Phelan Glenn, Katelyn Elizabeth Mooney, Ose Kadiri, Talia L Robinson, Rebecca E Amariglio, Reisa A Sperling, Kacie Deters
BackgroundFamily history (FH) of AD increases risk for sporadic AD, and has been associated with increased amyloid accumulation. Most of these studies were done in non‐Hispanic white groups, limiting the generalizability of these findings. The goal of this study was to determine if FH was associated with levels of amyloid in White, Black, and Hispanic/Latino participants.MethodsThis study included cognitively normal individuals screening for the Anti‐Amyloid Treatment in Asymptomatic Alzheimer’s (A4) cohort whom self‐identified as Non‐Hispanic/Latino Black (NHB; N=145), Non‐Hispanic white (NHW; N=3766), or Hispanic/Latino white (HL; N=107). The effect of FH (father, mother or both, vs none) on amyloid PET SUVr was assessed using linear regression analysis within each ethnic and racialized group. Age and sex were used as covariates. This analysis was repeated adding APOE e4 allele as a moderator.ResultsNHB participants were more likely to be female (71.7%), had the lowest FH rate (56.6%), and were less likely to be amyloid positive (20%) compared to HL participants (female=64.5%; FH=62.6%; amyloid+=27.1%) and NHW participants (female=59.7%; FH=66.2%; amyloid+=30.2%). Having a FH of AD was associated with higher levels of amyloid SUVr (β=0.028, p=2e‐05) in NHW participants only (Table). This effect became non‐significant when APOE e4 was included in the model.ConclusionsFH was associated with higher levels of amyloid SUVr in White participants only, but not in the presence of APOE e4. For Black and Hispanic participants, FH was not associated with levels of amyloid. These findings support previous findings in which risk factors for AD are not shared equally across different ethnic and racialized groups.
{"title":"Family history and amyloid PET in white, Black, and Hispanic/Latino, cognitively normal individuals","authors":"Phelan Glenn, Katelyn Elizabeth Mooney, Ose Kadiri, Talia L Robinson, Rebecca E Amariglio, Reisa A Sperling, Kacie Deters","doi":"10.1002/alz.091146","DOIUrl":"https://doi.org/10.1002/alz.091146","url":null,"abstract":"BackgroundFamily history (FH) of AD increases risk for sporadic AD, and has been associated with increased amyloid accumulation. Most of these studies were done in non‐Hispanic white groups, limiting the generalizability of these findings. The goal of this study was to determine if FH was associated with levels of amyloid in White, Black, and Hispanic/Latino participants.MethodsThis study included cognitively normal individuals screening for the Anti‐Amyloid Treatment in Asymptomatic Alzheimer’s (A4) cohort whom self‐identified as Non‐Hispanic/Latino Black (NHB; N=145), Non‐Hispanic white (NHW; N=3766), or Hispanic/Latino white (HL; N=107). The effect of FH (father, mother or both, vs none) on amyloid PET SUVr was assessed using linear regression analysis within each ethnic and racialized group. Age and sex were used as covariates. This analysis was repeated adding APOE e4 allele as a moderator.ResultsNHB participants were more likely to be female (71.7%), had the lowest FH rate (56.6%), and were less likely to be amyloid positive (20%) compared to HL participants (female=64.5%; FH=62.6%; amyloid+=27.1%) and NHW participants (female=59.7%; FH=66.2%; amyloid+=30.2%). Having a FH of AD was associated with higher levels of amyloid SUVr (β=0.028, p=2e‐05) in NHW participants only (Table). This effect became non‐significant when APOE e4 was included in the model.ConclusionsFH was associated with higher levels of amyloid SUVr in White participants only, but not in the presence of APOE e4. For Black and Hispanic participants, FH was not associated with levels of amyloid. These findings support previous findings in which risk factors for AD are not shared equally across different ethnic and racialized groups.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"75 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940222","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}
Amitha C M , Abhishek Mensegere Lingegodwa, Divya N M , Ajith Partha, Meenakshi Menon, Meghana R , Rajitha Narayanasamy, Vindhya vishwanath, Deva Kumar HS, Palash K Malo, Albert Stezin, Goutham Velavarajan, Prathima Arvind, Shafeeq K Shahul Hameed, Sunitha HS, Sadhana Singh, Banashree Mondal, Deepashri Agrawal, Jonas S. Sundarakumar, Thomas Gregor Issac
BackgroundThe impact of the pattern of daily food consumption on cognition is a less explored area. This study aims to identify the impact of dietary patterns on the cognition of the elderly population, specifically comparing absolute vegetarians and omnivores.MethodIt is a cross‐sectional analysis of the aging urban Indian population of 1237 participants recruited from the ongoing Tata Longitudinal Study of Aging (TLSA). The information on diet was obtained using a diet questionnaire. Cognition was assessed using COGNITO (Computerized Assessment of Information Processing), ACE (Addenbrooke’s Cognitive Examination) which includes memory, attention, fluency, language, and visuospatial span. Chi‐square test and multiple linear regression analysis models were used for statistical analysis.ResultResults reveal a cohort of 824 absolute vegetarians and 413 omnivores, with the latter being comparatively younger, though literacy rates show no significant difference between the groups. There is a significant association between omnivores and in few cognitive domains such as visual attention (β: 0.451, p<0.001), and dual attention (β: 0.368, p<0.002).ConclusionThe presented data suggests a noteworthy association between mixed dietary patterns, and cognitive function among aging urban Indians. Absolute vegetarians are recommended to consume more proteins in their preferred food forms to have a positive impact on cognition. Incorporating dietary recommendations with a focus on promoting a balanced diet has implications for public health interventions.
