James B Leverenz, John T O'Brien, John‐Paul Taylor
Lewy body dementia (LBD) clinically is characerized by a complex myriad of cognitive, behavioral, motor, sleep and autonomic symptoms that can be challenging to manage, particularly in the context of the fluctuations that are so characteristic for these patients. The DIAMOND Lewy Toolkits offer a resource to support clinicians in recognizing and managing this range of symptoms observed in LBD. This session will provide a guided introduction to the DIAMOND Lewy Toolkits, offering a framework to leverage the toolkits in support of patient centered care. In addition to an overview of the DIAMOND Lewy program (Dr. Leverenz), he will focus on motor symptom management. Subsequent speakers will address neuropsychiatric and sleep symptoms (Dr. Chiadi), cognition and autonomic dysfunction (Dr. Scharre) and the adaptation of the DIAMOND Lewy Tool kits in the U.S. (Dr. Amodeo).
{"title":"The US‐Based DIAMOND Lewy Toolkit: Overview and management of motor symptoms","authors":"James B Leverenz, John T O'Brien, John‐Paul Taylor","doi":"10.1002/alz.090803","DOIUrl":"https://doi.org/10.1002/alz.090803","url":null,"abstract":"Lewy body dementia (LBD) clinically is characerized by a complex myriad of cognitive, behavioral, motor, sleep and autonomic symptoms that can be challenging to manage, particularly in the context of the fluctuations that are so characteristic for these patients. The DIAMOND Lewy Toolkits offer a resource to support clinicians in recognizing and managing this range of symptoms observed in LBD. This session will provide a guided introduction to the DIAMOND Lewy Toolkits, offering a framework to leverage the toolkits in support of patient centered care. In addition to an overview of the DIAMOND Lewy program (Dr. Leverenz), he will focus on motor symptom management. Subsequent speakers will address neuropsychiatric and sleep symptoms (Dr. Chiadi), cognition and autonomic dysfunction (Dr. Scharre) and the adaptation of the DIAMOND Lewy Tool kits in the U.S. (Dr. Amodeo).","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"30 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariateresa (Teri) H Muñoz, Joana Okine, Ellen L Brown, Nicole Ruggiano
Patients with dementia (PWD) often face challenges with daily activities due to communication challenges, which may lead to negative outcomes for those with dementia and their family caregivers alike. Augmentative and alternative communication (AAC) devices have demonstrated to be feasible in supporting communication among PWD (May et al., 2019) through text, graphics, and/or sound. Traditional AAC devices have been non‐electronic memory and communication aids (May et al., 2019). However, in recent years many primary caregivers of PWD are seeking out mobile applications to address this challenge using their smartphone or tablet. However, mobile applications addressing communication skills specifically for dementia care are scarce despite their potential to improve quality of life (Ambegaonkare et al., 2021; Brown et al., 2023). To better understand the current landscape of AAC mobile applications, this systematic review identified and evaluated the features and design of commercially‐available mobile applications. A total of 27 AAC apps were identified through searches on the Apple IOS store and Google Play, after excluding duplicates and apps that targeted primarily children. Four research team members were involved in cataloging features and evaluating the apps using a modified version of the Mobile App Rating Scale (Stoyanov et al., 2015). The price of apps varied, though many listed as being free or low‐cost often required higher‐priced subscriptions or licensing fees. All apps were compatible for English speakers, though several were available in multiple languages. It was found that the apps varied in their potential for engagement, functionality, aesthetics, and information. It was also found that many apps are limited in their potential to support caregiving activities (e.g., mealtime, dressing) for those with communication barriers related to cognitive impairment. Apps that are limited in their ability to customize the interface to the user’s preferences for daily care may impede person‐centered care practices for PWD. Implications for practice, policy, and research are discussed.
{"title":"The State of the Art in mobile Augmentative and Alternative Communication Devised for People with Dementia: Evaluation of Features and Functions","authors":"Mariateresa (Teri) H Muñoz, Joana Okine, Ellen L Brown, Nicole Ruggiano","doi":"10.1002/alz.088864","DOIUrl":"https://doi.org/10.1002/alz.088864","url":null,"abstract":"Patients with dementia (PWD) often face challenges with daily activities due to communication challenges, which may lead to negative outcomes for those with dementia and their family caregivers alike. Augmentative and alternative communication (AAC) devices have demonstrated to be feasible in supporting communication among PWD (May et al., 2019) through text, graphics, and/or sound. Traditional AAC devices have been non‐electronic memory and communication aids (May et al., 2019). However, in recent years many primary caregivers of PWD are seeking out mobile applications to address this challenge using their smartphone or tablet. However, mobile applications addressing communication skills specifically for dementia care are scarce despite their potential to improve quality of life (Ambegaonkare et al., 2021; Brown et al., 2023). To better understand the current landscape of AAC mobile applications, this systematic review identified and evaluated the features and design of commercially‐available mobile applications. A total of 27 AAC apps were identified through searches on the Apple IOS store and Google Play, after excluding duplicates and apps that targeted primarily children. Four research team members were involved in cataloging features and evaluating the apps using a modified version of the Mobile App Rating Scale (Stoyanov et al., 2015). The price of apps varied, though many listed as being free or low‐cost often required higher‐priced subscriptions or licensing fees. All apps were compatible for English speakers, though several were available in multiple languages. It was found that the apps varied in their potential for engagement, functionality, aesthetics, and information. It was also found that many apps are limited in their potential to support caregiving activities (e.g., mealtime, dressing) for those with communication barriers related to cognitive impairment. Apps that are limited in their ability to customize the interface to the user’s preferences for daily care may impede person‐centered care practices for PWD. Implications for practice, policy, and research are discussed.