Alzheimer's & Dementia最新文献

In the last two decades, the Alzheimer's Disease Neuroimaging Initiative (ADNI) has significantly advanced our understanding, technologies, and methods for detecting and diagnosing Alzheimer's disease and related dementias. This perspective proposes repurposing ADNI to address emerging research and healthcare challenges. The focus would shift toward early detection of cognitive impairment, discovering new interventions, evaluating non-pharmacological treatments, adopting a public health approach, and enrolling a diverse international cohort. Key elements of this new model include emphasizing vascular-metabolic factors, leveraging biomarkers, and enhancing computational capabilities. By reimagining ADNI's mission and framework, the initiative may be better poised to tackle the evolving complexities of dementia research and improve patient outcomes through a more comprehensive, multidisciplinary approach.

Highlights

INTRODUCTION

The increased interest in evidence-based medicine has led to the emergence of disease registries worldwide to help tackle the impact of chronic diseases. A national dementia registry in Egypt would provide a valuable source of patient data that will significantly advance the disease management strategies, quality of patient care, and impact health policy- and decision making.

METHODS

This study investigates the complexity of creating a disease registry for dementia in Egypt by interviewing 24 experts to provide recommendations for the most appropriate registry model to be developed.

RESULTS

Several core themes emerged from the analysis discussing many points that should direct the creation of any registry in Egypt in terms of functionality, planning, comprehension, governance, ethics, and challenges to avoid.

DISCUSSION

Developing such a dataset is beneficial to the Egyptian health-care system, which makes the investment worthwhile. Support and collaborative work from all stakeholders, along with suitable funding, are essential elements of the proper implementation of the project.

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INTRODUCTION

Improved recognition of non-cognitive presentations of dementia could reduce inequalities in dementia diagnosis, particularly if sociocultural factors influence help-seeking for cognitive symptoms.

METHODS

We conducted a nested case-control study using electronic healthcare records from primary care practices in East London, United Kingdom, to assess associations between prediagnostic presentations to primary care and subsequent dementia diagnosis.

RESULTS

We included 4137 individuals with a dementia diagnosis and 15,754 controls in the matched analysis. In addition to memory difficulties, a range of symptoms were more common in the decade before diagnosis, including depression, anxiety, use of antipsychotics, insomnia, constipation, incontinence, hypotension, hearing loss, imbalance, and dizziness.

DISCUSSION

A range of non-cognitive presentations are seen during the prodromal period of dementia in a diverse population. Improved recognition of these associations and their variation by ethnicity could increase access to dementia diagnosis through improved recognition of early features in people from different sociocultural backgrounds.

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INTRODUCTION

Eating and swallowing difficulties are prevalent and distressing among persons living with dementia (PLWD). These challenges may be especially burdensome for PLWD in lower-resourced settings, where environmental factors such as social support, health-care infrastructure, and food access are critical for meeting quality standards of eating and swallowing care. However, clinical practices and research methods have not sufficiently focused on the lived environment to promote high-quality, socially and culturally aligned management approaches.

METHODS

To address this gap, we developed a conceptual framework informed by the literature, grounded in ecological systems and fundamental cause theories, and refined through iterative discussion.

RESULTS

Our framework highlights individual-, system-, and community-level factors and resources influencing person-centered eating and swallowing care for PLWD. It identifies areas at risk for inequitable care along the swallowing management continuum.

DISCUSSION

We propose future research areas to help health-care providers reconcile the demands of eating and swallowing care with the lived realities of PLWD.

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INTRODUCTION

Educational attainment is associated with midlife cognitive functioning. However, degree attainment is the culmination of complex and unequal processes involving students’ backgrounds, the opportunities that schools provide them, and their performance within those schools─all of which may also shape midlife cognition. What do educational gradients in midlife cognition look like using a richer conceptualization and measures of “education?”

METHODS

We use data from High School and Beyond (HS&B:80)─a large, nationally representative sample of Americans followed from high school through age ∼60─to assess the role of education in stratifying midlife cognition.

RESULTS

High schools’ academic and socioeconomic environments predict midlife cognition primarily through their associations with their students’ academic performance. Student academic performance strongly predicts midlife cognition, partially through its association with degree attainment.