{"title":"A Cross‐Sectional Study to Evaluate the Impact of Dietary Patterns on Cognition in the Aging Urban Indian Population","authors":"Amitha C M , Abhishek Mensegere Lingegodwa, Divya N M , Ajith Partha, Meenakshi Menon, Meghana R , Rajitha Narayanasamy, Vindhya vishwanath, Deva Kumar HS, Palash K Malo, Albert Stezin, Goutham Velavarajan, Prathima Arvind, Shafeeq K Shahul Hameed, Sunitha HS, Sadhana Singh, Banashree Mondal, Deepashri Agrawal, Jonas S. Sundarakumar, Thomas Gregor Issac","doi":"10.1002/alz.091252","DOIUrl":"https://doi.org/10.1002/alz.091252","url":null,"abstract":"BackgroundThe impact of the pattern of daily food consumption on cognition is a less explored area. This study aims to identify the impact of dietary patterns on the cognition of the elderly population, specifically comparing absolute vegetarians and omnivores.MethodIt is a cross‐sectional analysis of the aging urban Indian population of 1237 participants recruited from the ongoing Tata Longitudinal Study of Aging (TLSA). The information on diet was obtained using a diet questionnaire. Cognition was assessed using COGNITO (Computerized Assessment of Information Processing), ACE (Addenbrooke’s Cognitive Examination) which includes memory, attention, fluency, language, and visuospatial span. Chi‐square test and multiple linear regression analysis models were used for statistical analysis.ResultResults reveal a cohort of 824 absolute vegetarians and 413 omnivores, with the latter being comparatively younger, though literacy rates show no significant difference between the groups. There is a significant association between omnivores and in few cognitive domains such as visual attention (β: 0.451, p<0.001), and dual attention (β: 0.368, p<0.002).ConclusionThe presented data suggests a noteworthy association between mixed dietary patterns, and cognitive function among aging urban Indians. Absolute vegetarians are recommended to consume more proteins in their preferred food forms to have a positive impact on cognition. Incorporating dietary recommendations with a focus on promoting a balanced diet has implications for public health interventions.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"6 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940297","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}
Christina S. Dintica, Amber L Bahorik, Feng Xia, W John Boscardin, Kristine Yaffe
BackgroundStudies in prevalence and incidence in the United States have been limited to clinical populations and single site studies, therefore, there is a notable lack in estimates of regional differences in dementia incidence and the drivers of such disparities.MethodsWe included 1,268,599 US Veterans Health Administration (VHA) dementia‐free patients aged 65 years or older living within the U.S. with a residential zip code from year 2000‐2021. Dementia incidence was estimated according to US geographical areas from residential zip codes, based on the 10 Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) regions, labeled from A to J. Incident diagnosis of dementia was ascertained using the 9th and 10th editions of the International Classification of Diseases. Poisson regression models adjusted for age were used to asses differences in dementia incidence based on geographical regions, and the sensitivity of the findings were evaluated by accounting for competing risk of death.ResultsAmong the 1,268,599 study participants (mean age 73.9 [SD, 6.1] years; 25 335 women [2%]; 15.5% received a diagnosis of dementia over a mean follow‐up of 12.6 years. Unadjusted incidence of dementia per 1000 person‐years was the lowest for the Northeast region, B and the highest in in the Southeastern region D (Figure 1). Residence within the Southeastern region D was associated a 27% higher risk of dementia, 19% higher risk in the Southern region F, 17% the midwestern region H and Northwestern region J, 12% for Southeastern region C; the remaining regions had an increased risk <10% compared to region B (Table 1). Additional adjustment for sex and race, and accounting for the competing risk of death produced similar results.ConclusionAmong older adults who received care at VHA medical centers, there were significant geographical differences in dementia incidence across the U.S, suggesting important roles for geographically patterned risk factors. Identifying geographical differences in dementia incidence allows for a more strategic and targeted approach to healthcare planning, public health interventions, and policy development.