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"101 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundCognitive impairment is very common in stroke patients and is rarely diagnosed. Cognitive deficits involving language functions, praxis, visuospatial, visuoconstructive skills and memory are prominent. The available cognitive assessment tests do not address some specific characteristics of stroke patients and have important limitations in relation to the most compromised cognitive domains.MethodObservational and descriptive study, with cognitively normal individuals and patients with a history of Cerebral Vascular Accident (CVA) from the Unified Health System of São Caetano do Sul and São Paulo in Brazil from September 2021 to July 2023.Result108 participants were included in this evaluation, 50 (46.3%) from the stroke group and 58 (53.7%) from the healthy group. The average age was 67 years for the stroke group and 69 years for the healthy group. Our total average number of years of study was 9 years. When comparing the OCS‐Br scores between the groups, we found that there was a significant difference between the groups in writing tasks, executive functions (attention, change of strategy) and memory (Table 1). The comparison of scores on the OCS‐Br by classification of cognition was carried out with a group stratified between Cognitively Healthy and Cognitive Impairment With and Without Dementia, with a statistically significant result between the groups in orientation (p<0.013), visual field (p< 0.045), free evocation (p<0.002), recognition (p<0.010) and circles in seconds (p<0.008).ConclusionWith our results, the need for adequate monitoring and rehabilitation of post‐stroke patients becomes more evident. The advantages of the OCS‐Br are: focus on specific cognitive aspects of stroke, such as visual inattention and visual field testing; assessment in patients with aphasia and visual impairment and prognostic value to predict long‐term functioning
{"title":"Oxford Cognitive Screen Brazilian Version: Assessment of Vascular Cognitive Impairment","authors":"Claudia Cristina Ferreira Ramos, Caroline Suemi Ogusuku, Sonia Maria Dozzi Brucki, Ricardo Nitrini","doi":"10.1002/alz.094850","DOIUrl":"https://doi.org/10.1002/alz.094850","url":null,"abstract":"BackgroundCognitive impairment is very common in stroke patients and is rarely diagnosed. Cognitive deficits involving language functions, praxis, visuospatial, visuoconstructive skills and memory are prominent. The available cognitive assessment tests do not address some specific characteristics of stroke patients and have important limitations in relation to the most compromised cognitive domains.MethodObservational and descriptive study, with cognitively normal individuals and patients with a history of Cerebral Vascular Accident (CVA) from the Unified Health System of São Caetano do Sul and São Paulo in Brazil from September 2021 to July 2023.Result108 participants were included in this evaluation, 50 (46.3%) from the stroke group and 58 (53.7%) from the healthy group. The average age was 67 years for the stroke group and 69 years for the healthy group. Our total average number of years of study was 9 years. When comparing the OCS‐Br scores between the groups, we found that there was a significant difference between the groups in writing tasks, executive functions (attention, change of strategy) and memory (Table 1). The comparison of scores on the OCS‐Br by classification of cognition was carried out with a group stratified between Cognitively Healthy and Cognitive Impairment With and Without Dementia, with a statistically significant result between the groups in orientation (p<0.013), visual field (p< 0.045), free evocation (p<0.002), recognition (p<0.010) and circles in seconds (p<0.008).ConclusionWith our results, the need for adequate monitoring and rehabilitation of post‐stroke patients becomes more evident. The advantages of the OCS‐Br are: focus on specific cognitive aspects of stroke, such as visual inattention and visual field testing; assessment in patients with aphasia and visual impairment and prognostic value to predict long‐term functioning","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"1 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundType 2 diabetes mellitus (T2DM) is among the modifiable risk factors for Alzheimer's disease (AD) and ranks among the leading chronic diseases globally. It is characterized by elevated blood glucose levels and insulin resistance, which over time may impair memory performance. More so, saliva appears to be a promising biomarker for the diagnosis of AD since conventional methods appear invasive and expensive in the country. Therefore, we investigated the impact of T2DM on memory function in diabetic patients at the Afe Babalola Multisystem Hospital, Nigeria and also determined if saliva may be a reliable diagnostic tool to detect the risk of AD in diabetic patients.MethodSixty (60) subjects, consisting of 20 diabetic patients and 40 healthy controls who consented to the study were recruited. A mini‐mental state examination (MMSE) was used to assess the participants’ memory performance. Blood samples were collected from the subjects to estimate biochemical parameters, which include: fasting blood glucose, insulin levels, glycated hemoglobin levels oxidative stress markers (malondialdehyde (MDA), sodium dismutase (SOD), and reduced glutathione (GSH)), as well as inflammatory markers (interleukin‐6 (IL‐6) and tumor necrosis factor‐alpha (TNF‐α)). Saliva was collected to estimate the level of amyloid beta‐42 (Aβ‐42). All these parameters were analyzed using enzyme‐linked immunosorbent assay.ResultThere were significant differences (p<0.05) between the values for glucose, insulin, Aβ‐42, SOD, GSH, MDA, TNF‐α, IL‐6 amongst diabetic and healthy controls. The MMSE result on severity of cognitive impairment showed that 14 (70%) diabetic patients between the scores of 24 and 30 suffer no cognitive impairment, 4 (20%) diabetic patients within the score of 18–23 have mild cognitive impairment, and 2 (10%) diabetic patients between the scores of 0 and 17 suffer severe cognitive impairment in comparison to the healthy control, who suffered no cognitive impairment.ConclusionOur results show that T2DM may impair memory performance later in life and that oxidative stress, insulin resistance, elevated levels of Aβ42, increased glycated hemoglobin and inflammation may be implicated in this decline. This ongoing study also strongly suggests that saliva may be an effective and alternative method for the diagnosis of AD in diabetes patients.