DISCUSSION

Inequalities in educational opportunities and in students’ performance in schools shape midlife cognition─even among students with the same attained degrees.

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INTRODUCTION

We assessed the prognostic accuracy of plasma p-tau217 in predicting the progression to mild cognitive impairment (MCI) in cognitively unimpaired (CU) individuals over a mean follow-up of 5.65 years after plasma collection (range 1.01–10.47).

METHODS

We included 215 participants from the PREVENT−AD cohort with plasma Aβ_42/40 and p-tau217, 159 with cerebrospinal fluid (CSF) Aβ_42/40 and p-tau217, and 155 with ¹⁸F-NAV4694 and ¹⁸F-flortaucipir PET scans. MCI progression was determined by multidisciplinary consensus among memory experts blind to biomarker and genetic information.

RESULTS

Cox proportional hazard models indicated a greater progression rate in A+T+_plasma and A−T+_plasma compared to A−T−_plasma individuals (HR = 7.81 [95% CI = 3.92 to 15.59] and HR = 4.25 [1.60–11.31] respectively). Similar results were found with CSF (HR = 3.63 [1.72–7.70]) and PET (HR = 9.30 [3.67–23.55]).

DISCUSSION

Plasma p-tau217 is a prognostic marker for identifying individuals who will develop cognitive impairment within ten years.

Highlights

INTRODUCTION

Limited research has examined dementia prevalence and associated factors in Lesotho. This study investigates dementia prevalence and the associated factors in Lesotho.

METHODS

A survey in Lesotho included 1738 participants screened for dementia and potential associated factors with a focus on modifiable factors. Associations were evaluated using logistic regression models.

RESULTS

The median age was 66 years, with 54.83% women. The prevalence of dementia was 4.89%. Those with depressive symptoms (adjusted odds ratio [aOR]: 3.97, 95% confidence interval [CI]: 1.39–11.30), age ≥ 75 (aOR: 2.68, 95% CI: 1.42–5.04), and underweight (aOR 2.30, 95% CI: 1.23–4.29) had increased odds of dementia. Those with moderate (aOR: 0.32, 95% CI: 0.17–0.58) to high (aOR: 0.35, 95% CI: 0.16–0.77) physical activity and obesity (aOR: 0.30, 95% CI: 0.11–0.80) presented lower odds for dementia.

DISCUSSION

This study provides a contemporary estimate of dementia prevalence in Lesotho, highlighting an association with modifiable factors.

Highlights

Clinical studies have revealed a significant correlation between pain and neurodegenerative diseases, particularly Alzheimer's disease (AD). However, due to cognitive and speech impairments, AD patients, especially those in moderate to severe stages, are often overlooked in pain management. The challenges in obtaining pain-related information from this population exacerbate the issue. Although recent clinical research has increasingly recognized the comorbidity of AD and pain, the pathological alterations and interactive mechanisms underlying this relationship remain inadequately explored. This review provides a comprehensive analysis of the clinical features and pathological mechanisms of AD with and without pain comorbidity. It examines underlying processes, including neuroinflammation, peripheral-central immune interactions, and neurotransmitter dynamics. Furthermore, it highlights current pain assessment and management strategies in AD patients. By offering a theoretical framework, this review aims to support the development of effective pain management approaches and serve as a reference for clinical interventions targeting AD-associated pain.

Highlights

INTRODUCTION

Cognitive decline has become a growing public concern, yet large-scale exposure data identifying the contributing factors remain limited.

METHODS

We conducted an exposure-wide association study involving 1142 participants and 207 exposures, using machine learning to assess the relative contribution and joint effects of key factors. Cluster analysis and intervention simulation trials helped identify high-risk subpopulations and the potential benefits of targeted interventions.

RESULTS

In adjusted mixed models, the socioeconomic status domain emerged as the strongest predictor of longitudinal global cognitive score (β = 2.91, p < 0.0001, q < 0.0001), while the dietary domain also played an important role in memory function. The cluster analysis found that the “unfavorable lifestyle” dominated phenotype was associated with the poorest cognitive outcomes. Simulation trials indicated that cognitive scores could improve by shifting individuals from unfavorable to favorable phenotypes.

DISCUSSION

Cognitive health requires multidomain interventions, particularly in the socioeconomic and dietary fields, and necessitates collaboration between government and individuals.

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