{"title":"Regional Difference in Dementia Incidence in Older Adults","authors":"Christina S. Dintica, Amber L Bahorik, Feng Xia, W John Boscardin, Kristine Yaffe","doi":"10.1002/alz.091877","DOIUrl":"https://doi.org/10.1002/alz.091877","url":null,"abstract":"BackgroundStudies in prevalence and incidence in the United States have been limited to clinical populations and single site studies, therefore, there is a notable lack in estimates of regional differences in dementia incidence and the drivers of such disparities.MethodsWe included 1,268,599 US Veterans Health Administration (VHA) dementia‐free patients aged 65 years or older living within the U.S. with a residential zip code from year 2000‐2021. Dementia incidence was estimated according to US geographical areas from residential zip codes, based on the 10 Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) regions, labeled from A to J. Incident diagnosis of dementia was ascertained using the 9th and 10th editions of the International Classification of Diseases. Poisson regression models adjusted for age were used to asses differences in dementia incidence based on geographical regions, and the sensitivity of the findings were evaluated by accounting for competing risk of death.ResultsAmong the 1,268,599 study participants (mean age 73.9 [SD, 6.1] years; 25 335 women [2%]; 15.5% received a diagnosis of dementia over a mean follow‐up of 12.6 years. Unadjusted incidence of dementia per 1000 person‐years was the lowest for the Northeast region, B and the highest in in the Southeastern region D (Figure 1). Residence within the Southeastern region D was associated a 27% higher risk of dementia, 19% higher risk in the Southern region F, 17% the midwestern region H and Northwestern region J, 12% for Southeastern region C; the remaining regions had an increased risk <10% compared to region B (Table 1). Additional adjustment for sex and race, and accounting for the competing risk of death produced similar results.ConclusionAmong older adults who received care at VHA medical centers, there were significant geographical differences in dementia incidence across the U.S, suggesting important roles for geographically patterned risk factors. Identifying geographical differences in dementia incidence allows for a more strategic and targeted approach to healthcare planning, public health interventions, and policy development.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"129 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940423","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}
Rufus O. Akinyemi, Oludotun V Olalusi, Tolulope O Akinyemi, Joseph O Yaria, Gabriel O Ogunde, Joshua O. Akinyemi, Brian Lawlor, Adesola Ogunniyi
BackgroundHand‐grip strength (HGS) is known to be a surrogate marker of not only fitness and frailty, but of cognitive and cardiometabolic health. It is cheap, readily deployed and can be a valuable tool in resource‐limited settings. Little however is known about the determinants and correlates of HGS in sub‐Saharan Africa, where stroke and vascular cognitive disorders are projected to exponentially increase. We examined the determinants of HGS among older adults in a rural community in Ibadan, South West Nigeria.MethodVascular heAlth, fraiLty and cognition in Ageing Nigerians (VALIANT) Study is an ongoing longitudinal community‐based cohort study aimed at exploring the association between cardiovascular health, cognition and frailty in Nigeria. One thousand (1000) participants have so far been recruited (via a multistage, stratified cluster random sampling method) and have been taken through a battery of cardiovascular, cognitive and frailty assessment tools. Data on HGS, obtained using a digital hand dynamometer, was available for 480 men and women aged ≥50years. A multivariable adjusted linear regression analysis was used to assess the determinants of HGS. All associations were reported as coefficients with 95% confidence intervals (CI)ResultThe mean age was 64.5 (11.8) with 35% males. The mean HGS was higher among males (22.86 10.1) than in females (16.26 6.1) (p<0.001) and decreased with increasing age and in the left hand. Using the Rockwood frailty scale, 66 (13.8%) of the study participants were vulnerable to frail while 80% had cognitive impairment (MoCA <26). In the multivariable linear regression analysis, the independent determinants of hand grip strength with corresponding beta coefficients (95%CI) were attainment of tertiary/postgraduate education 5.19 (1.70; 8.68), being a widow/widower ‐2.75 (‐5.47; ‐0.03), lower MoCA score<19 ‐2.50 (‐4.42; ‐0.59) and higher IDEA‐IADL score 0.23 (0.02, 0.44)ConclusionAmongst older adults in rural Nigeria, attainment of tertiary/postgraduate education was independently associated with higher HGS; while being a widow/widower and presence of low cognitive reserve were independently associated with lower HGS. This study has identified unique determinants of HGS among West Africans.