{"title":"Memory function decline among Nigerian type 2 diabetic patients: Preliminary results from an ongoing multi‐centre case control study","authors":"Juliet Nnenda Olayinka, Emmanuel Irek, Olusegun Adebayo Adeoluwa, Okechukwu Ezekpo, Benjamin Omiyale, Oluwafemi Ogunniyi, Idowu Adarabioyo, Olakunle Aberejo, Lily Otomewo, Oluwaseyi Akpor, Raymond Ozolua","doi":"10.1002/alz.085483","DOIUrl":"https://doi.org/10.1002/alz.085483","url":null,"abstract":"BackgroundType 2 diabetes mellitus (T2DM) is among the modifiable risk factors for Alzheimer's disease (AD) and ranks among the leading chronic diseases globally. It is characterized by elevated blood glucose levels and insulin resistance, which over time may impair memory performance. More so, saliva appears to be a promising biomarker for the diagnosis of AD since conventional methods appear invasive and expensive in the country. Therefore, we investigated the impact of T2DM on memory function in diabetic patients at the Afe Babalola Multisystem Hospital, Nigeria and also determined if saliva may be a reliable diagnostic tool to detect the risk of AD in diabetic patients.MethodSixty (60) subjects, consisting of 20 diabetic patients and 40 healthy controls who consented to the study were recruited. A mini‐mental state examination (MMSE) was used to assess the participants’ memory performance. Blood samples were collected from the subjects to estimate biochemical parameters, which include: fasting blood glucose, insulin levels, glycated hemoglobin levels oxidative stress markers (malondialdehyde (MDA), sodium dismutase (SOD), and reduced glutathione (GSH)), as well as inflammatory markers (interleukin‐6 (IL‐6) and tumor necrosis factor‐alpha (TNF‐α)). Saliva was collected to estimate the level of amyloid beta‐42 (Aβ‐42). All these parameters were analyzed using enzyme‐linked immunosorbent assay.ResultThere were significant differences (p<0.05) between the values for glucose, insulin, Aβ‐42, SOD, GSH, MDA, TNF‐α, IL‐6 amongst diabetic and healthy controls. The MMSE result on severity of cognitive impairment showed that 14 (70%) diabetic patients between the scores of 24 and 30 suffer no cognitive impairment, 4 (20%) diabetic patients within the score of 18–23 have mild cognitive impairment, and 2 (10%) diabetic patients between the scores of 0 and 17 suffer severe cognitive impairment in comparison to the healthy control, who suffered no cognitive impairment.ConclusionOur results show that T2DM may impair memory performance later in life and that oxidative stress, insulin resistance, elevated levels of Aβ42, increased glycated hemoglobin and inflammation may be implicated in this decline. This ongoing study also strongly suggests that saliva may be an effective and alternative method for the diagnosis of AD in diabetes patients.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"21 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jason F Moody, Erin M. Jonaitis, Rebecca E. Langhough, Douglas C Dean, Andrew L Alexander, Sterling C. Johnson, Barbara B. Bendlin
BackgroundWhile magnetic resonance imaging (MRI) markers of neurodegeneration are nonspecific to Alzheimer’s disease (AD) pathology, they have been correlated with cognitive dysfunction, and therefore, provide important information pertaining to disease staging. Neurodegeneration in AD is commonly assessed with macrostructural measures of brain atrophy, such as hippocampal volume. However, recent investigations have shown that markers of neural microstructure derived from diffusion MRI (DWI) may provide supplementary insight into the progression of AD pathophysiology. Furthermore, DWI measures of neurite density index (NDI), isotropic volume fraction (ISO), return to origin probability (RTOP), and mean squared displacement (MSD) have recently been associated with cerebrospinal fluid markers of senile plaques, neurofibrillary tangles, and AD‐related neurodegeneration.In this study, we used linear mixed‐effects (LME) modeling to compare the utility of different MRI markers for predicting performance on a three‐test Preclinical Alzheimer’s Cognitive Composite (PACC3) in 268 late‐middle‐aged participants.Methods268 participants from the Wisconsin Registry for Alzheimer’s Prevention and the Wisconsin Alzheimer’s Disease Research Center (216 unimpaired, 37 MCI, 15 AD) were imaged between 1 and 2 times with T1‐weighted MRI and multi‐shell DWI (Table 1). For each scan, hippocampal volume was estimated and average NDI, ISO, RTOP, and MSD values were extracted from the hippocampus and anterior parahippocampal gyrus. PACC3 scores were calculated from comprehensive neuropsychological testing within 6 months of imaging. Neuroimaging metrics were used as predictors in separate LME models of the following form:PACC3 = b0 + b1*(metric) + b2 *(age) + b3*(sex) + b4*(metric*clinical status) + b5*(years of education) + uiResultsDWI metrics consistently outperformed hippocampal volume in predicting PACC3 scores across both brain regions (Table 2). Anterior parahippocampal MSD exhibited the lowest AIC/BIC values, while hippocampal NDI had the strongest association with PACC3 scores among unimpaired participants. Meanwhile, hippocampal volume had the largest AIC/BIC values and the weakest correlation with PACC3 scores (Table 2, Figure 1).ConclusionOur study provides evidence that neuroimaging markers of brain microstructure may be particularly sensitive to subtle alterations predictive of cognitive performance, especially early in AD. Future work will translate these analyses to larger cohorts and incorporate fluid markers of amyloid and tau.
