, marital status, household size, and educational attainment (social); depressive symptoms (psychological); and food security, nutritional knowledge, and cooking skills (behavioral). Reduced oral function was associated with lower intakes of meat, fish, legumes, vegetables, and fruits. Low economic status and educational level were associated with poor diet quality. However, there was limited research characterizing the dietary intakes of individuals with other factors, such as poor cooking skills or decreased sense of taste and smell. Further research is needed.

Background: APOE ε4/ε4 genotype increases the risk of Amyloid-Related Imaging Abnormalities (ARIA) from anti-amyloid antibody treatment (AAT). While guidelines recommend testing, its practical utility depends on the resulting probability (p) that treatment is actually withheld for ε4-homozygotes, which varies significantly across clinical settings.

Objectives: To quantify the Number Needed to Test (NNT) to prevent one ARIA event as a function of p of withholding AAT in ε4/ε4 patients.

Design: A Bayesian simulation study using a Beta-Binomial model to analyze genotype-stratified contingency tables.

Setting: Data were derived from two published, phase 3 clinical trials: Clarity-AD (lecanemab) and TRAILBLAZER-ALZ 2 (donanemab).

Participants: Aggregate data from source trials.

Intervention: Simulation of varying treatment discontinuation probability p from 0 (none) to 1 (universal for ε4-homozygotes).

Measurements: NNT to prevent one ARIA event (any ARIA-E, any ARIA-H, and symptomatic ARIA-E) and the fractional reduction in total ARIA events as a function of p.

Results: NNTs increased (worsened) significantly as p decreased. Under the most conservative policy (p = 1), the median NNT to prevent one any ARIA-E event was 20-30 (lecanemab) and 15-25 (donanemab), yet this only reduced total ARIA events by 10-30%. The NNT to prevent one symptomatic ARIA-E (lecanemab) was substantially higher, at 70-90 (at p = 1).

Conclusions: The direct safety impact of APOE testing for ARIA mitigation is limited, even under universal discontinuation policies. Its primary value lies in supporting shared decision-making and operational planning rather than as a standalone safety lever.

Background: Subjective memory complaints (SMC) are associated with increased risk of cognitive decline and dementia. SMCs are also influenced by mood and anxiety symptoms, which increased among older adults during the COVID-19 pandemic.

Objective: We investigated whether a single-item SMC measure predicts one-year cognitive decline and whether this predictive relationship remained stable during the early COVID-19 period (2020).

Methods: We analyzed longitudinal data (2011-2023) from the National Health And Aging Trends Study (NHATS), an annual survey of Medicare beneficiaries in the United States. Mixed-effects models assessed the association between self-perceived memory worsening and next-year cognitive outcomes, and tested whether this association differed in 2020.

Results: A total of 33,244 observations from 6676 elderly individuals were included. Higher age, male sex, non-white race, education at or below high school level, lower scores on basic and instrumental activities of daily living, poorer social activity, anxiety symptoms, lower annual income, and self-perceived memory decline each predicted worse cognitive function one year later. However, the interaction between self-perceived memory decline and the COVID-19 pandemic (in 2020) was not significant.

Discussion: A single-item measure of self-perceived memory decline effectively predicts next-year cognitive decline in older adults, independent of the broader social impacts observed during the 2020 COVID-19 pandemic.