{"title":"Determinants of hand grip strength among community dwelling older adults in southwestern Nigeria: Data from the VALIANT Study","authors":"Rufus O. Akinyemi, Oludotun V Olalusi, Tolulope O Akinyemi, Joseph O Yaria, Gabriel O Ogunde, Joshua O. Akinyemi, Brian Lawlor, Adesola Ogunniyi","doi":"10.1002/alz.093554","DOIUrl":"https://doi.org/10.1002/alz.093554","url":null,"abstract":"BackgroundHand‐grip strength (HGS) is known to be a surrogate marker of not only fitness and frailty, but of cognitive and cardiometabolic health. It is cheap, readily deployed and can be a valuable tool in resource‐limited settings. Little however is known about the determinants and correlates of HGS in sub‐Saharan Africa, where stroke and vascular cognitive disorders are projected to exponentially increase. We examined the determinants of HGS among older adults in a rural community in Ibadan, South West Nigeria.MethodVascular heAlth, fraiLty and cognition in Ageing Nigerians (VALIANT) Study is an ongoing longitudinal community‐based cohort study aimed at exploring the association between cardiovascular health, cognition and frailty in Nigeria. One thousand (1000) participants have so far been recruited (via a multistage, stratified cluster random sampling method) and have been taken through a battery of cardiovascular, cognitive and frailty assessment tools. Data on HGS, obtained using a digital hand dynamometer, was available for 480 men and women aged ≥50years. A multivariable adjusted linear regression analysis was used to assess the determinants of HGS. All associations were reported as coefficients with 95% confidence intervals (CI)ResultThe mean age was 64.5 (11.8) with 35% males. The mean HGS was higher among males (22.86 10.1) than in females (16.26 6.1) (p<0.001) and decreased with increasing age and in the left hand. Using the Rockwood frailty scale, 66 (13.8%) of the study participants were vulnerable to frail while 80% had cognitive impairment (MoCA <26). In the multivariable linear regression analysis, the independent determinants of hand grip strength with corresponding beta coefficients (95%CI) were attainment of tertiary/postgraduate education 5.19 (1.70; 8.68), being a widow/widower ‐2.75 (‐5.47; ‐0.03), lower MoCA score<19 ‐2.50 (‐4.42; ‐0.59) and higher IDEA‐IADL score 0.23 (0.02, 0.44)ConclusionAmongst older adults in rural Nigeria, attainment of tertiary/postgraduate education was independently associated with higher HGS; while being a widow/widower and presence of low cognitive reserve were independently associated with lower HGS. This study has identified unique determinants of HGS among West Africans.","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":"142940425","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}
Ainara Jauregi-Zinkunegi, Carey E. Gleason, Barbara Bendlin, Ozioma Okonkwo, Bruce P. Hermann, Kaj Blennow, Henrik Zetterberg, Eef Hogervorst, Sterling C. Johnson, Rebecca Langhough, Kimberly D. Mueller, Davide Bruno
Menopausal hormone therapy (MHT), along with the apolipoprotein E (APOE) ε4 allele, has been suggested as a possible risk factor for Alzheimer's disease (AD). However, the relationship between MHT and cerebrospinal fluid (CSF) biomarkers is unknown: we investigated this association, and whether APOE ε4 carrier status moderates it.
{"title":"Menopausal hormone therapy is associated with worse levels of Alzheimer's disease biomarkers in APOE ε4-carrying women: An observational study","authors":"Ainara Jauregi-Zinkunegi, Carey E. Gleason, Barbara Bendlin, Ozioma Okonkwo, Bruce P. Hermann, Kaj Blennow, Henrik Zetterberg, Eef Hogervorst, Sterling C. Johnson, Rebecca Langhough, Kimberly D. Mueller, Davide Bruno","doi":"10.1002/alz.14456","DOIUrl":"https://doi.org/10.1002/alz.14456","url":null,"abstract":"Menopausal hormone therapy (MHT), along with the apolipoprotein E (<i>APOE</i>) ε4 allele, has been suggested as a possible risk factor for Alzheimer's disease (AD). However, the relationship between MHT and cerebrospinal fluid (CSF) biomarkers is unknown: we investigated this association, and whether <i>APOE</i> ε4 carrier status moderates it.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"12 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937769","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}
Brad Amoateng, Mustafa Sheikh, Bernadette A. Fausto, Mark A. Gluck
BackgroundAfrican Americans are at increased risk for cardiovascular‐related health problems (e.g., hypertension, cardiovascular disease, stroke, obesity) and cognitive dysfunction, including Alzheimer’s disease (AD)1,2. However, few studies have looked at the longitudinal influence of cardiovascular health and cognitive function in older African Americans. This study investigated the relationship between cardiovascular health markers and cognition in older African Americans.Method836 participants were drawn from Pathways to Healthy Aging in African Americans, a longitudinal cohort study at Rutgers University–Newark. Participants completed a battery of self‐reported health and demographic questionnaires, neuropsychological tests, and a short physical battery of both anthropometric and physical assessments. Linear mixed models were used to examine the relationship between baseline cardiovascular health markers and cognitive function up to 6 years of follow up.ResultHigher diastolic blood pressure was significantly associated with worse Trail Making Test Part A (B = 0.035, p < .001), and Montreal Cognitive Assessment (B = 0.085, p = .0029) performance across time. Higher systolic blood pressure was significantly associated with poorer Trail Making Test Part A (B = 0.017, p < .001) and MoCA (B = 0.055, p < .001). Higher resting heart rate was significantly associated with worse Trail Making Test Part A (B = 0.018, p = .0031) and Part B (B = 0.085, p = .013), Controlled Oral Word Association Test (B = 0.036, p = .025), and Montreal Cognitive Assessment performance across time (B = 0.047, p = .046).ConclusionIn cognitively unimpaired older African Americans, cardiovascular health markers are predictive biomarkers for early working memory decline in preclinical AD. Our findings may inform holistic clinical decision‐making in AD prevention and personalized AD monitoring in patients with cardiovascular disease.