{"title":"Neuroimaging Markers of Microstructural Neurodegeneration are More Sensitive to Cognitive Dysfunction than Hippocampal Volume in Early Alzheimer’s Disease: A Mixed‐Longitudinal Study","authors":"Jason F Moody, Erin M. Jonaitis, Rebecca E. Langhough, Douglas C Dean, Andrew L Alexander, Sterling C. Johnson, Barbara B. Bendlin","doi":"10.1002/alz.091915","DOIUrl":"https://doi.org/10.1002/alz.091915","url":null,"abstract":"BackgroundWhile magnetic resonance imaging (MRI) markers of neurodegeneration are nonspecific to Alzheimer’s disease (AD) pathology, they have been correlated with cognitive dysfunction, and therefore, provide important information pertaining to disease staging. Neurodegeneration in AD is commonly assessed with macrostructural measures of brain atrophy, such as hippocampal volume. However, recent investigations have shown that markers of neural microstructure derived from diffusion MRI (DWI) may provide supplementary insight into the progression of AD pathophysiology. Furthermore, DWI measures of neurite density index (NDI), isotropic volume fraction (ISO), return to origin probability (RTOP), and mean squared displacement (MSD) have recently been associated with cerebrospinal fluid markers of senile plaques, neurofibrillary tangles, and AD‐related neurodegeneration.In this study, we used linear mixed‐effects (LME) modeling to compare the utility of different MRI markers for predicting performance on a three‐test Preclinical Alzheimer’s Cognitive Composite (PACC3) in 268 late‐middle‐aged participants.Methods268 participants from the Wisconsin Registry for Alzheimer’s Prevention and the Wisconsin Alzheimer’s Disease Research Center (216 unimpaired, 37 MCI, 15 AD) were imaged between 1 and 2 times with T1‐weighted MRI and multi‐shell DWI (Table 1). For each scan, hippocampal volume was estimated and average NDI, ISO, RTOP, and MSD values were extracted from the hippocampus and anterior parahippocampal gyrus. PACC3 scores were calculated from comprehensive neuropsychological testing within 6 months of imaging. Neuroimaging metrics were used as predictors in separate LME models of the following form:PACC3 = b<jats:sub>0</jats:sub> + b<jats:sub>1</jats:sub>*(metric) + b<jats:sub>2</jats:sub> *(age) + b<jats:sub>3</jats:sub>*(sex) + b<jats:sub>4</jats:sub>*(metric*clinical status) + b<jats:sub>5</jats:sub>*(years of education) + u<jats:sub>i</jats:sub>ResultsDWI metrics consistently outperformed hippocampal volume in predicting PACC3 scores across both brain regions (Table 2). Anterior parahippocampal MSD exhibited the lowest AIC/BIC values, while hippocampal NDI had the strongest association with PACC3 scores among unimpaired participants. Meanwhile, hippocampal volume had the largest AIC/BIC values and the weakest correlation with PACC3 scores (Table 2, Figure 1).ConclusionOur study provides evidence that neuroimaging markers of brain microstructure may be particularly sensitive to subtle alterations predictive of cognitive performance, especially early in AD. Future work will translate these analyses to larger cohorts and incorporate fluid markers of amyloid and tau.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"20 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Robert Warren, Ryan Demmer, Eric Grodsky, Chandra Muller
BackgroundPeriodontal disease is a prevalent, preventable, and highly treatable oral infection that is (1) stratified by sociodemographic, educational, and spatial factors and (2) is believed to impact cognitive impairment and ADRD risk. However, there is very little information from community‐based, population‐representative, longitudinal studies about the association between periodontal disease and midlife cognitive functioning net of early life confounders.MethodWe use data from the U.S. High School and Beyond (HSB) cohort study, which has followed a nationally representative sample of ∼25,500 people from high school in 1980 through midlife in 2021‐22. HSB data from the 1980s includes rich information about educational contexts, opportunities, and outcomes; early life socioeconomic and family circumstances; spatial location; and demographic group memberships. HSB data from 2021‐22 include indicators of periodontal disease diagnosis and multiple measures of cognitive functioning.ResultPeople who have been diagnosed with periodontal disease score worse on measures of memory, executive function, and other domains of cognitive functioning at midlife. These associations are only partly attributable to early life confounders. Some ─ but not all ─ of the association can be attributed to the mediating role of diabetes and CVD.ConclusionPeriodontal disease is a preventable and treatable risk factor for subsequent cognitive impairment. Because risk of periodontal disease is stratified by demographic, educational, and other social factors, periodontal disease may also be important in shaping sociodemographic gradients in midlife cognitive functioning. This is the first population‐representative study using data from a community‐based cohort that has been followed from adolescence through midlife. As such, this work provides important evidence about the role of periodontal disease in stratifying cognitive outcomes.
{"title":"Midlife Periodontal Disease and Cognitive Functioning: Evidence from High School and Beyond","authors":"John Robert Warren, Ryan Demmer, Eric Grodsky, Chandra Muller","doi":"10.1002/alz.088355","DOIUrl":"https://doi.org/10.1002/alz.088355","url":null,"abstract":"BackgroundPeriodontal disease is a prevalent, preventable, and highly treatable oral infection that is (1) stratified by sociodemographic, educational, and spatial factors and (2) is believed to impact cognitive impairment and ADRD risk. However, there is very little information from community‐based, population‐representative, longitudinal studies about the association between periodontal disease and midlife cognitive functioning net of early life confounders.MethodWe use data from the U.S. High School and Beyond (HSB) cohort study, which has followed a nationally representative sample of ∼25,500 people from high school in 1980 through midlife in 2021‐22. HSB data from the 1980s includes rich information about educational contexts, opportunities, and outcomes; early life socioeconomic and family circumstances; spatial location; and demographic group memberships. HSB data from 2021‐22 include indicators of periodontal disease diagnosis and multiple measures of cognitive functioning.ResultPeople who have been diagnosed with periodontal disease score worse on measures of memory, executive function, and other domains of cognitive functioning at midlife. These associations are only partly attributable to early life confounders. Some ─ but not all ─ of the association can be attributed to the mediating role of diabetes and CVD.ConclusionPeriodontal disease is a preventable and treatable risk factor for subsequent cognitive impairment. Because risk of periodontal disease is stratified by demographic, educational, and other social factors, periodontal disease may also be important in shaping sociodemographic gradients in midlife cognitive functioning. This is the first population‐representative study using data from a community‐based cohort that has been followed from adolescence through midlife. As such, this work provides important evidence about the role of periodontal disease in stratifying cognitive outcomes.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"15 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krystal R. Kittle, Ethan C. Cicero, Jordan Pelkmans, Jason D. Flatt, Joel G Anderson
BackgroundBi+ people, those with non‐monosexual identities (e.g., bisexual, pansexual, sexually fluid) are more likely to experience poor physical and mental health compared with monosexual minority (i.e., gay[G], lesbian[L]) people. These poor health outcomes stem from minority stress related to their sexual minority status (e.g., discrimination, victimization). Due to minority and caregiver stress, LGB+ people providing care to someone with ADRD are more likely to have worse health than their straight counterparts. Little is known about how minority and caregiver stress affect the health of bi+ ADRD caregivers versus monosexual minority ADRD caregivers.MethodCross‐sectional survey data from a non‐probabilistic sample of sexual minority ADRD caregivers (bi+, <jats:italic>n</jats:italic> = 125; gay/lesbian, <jats:italic>n</jats:italic> = 161) were used to examine associations between minority stress (discrimination, victimization, microaggressions, perceived stress), caregiver stress (caring for spouse/partner, respite use, distress from care recipient’s neuropsychiatric symptoms, care recipient’s level of independence) on overall self‐rated health and if these associations differed among bi+ and monosexual minority ADRD caregivers. Multivariable regression, adjusting for demographic characteristics, was used to investigate if sexual orientation (bi+ vs. gay/lesbian) moderated the association between minority/caregiver stress variables and health.ResultAll minority stressors and two caregiving stressors (caring for spouse, care recipient’s level of independence) were associated with overall health. In our adjusted model, three variables (lifetime victimization, day‐to‐day discrimination, caring for spouse/partner) moderated the association between sexual orientation and overall health. As lifetime victimization scores increased, bi+ overall health decreased while monosexual minority overall health increased (<jats:italic>B</jats:italic> = ‐0.56; 95% CI = 1.06,0.05; <jats:italic>p</jats:italic> = 0.03). Caring for a spouse/partner, protective for both groups (<jats:italic>B</jats:italic> = 5.11; 95%CI = 3.04,7.17; <jats:italic>p</jats:italic><0.001), had a greater effect on health for monosexual minorities (<jats:italic>B</jats:italic> = ‐4.26; 95% CI = ‐7.49,‐1.03; <jats:italic>p</jats:italic><0.001). Higher day‐to‐day discrimination scores predicted worse health for both groups (<jats:italic>B</jats:italic> = ‐0.61; 95% CI = ‐0.91,‐0.32; <jats:italic>p</jats:italic><0.001), but the magnitude was greater for monosexual minorities (<jats:italic>B</jats:italic> = 0.41; 95% CI = 0.01,0.80; <jats:italic>p</jats:italic> = 0.044).ConclusionThe effects of lifetime victimization, day‐to‐day discrimination, and caring for one’s spouse/partner on health differ significantly dependent on being bi+ or gay/lesbian. Qualitative inquiries may help illuminate the underlying mechanisms for this phenomenon, informing interventions and policy development a