{"title":"Cardiovascular health predicts working memory decline among cognitively healthy older African Americans","authors":"Brad Amoateng, Mustafa Sheikh, Bernadette A. Fausto, Mark A. Gluck","doi":"10.1002/alz.095802","DOIUrl":"https://doi.org/10.1002/alz.095802","url":null,"abstract":"BackgroundAfrican Americans are at increased risk for cardiovascular‐related health problems (e.g., hypertension, cardiovascular disease, stroke, obesity) and cognitive dysfunction, including Alzheimer’s disease (AD)<jats:sup>1,2</jats:sup>. However, few studies have looked at the longitudinal influence of cardiovascular health and cognitive function in older African Americans. This study investigated the relationship between cardiovascular health markers and cognition in older African Americans.Method836 participants were drawn from Pathways to Healthy Aging in African Americans, a longitudinal cohort study at Rutgers University–Newark. Participants completed a battery of self‐reported health and demographic questionnaires, neuropsychological tests, and a short physical battery of both anthropometric and physical assessments. Linear mixed models were used to examine the relationship between baseline cardiovascular health markers and cognitive function up to 6 years of follow up.ResultHigher diastolic blood pressure was significantly associated with worse Trail Making Test Part A (B = 0.035, p < .001), and Montreal Cognitive Assessment (B = 0.085, p = .0029) performance across time. Higher systolic blood pressure was significantly associated with poorer Trail Making Test Part A (B = 0.017, p < .001) and MoCA (B = 0.055, p < .001). Higher resting heart rate was significantly associated with worse Trail Making Test Part A (B = 0.018, p = .0031) and Part B (B = 0.085, p = .013), Controlled Oral Word Association Test (B = 0.036, p = .025), and Montreal Cognitive Assessment performance across time (B = 0.047, p = .046).ConclusionIn cognitively unimpaired older African Americans, cardiovascular health markers are predictive biomarkers for early working memory decline in preclinical AD. Our findings may inform holistic clinical decision‐making in AD prevention and personalized AD monitoring in patients with cardiovascular disease.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"7 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936707","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}
Christine W. Musyimi, David Ndetei, Levi A. Muyela, Elizabeth Kasimu Mutunga, Joe Masila, Nicolas Farina
BackgroundThe Integration and Evaluation of a Community‐Level Dementia Screening Programme in rural KenYa (DEM‐SKY) program, supported by the Davos Alzheimer’s Collaborative, leverages existing community resources to promote early detection of dementia among older adults and strengthen health system policy and practice in Kenya.MethodsThe DEM‐SKY program consisted of two key components: a training component and dementia screening component using then brief Community Screening Instrument for Dementia (brief‐CSID). The training component was divided into two stakeholder groups: Community Health Workers (CHWs) and hospital staff. Each group had different training needs to ensure the successful implementation of DEM‐SKY. Over a six‐month period, ten CHWs approached 3,546 older adults in Makueni County aged 60+ years to offer dementia screening. We adopted a process evaluation framework and used qualitative interviews to help identify factors that hampered or facilitated the successful adoption of dementia screening within the rural Kenyan context.ResultsOur findings revealed that 18% of older adults in rural Kenya have cognitive and functional impairment indicative of dementia, translating to over half a million older adults in Kenya. The DEM‐SKY program also illustrated the importance of collaborative partnerships with policy makers, health care providers and community members while encouraging a proactive approach in tackling challenges right from project conception. Through emerging themes and experiences, we also highlight opportunities that strengthened health care systems and promoted infrastructure readiness to address dementia care gaps during implementation of a novel dementia screening program in a low‐resource setting. These include use of existing community resources, community‐based participatory approaches and stigma‐reduction activities prior to program implementation.ConclusionThe implementation of the DEM‐SKY program has been a landmark in early detection of dementia in Kenya. It forms the first community‐based dementia detection program implemented in rural Kenya with limited specialists and inadequate infrastructure, hence providing timely initiation of care cascade for individuals with cognitive and functional impairment. This program could be used to inform governments to drive innovations that promote early detection and healthy ageing; and invest in future development and implementation of treatment and support systems for older adults with dementia in low‐resource settings.
{"title":"Community screening for dementia in Kenya: Lessons learnt from the DEM‐SKY program","authors":"Christine W. Musyimi, David Ndetei, Levi A. Muyela, Elizabeth Kasimu Mutunga, Joe Masila, Nicolas Farina","doi":"10.1002/alz.086152","DOIUrl":"https://doi.org/10.1002/alz.086152","url":null,"abstract":"BackgroundThe Integration and Evaluation of a Community‐Level Dementia Screening Programme in rural KenYa (DEM‐SKY) program, supported by the Davos Alzheimer’s Collaborative, leverages existing community resources to promote early detection of dementia among older adults and strengthen health system policy and practice in Kenya.MethodsThe DEM‐SKY program consisted of two key components: a training component and dementia screening component using then brief Community Screening Instrument for Dementia (brief‐CSID). The training component was divided into two stakeholder groups: Community Health Workers (CHWs) and hospital staff. Each group had different training needs to ensure the successful implementation of DEM‐SKY. Over a six‐month period, ten CHWs approached 3,546 older adults in Makueni County aged 60+ years to offer dementia screening. We adopted a process evaluation framework and used qualitative interviews to help identify factors that hampered or facilitated the successful adoption of dementia screening within the rural Kenyan context.ResultsOur findings revealed that 18% of older adults in rural Kenya have cognitive and functional impairment indicative of dementia, translating to over half a million older adults in Kenya. The DEM‐SKY program also illustrated the importance of collaborative partnerships with policy makers, health care providers and community members while encouraging a proactive approach in tackling challenges right from project conception. Through emerging themes and experiences, we also highlight opportunities that strengthened health care systems and promoted infrastructure readiness to address dementia care gaps during implementation of a novel dementia screening program in a low‐resource setting. These include use of existing community resources, community‐based participatory approaches and stigma‐reduction activities prior to program implementation.ConclusionThe implementation of the DEM‐SKY program has been a landmark in early detection of dementia in Kenya. It forms the first community‐based dementia detection program implemented in rural Kenya with limited specialists and inadequate infrastructure, hence providing timely initiation of care cascade for individuals with cognitive and functional impairment. This program could be used to inform governments to drive innovations that promote early detection and healthy ageing; and invest in future development and implementation of treatment and support systems for older adults with dementia in low‐resource settings.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"84 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936767","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}
Marissa C Ciesla, Claudio Toro‐Serey, Ali Jannati, Joyce Rios Gomes‐Osman, Russel Banks, John Showalter, Sean Tobyne, Alvaro Pascual‐Leone
IntroductionEvaluation of functional dependence in activities of daily living (ADLs) and instrumental activities of daily living (iADLs) is necessary for dementia diagnosis. ADL and iADL questionnaires are typically employed, but with progressive cognitive impairment, a care partner must step in to assist with these tests, causing logistical burdens. Pre‐screening tools that triage patients in need of formal functional assessment would optimize clinical workflows. Here we evaluated whether the Linus Health Digital Clock and Recall (DCRTM), a brief automatically‐scored test of multiple cognitive domains, could concurrently predict functional impairment among individuals with and without cognitive impairment.MethodsWe collected data from 922 participants in the Bio‐Hermes‐001 multi‐site study (age mean±SD = 72±6.6; 57% female; years of education mean±SD = 15±2.71; primary language English), classified as cognitively unimpaired (n = 402), mild cognitively impaired (n = 298), or probable Alzheimer’s dementia (n = 242) based on clinical consensus and neuropsychological evaluation. We split participants, each including 2000 speech and drawing DCR metrics and age, into training (80%) and test (20%) sets, ensuring equal rates of functional impairment across sets (Functional Activities Questionnaire ≥ 6; 25% rate). We performed recursive feature elimination on 10‐fold cross‐validated random forests (5 repetitions) on the training set to identify the best model and feature set. Model performance was evaluated on the test set.ResultsThe optimal model (500 features) classified functional impairment with 0.77 sensitivity, 0.82 specificity, 0.90 negative predictive value (NPV), 0.61 positive predictive value (PPV), 0.86 area under the receiver operating characteristic curve (AUC), and 0.80 accuracy. The most predictive features were the duration of speech during recall and the placement of clock components.ConclusionThe DCR, a brief digital cognitive assessment with automatic scoring that can be completed in primary‐care settings, can also be used to identify individuals in need of further evaluation and engagement of care partners as informants. The high NPV can reassure healthcare professionals when no further assessment of ADLs and iADLs is indicated. These results also enable identifying care partners who are likely to benefit from receiving personalized recommendations or training to assist them in caregiving tasks and alleviate caregiver burden.