{"title":"Minority Stress, Caregiving Experiences, and Health of Bi+ Informal Caregivers of People with Alzheimer’s Disease and Related Dementias","authors":"Krystal R. Kittle, Ethan C. Cicero, Jordan Pelkmans, Jason D. Flatt, Joel G Anderson","doi":"10.1002/alz.091581","DOIUrl":"https://doi.org/10.1002/alz.091581","url":null,"abstract":"BackgroundBi+ people, those with non‐monosexual identities (e.g., bisexual, pansexual, sexually fluid) are more likely to experience poor physical and mental health compared with monosexual minority (i.e., gay[G], lesbian[L]) people. These poor health outcomes stem from minority stress related to their sexual minority status (e.g., discrimination, victimization). Due to minority and caregiver stress, LGB+ people providing care to someone with ADRD are more likely to have worse health than their straight counterparts. Little is known about how minority and caregiver stress affect the health of bi+ ADRD caregivers versus monosexual minority ADRD caregivers.MethodCross‐sectional survey data from a non‐probabilistic sample of sexual minority ADRD caregivers (bi+, <jats:italic>n</jats:italic> = 125; gay/lesbian, <jats:italic>n</jats:italic> = 161) were used to examine associations between minority stress (discrimination, victimization, microaggressions, perceived stress), caregiver stress (caring for spouse/partner, respite use, distress from care recipient’s neuropsychiatric symptoms, care recipient’s level of independence) on overall self‐rated health and if these associations differed among bi+ and monosexual minority ADRD caregivers. Multivariable regression, adjusting for demographic characteristics, was used to investigate if sexual orientation (bi+ vs. gay/lesbian) moderated the association between minority/caregiver stress variables and health.ResultAll minority stressors and two caregiving stressors (caring for spouse, care recipient’s level of independence) were associated with overall health. In our adjusted model, three variables (lifetime victimization, day‐to‐day discrimination, caring for spouse/partner) moderated the association between sexual orientation and overall health. As lifetime victimization scores increased, bi+ overall health decreased while monosexual minority overall health increased (<jats:italic>B</jats:italic> = ‐0.56; 95% CI = 1.06,0.05; <jats:italic>p</jats:italic> = 0.03). Caring for a spouse/partner, protective for both groups (<jats:italic>B</jats:italic> = 5.11; 95%CI = 3.04,7.17; <jats:italic>p</jats:italic><0.001), had a greater effect on health for monosexual minorities (<jats:italic>B</jats:italic> = ‐4.26; 95% CI = ‐7.49,‐1.03; <jats:italic>p</jats:italic><0.001). Higher day‐to‐day discrimination scores predicted worse health for both groups (<jats:italic>B</jats:italic> = ‐0.61; 95% CI = ‐0.91,‐0.32; <jats:italic>p</jats:italic><0.001), but the magnitude was greater for monosexual minorities (<jats:italic>B</jats:italic> = 0.41; 95% CI = 0.01,0.80; <jats:italic>p</jats:italic> = 0.044).ConclusionThe effects of lifetime victimization, day‐to‐day discrimination, and caring for one’s spouse/partner on health differ significantly dependent on being bi+ or gay/lesbian. Qualitative inquiries may help illuminate the underlying mechanisms for this phenomenon, informing interventions and policy development a","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"124 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundNow, at the beginning of the era of disease‐modifying drugs for AD, many questions must be addressed in the effort to optimize benefits. Important issues remain regarding the timing and duration of amyloid‐removing immunotherapy and the potential advantages of combination therapies. Anti‐fibrillar amyloid antibodies effectively remove amyloid but may not be appropriate for maintenance of the low amyloid state; secretase inhibition is a reasonable alternative. Evidence suggests that the earlier amyloid is removed the larger the benefit; by extension, beginning anti‐amyloid therapy before plaque accumulation may be optimal but may require targeting the generation of amyloid monomers. The toxicity of diffusible amyloid species suggests that combining immunotherapy with secretase inhibition may provide additive benefit. As reviewed in this session, the availability of substantial pre‐clinical and clinical data on BACEi therapy suggests that this approach can provide fine‐tuned reduction in amyloid peptide generation while avoiding the reversible cognitive toxicity associated with this class of drug.MethodsFindings from trials with amyloid‐removing antibodies and various BACE inhibitors along with growing data on accurate plasma markers of AD neurobiology inform considerations of the next generation of trials needed to clarify the role of BACEi therapy for disease‐modification.ResultsExperience from ongoing clinical trials indicates that plasma biomarkers, particularly mass spectroscopy assays of abeta and ptau217 ratios, accurately predict amyloid levels by PET below the normal range. Further, changes in plasma ptau assays precede reaccumulation of fibrillar amyloid after cessation of amyloid‐lowering immunotherapy. These findings suggest that marrying accurate monitoring of plasma markers to BACEi therapy can provide a path to optimization of anti‐amyloid therapy. Future studies may demonstrate that screening individuals in late‐middle age with these plasma measures facilitates management of amyloid dysregulation at the pre‐plaque stage for primary prevention of AD.ConclusionCoupled with plasma biomarkers of AD pathology, BACE inhibitor therapy may provide a feasible approach to the optimization of anti‐amyloid therapy for established AD as well as primary prevention of the disease.
{"title":"Potential roles for BACE inhibitors in AD therapeutic trials","authors":"Paul S. Aisen","doi":"10.1002/alz.094708","DOIUrl":"https://doi.org/10.1002/alz.094708","url":null,"abstract":"BackgroundNow, at the beginning of the era of disease‐modifying drugs for AD, many questions must be addressed in the effort to optimize benefits. Important issues remain regarding the timing and duration of amyloid‐removing immunotherapy and the potential advantages of combination therapies. Anti‐fibrillar amyloid antibodies effectively remove amyloid but may not be appropriate for maintenance of the low amyloid state; secretase inhibition is a reasonable alternative. Evidence suggests that the earlier amyloid is removed the larger the benefit; by extension, beginning anti‐amyloid therapy before plaque accumulation may be optimal but may require targeting the generation of amyloid monomers. The toxicity of diffusible amyloid species suggests that combining immunotherapy with secretase inhibition may provide additive benefit. As reviewed in this session, the availability of substantial pre‐clinical and clinical data on BACEi therapy suggests that this approach can provide fine‐tuned reduction in amyloid peptide generation while avoiding the reversible cognitive toxicity associated with this