{"title":"The Digital Clock and Recall can predict functional impairment in individuals with and without cognitive impairment and triage those in need of further assessment","authors":"Marissa C Ciesla, Claudio Toro‐Serey, Ali Jannati, Joyce Rios Gomes‐Osman, Russel Banks, John Showalter, Sean Tobyne, Alvaro Pascual‐Leone","doi":"10.1002/alz.089288","DOIUrl":"https://doi.org/10.1002/alz.089288","url":null,"abstract":"IntroductionEvaluation of functional dependence in activities of daily living (ADLs) and instrumental activities of daily living (iADLs) is necessary for dementia diagnosis. ADL and iADL questionnaires are typically employed, but with progressive cognitive impairment, a care partner must step in to assist with these tests, causing logistical burdens. Pre‐screening tools that triage patients in need of formal functional assessment would optimize clinical workflows. Here we evaluated whether the Linus Health Digital Clock and Recall (DCRTM), a brief automatically‐scored test of multiple cognitive domains, could concurrently predict functional impairment among individuals with and without cognitive impairment.MethodsWe collected data from 922 participants in the Bio‐Hermes‐001 multi‐site study (age mean±SD = 72±6.6; 57% female; years of education mean±SD = 15±2.71; primary language English), classified as cognitively unimpaired (n = 402), mild cognitively impaired (n = 298), or probable Alzheimer’s dementia (n = 242) based on clinical consensus and neuropsychological evaluation. We split participants, each including 2000 speech and drawing DCR metrics and age, into training (80%) and test (20%) sets, ensuring equal rates of functional impairment across sets (Functional Activities Questionnaire ≥ 6; 25% rate). We performed recursive feature elimination on 10‐fold cross‐validated random forests (5 repetitions) on the training set to identify the best model and feature set. Model performance was evaluated on the test set.ResultsThe optimal model (500 features) classified functional impairment with 0.77 sensitivity, 0.82 specificity, 0.90 negative predictive value (NPV), 0.61 positive predictive value (PPV), 0.86 area under the receiver operating characteristic curve (AUC), and 0.80 accuracy. The most predictive features were the duration of speech during recall and the placement of clock components.ConclusionThe DCR, a brief digital cognitive assessment with automatic scoring that can be completed in primary‐care settings, can also be used to identify individuals in need of further evaluation and engagement of care partners as informants. The high NPV can reassure healthcare professionals when no further assessment of ADLs and iADLs is indicated. These results also enable identifying care partners who are likely to benefit from receiving personalized recommendations or training to assist them in caregiving tasks and alleviate caregiver burden.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"19 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936998","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}
BackgroundGuidelines that provide current and comprehensive overviews of the evidence quality and effectiveness of interventions that address behaviours and psychological symptoms associated with dementia (BPSD, also known as Changed Behaviours) are needed for clinicians, professional care staff and family care partners. With funding provided by the Australian Government Department of Health and Aged Care, we aimed to update the existing Behaviour Management: A Guide to Good Practice, Managing Behavioural and Psychological Symptoms of Dementia (2012) text and app resources to reflect findings from the most recent literature and other sources.MethodsWe systematically searched PubMed, Medline, Embase, and PsycINFO for psychosocial and environmental and biological and pharmacological interventions published between 2012‐2021 that addressed BPSD. We reviewed identified studies, rated research quality using predetermined criteria, calculated effect sizes where possible, and synthesised the moderate to strong quality evidence and advice from the most recent clinical guidelines. The final updated resource was reviewed by frontline expert advisors and dementia support specialists working with people with lived experience.ResultsWe identified 420 studies of psychosocial and environmental interventions and 221 studies of biological/pharmacological interventions for review and rating. The final updated resource A Clinician’s BPSD Guide 2023: Understanding and helping people experiencing changed behaviours and psychological symptoms associated with dementia includes moderate to strong quality evidence from 348 studies of psychosocial and environmental interventions and 178 studies of biological/pharmacological interventions. Sections detailing additional considerations for Aboriginal and Torres Strait Island peoples and those from culturally and linguistically diverse backgrounds with dementia are included.ConclusionsPublished research evidence relating to interventions to support people living with dementia who experience changed behaviours has increased dramatically in volume and quality since 2012. Future advances will necessitate ongoing evidence updates. The 2023 Clinician’s BPSD Guide provides a comprehensive overview of evidence and practice‐based principles for supporting people who present with behaviours and psychological symptoms associated with dementia (BPSD) and their family care partners. Travel size summary versions A Clinician’s Field Guide 2023 and A Guide for Carers 2023, and mobile apps A Clinician’s BPSD Guide and CareForDementia (c4d) are also available. All are free to download1.