class of drug.MethodsFindings from trials with amyloid‐removing antibodies and various BACE inhibitors along with growing data on accurate plasma markers of AD neurobiology inform considerations of the next generation of trials needed to clarify the role of BACEi therapy for disease‐modification.ResultsExperience from ongoing clinical trials indicates that plasma biomarkers, particularly mass spectroscopy assays of abeta and ptau217 ratios, accurately predict amyloid levels by PET below the normal range. Further, changes in plasma ptau assays precede reaccumulation of fibrillar amyloid after cessation of amyloid‐lowering immunotherapy. These findings suggest that marrying accurate monitoring of plasma markers to BACEi therapy can provide a path to optimization of anti‐amyloid therapy. Future studies may demonstrate that screening individuals in late‐middle age with these plasma measures facilitates management of amyloid dysregulation at the pre‐plaque stage for primary prevention of AD.ConclusionCoupled with plasma biomarkers of AD pathology, BACE inhibitor therapy may provide a feasible approach to the optimization of anti‐amyloid therapy for established AD as well as primary prevention of the disease.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"14 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariana S L C Real, Izabela G Barbosa, Carla V Carvalho, Marco Aurelio Romano‐Silva, Maria Aparecida Camargos Bicalho, Edgar Nunes de Moraes, Bernardo M Viana
BackgroundDementia syndromes are chronic health conditions that lead to significant cognitive decline and functional impairment, including acts of civil life. Concerning the latter, a guardianship petition maybe needed when patients or family are at risk.MethodsRetrospective cross‐sectional study of documentary research on 72 electronical guardianship proceedings involving adults with dementia. The study sample comprises reports from six out of twelve Family Courts within the Court of Justice of Minas Gerais, with twelve reports collected from each selected court. The results were analyzed using descriptive statistics, involving mean, standard deviation, median, minimum and maximum. For statistical analyzes the software SPSS Version 20.0 for Microsoft Windows was used. When comparing continuous variables, the non‐parametric Mann‐Whitney test and the Kruskal‐Wallis test were used. The study was approved by the ethics committee by Federal University of Minas Gerais.ResultsThe sample had median age of 82.5 years with high level of education by Brazilian standards with a median of 8 years, and mainly composed by elderly women (68,1%) and widows (41,7%). Notably, 76.4% of guardianship proceedings were petitioned by sons, with predominance of daughters appointed as guardians. Geriatrics and Family Physicians (54.1%) stood out as the specialties that issued the majority of the initial medical reports. Alzheimer’s Disease Dementia (ADD) (61.1%) was the most prevalent diagnosis with a predominance of women (67.3%) and older people with a mean of 84.9 years (SD 8,6). In second place, vascular dementia (VD) (15.3%) followed by unspecified etiology of dementia (12.5%). In the non‐Alzheimer dementia group, the median age was 79.5 years (p = 0.016). In relation to education, there was no statistically significant difference between the group of patients with Alzheimer’s disease and non‐Alzheimer’s disease (p = 0.547).ConclusionsThe present work identified that the majority of medical reports were related to ADD and VD and were made by geriatricians and family physicians. This points to the importance of these specialties regarding the protection and promotion of rights of people with these dementias.
{"title":"Analysis of medical reports of guardianship proceedings of people with dementia a sample from Belo Horizonte, Minas Gerais, Brazil","authors":"Mariana S L C Real, Izabela G Barbosa, Carla V Carvalho, Marco Aurelio Romano‐Silva, Maria Aparecida Camargos Bicalho, Edgar Nunes de Moraes, Bernardo M Viana","doi":"10.1002/alz.092606","DOIUrl":"https://doi.org/10.1002/alz.092606","url":null,"abstract":"BackgroundDementia syndromes are chronic health conditions that lead to significant cognitive decline and functional impairment, including acts of civil life. Concerning the latter, a guardianship petition maybe needed when patients or family are at risk.MethodsRetrospective cross‐sectional study of documentary research on 72 electronical guardianship proceedings involving adults with dementia. The study sample comprises reports from six out of twelve Family Courts within the Court of Justice of Minas Gerais, with twelve reports collected from each selected court. The results were analyzed using descriptive statistics, involving mean, standard deviation, median, minimum and maximum. For statistical analyzes the software SPSS Version 20.0 for Microsoft Windows was used. When comparing continuous variables, the non‐parametric Mann‐Whitney test and the Kruskal‐Wallis test were used. The study was approved by the ethics committee by Federal University of Minas Gerais.ResultsThe sample had median age of 82.5 years with high level of education by Brazilian standards with a median of 8 years, and mainly composed by elderly women (68,1%) and widows (41,7%). Notably, 76.4% of guardianship proceedings were petitioned by sons, with predominance of daughters appointed as guardians. Geriatrics and Family Physicians (54.1%) stood out as the specialties that issued the majority of the initial medical reports. Alzheimer’s Disease Dementia (ADD) (61.1%) was the most prevalent diagnosis with a predominance of women (67.3%) and older people with a mean of 84.9 years (SD 8,6). In second place, vascular dementia (VD) (15.3%) followed by unspecified etiology of dementia (12.5%). In the non‐Alzheimer dementia group, the median age was 79.5 years (p = 0.016). In relation to education, there was no statistically significant difference between the group of patients with Alzheimer’s disease and non‐Alzheimer’s disease (p = 0.547).ConclusionsThe present work identified that the majority of medical reports were related to ADD and VD and were made by geriatricians and family physicians. This points to the importance of these specialties regarding the protection and promotion of rights of people with these dementias.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"20 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henry Gilreath Stephenson, Tobey J. Betthauser, Carol A. Van Hulle, Lianlian Du, Rebecca E. Langhough, Erin M. Jonaitis, Gwendlyn Kollmorgen, Clara Quijano‐Rubio, Nathaniel A. Chin, Ozioma C Okonkwo, Cynthia M. Carlsson, Sanjay Asthana, Bradley T. Christian, Sterling C. Johnson, Kaj Blennow, Henrik Zetterberg, Barbara B. Bendlin
BackgroundThe timing of neurodegeneration in relation to the onset of Alzheimer’s disease pathology is not fully known. This study examined the association of longitudinal atrophy derived from T1‐weighted MRI with 1) cerebrospinal fluid (CSF) amyloid‐tau (AT) groupings and 2) Pittsburgh compound B (PiB) PET‐derived estimates of amyloid duration among cognitively unimpaired (CU) individuals.MethodCU participants in the Wisconsin Registry for Alzheimer’s Prevention and Wisconsin Alzheimer’s Disease Research Center (N = 297) underwent longitudinal MRI, APOE genotyping, and lumbar puncture to determine CSF Aβ42/40 (A) and pTau181 (T) concentration at baseline using in‐house cutoffs. CSF measurements were performed using the NeuroToolKit, a panel of robust prototype biomarker assays (Roche Diagnostics International Ltd). Image segmentation was performed using a longitudinal pipeline in SPM12. Grey matter volumes from AD‐associated regions (adjusted for intracranial volume) were z‐scored according to age‐associated predictions from a robust longitudinal A‐T‐/APOE4‐/CU control group. Differences in longitudinal atrophy relative to controls were tested in linear mixed‐effects models using contrasts between A+T‐ and A+T+ groups and A‐T‐ controls and interactions with time (years from baseline). In the PiB PET subset, sampled iterative local approximation was used to estimate time‐to‐positivity at baseline relative to a PiB DVR threshold of 1.16. CSF A+ individuals were grouped as CSF A+ only, early PiB+ (PiB+ <= 5 years), and established PiB+ (PiB+ > 5 years). Differences in longitudinal atrophy were tested with A+ group/A‐T‐ contrasts and interactions with time. All analyses were FDR‐corrected. See Table 1 and Figure 1 for participant characteristics and model details.ResultBased on CSF assays, both A+ groups showed longitudinal atrophy relative to controls in a majority of ROIs, suggesting that A+, regardless of pTau+, is associated with neurodegeneration. Further analysis incorporating PET showed that CSF A+ in the absence of PiB+ was not associated with atrophy, but early PiB+ was associated with atrophy in medial temporal ROIs and precuneus. The largest and most widespread atrophy was observed in the established PiB+ group (Figure 2).ConclusionNeurodegeneration appears to begin soon after the onset of PET‐measurable amyloid‐positivity. Clinical intervention at the earliest signs of amyloid deposition may be needed to delay neurodegeneration.
{"title":"Longitudinal neurodegeneration in relation to amyloid pathology among cognitively unimpaired individuals","authors":"Henry Gilreath Stephenson, Tobey J. Betthauser, Carol A. Van Hulle, Lianlian Du, Rebecca E. Langhough, Erin M. Jonaitis, Gwendlyn Kollmorgen, Clara Quijano‐Rubio, Nathaniel A. Chin, Ozioma C Okonkwo, Cynthia M. Carlsson, Sanjay Asthana, Bradley T. Christian, Sterling C. Johnson, Kaj Blennow, Henrik Zetterberg, Barbara B. Bendlin","doi":"10.1002/alz.092448","DOIUrl":"https://doi.org/10.1002/alz.092448","url":null,"abstract":"BackgroundThe timing of neurodegeneration in relation to the onset of Alzheimer’s disease pathology is not fully known. This study examined the association of longitudinal atrophy derived from T1‐weighted MRI with 1) cerebrospinal fluid (CSF) amyloid‐tau (AT) groupings and 2) Pittsburgh compound B (PiB) PET‐derived estimates of amyloid duration among cognitively unimpaired (CU) individuals.MethodCU participants in the Wisconsin Registry for Alzheimer’s Prevention and Wisconsin Alzheimer’s Disease Research Center (N = 297) underwent longitudinal MRI, APOE genotyping, and lumbar puncture to determine CSF Aβ42/40 (A) and pTau181 (T) concentration at baseline using in‐house cutoffs. CSF measurements were performed using the NeuroToolKit, a panel of robust prototype biomarker assays (Roche Diagnostics International Ltd). Image segmentation was performed using a longitudinal pipeline in SPM12. Grey matter volumes from AD‐associated regions (adjusted for intracranial volume) were z‐scored according to age‐associated predictions from a robust longitudinal A‐T‐/APOE4‐/CU control group. Differences in longitudinal atrophy relative to controls were tested in linear mixed‐effects models using contrasts between A+T‐ and A+T+ groups and A‐T‐ controls and interactions with time (years from baseline). In the PiB PET subset, sampled iterative local approximation was used to estimate time‐to‐positivity at baseline relative to a PiB DVR threshold of 1.16. CSF A+ individuals were grouped as CSF A+ only, early PiB+ (PiB+ <= 5 years), and established PiB+ (PiB+ > 5 years). Differences in longitudinal atrophy were tested with A+ group/A‐T‐ contrasts and interactions with time. All analyses were FDR‐corrected. See Table 1 and Figure 1 for participant characteristics and model details.ResultBased on CSF assays, both A+ groups showed longitudinal atrophy relative to controls in a majority of ROIs, suggesting that A+, regardless of pTau+, is associated with neurodegeneration. Further analysis incorporating PET showed that CSF A+ in the absence of PiB+ was not associated with atrophy, but early PiB+ was associated with atrophy in medial temporal ROIs and precuneus. The largest and most widespread atrophy was observed in the established PiB+ group (Figure 2).ConclusionNeurodegeneration appears to begin soon after the onset of PET‐measurable amyloid‐positivity. Clinical intervention at the earliest signs of amyloid deposition may be needed to delay neurodegeneration.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"82 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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