{"title":"Evidence‐based comprehensive overview of research quality, effectiveness of interventions, and practice‐based principles for clinicians supporting people who present with changed behaviours associated with dementia and for family care partners","authors":"Kim Burns, Anne‐Nicole S. Casey, Henry Brodaty","doi":"10.1002/alz.088426","DOIUrl":"https://doi.org/10.1002/alz.088426","url":null,"abstract":"BackgroundGuidelines that provide current and comprehensive overviews of the evidence quality and effectiveness of interventions that address behaviours and psychological symptoms associated with dementia (BPSD, also known as Changed Behaviours) are needed for clinicians, professional care staff and family care partners. With funding provided by the Australian Government Department of Health and Aged Care, we aimed to update the existing <jats:italic>Behaviour Management: A Guide to Good Practice, Managing Behavioural and Psychological Symptoms of Dementia</jats:italic> (2012) text and app resources to reflect findings from the most recent literature and other sources.MethodsWe systematically searched PubMed, Medline, Embase, and PsycINFO for psychosocial and environmental and biological and pharmacological interventions published between 2012‐2021 that addressed BPSD. We reviewed identified studies, rated research quality using predetermined criteria, calculated effect sizes where possible, and synthesised the moderate to strong quality evidence and advice from the most recent clinical guidelines. The final updated resource was reviewed by frontline expert advisors and dementia support specialists working with people with lived experience.ResultsWe identified 420 studies of psychosocial and environmental interventions and 221 studies of biological/pharmacological interventions for review and rating. The final updated resource <jats:italic>A Clinician’s BPSD Guide 2023: Understanding and helping people experiencing changed behaviours and psychological symptoms associated with dementia</jats:italic> includes moderate to strong quality evidence from 348 studies of psychosocial and environmental interventions and 178 studies of biological/pharmacological interventions. Sections detailing additional considerations for Aboriginal and Torres Strait Island peoples and those from culturally and linguistically diverse backgrounds with dementia are included.ConclusionsPublished research evidence relating to interventions to support people living with dementia who experience changed behaviours has increased dramatically in volume and quality since 2012. Future advances will necessitate ongoing evidence updates. The <jats:italic>2023 Clinician’s BPSD Guide</jats:italic> provides a comprehensive overview of evidence and practice‐based principles for supporting people who present with behaviours and psychological symptoms associated with dementia (BPSD) and their family care partners. Travel size summary versions <jats:italic>A Clinician’s Field Guide 2023</jats:italic> and <jats:italic>A Guide for Carers 2023</jats:italic>, and mobile apps <jats:italic>A Clinician’s BPSD Guide</jats:italic> and <jats:italic>CareForDementia</jats:italic> (c4d) are also available. All are free to download<jats:sup>1</jats:sup>.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"37 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937051","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}
Carolyn K Clevenger, Anjali Khakharia, Laura J Medders, Miranda Moore
BackgroundHarmful care including the prescribing of high‐risk and potentially inappropriate medications for older people is widespread among older adults, including people living with dementia (PLWD). Integrated Memory Care (IMC) is a comprehensive dementia care model where patients and their family caregivers access dementia‐sensitive geriatric primary care.MethodsWe conducted a retrospective observational study of adult patients of IMC, Cognitive Neurology (CN), and Primary Care (PC) clinics aged 65 and older with a diagnosis of dementia in 2019‐2021. We matched patients by age, gender and race and measured the hospitalization, rate of deprescribing and inappropriate screening test referrals using logistic regressions controlling for clinic. Additionally, we conducted a regression adjusted for state of illness (proxied by activities of daily living (ADL)) for the IMC and CN clinics.ResultsOverall, 509 patients seen in IMC were matched with 490 CN patients and 509 PC patients. Most patients were female and white and aged 70‐85. IMC patients had higher overall ADL scores than CN indicating more functional dependence.IMC patients had higher odds of deprescribing high dose Antipsychotics (OR: 4.383, CI:1.405,13.677), benzodiazepines (OR: 3.338, CI: 1.541,7.231) and Opiates (OR: 1.004, CI: 0.415, 2.431) when compared to CN patients. After adjusting for ADL scores, the odds ratios were 4.952 (1.509,16.25), 3.434 (1.573, 7.494) and 0.991 (0.408, 2.404) respectively.IMC also had higher odds of deprescribing high dose Antipsychotics (OR 5.538 CI: 1.21,25.359), benzodiazepines (2.632, CI: 1.297, 5.341) and Opiates (1.424, CI: 0.571, 3.55) when compared to PC patients.ConclusionsPatients managed in a dementia‐sensitive primary care practice were deprescribed high‐risk medications after one‐year of management, reducing avoidable adverse events.
{"title":"Integrated Primary Care Model Reduces High‐Risk Medications for People Living with Dementia","authors":"Carolyn K Clevenger, Anjali Khakharia, Laura J Medders, Miranda Moore","doi":"10.1002/alz.086128","DOIUrl":"https://doi.org/10.1002/alz.086128","url":null,"abstract":"BackgroundHarmful care including the prescribing of high‐risk and potentially inappropriate medications for older people is widespread among older adults, including people living with dementia (PLWD). Integrated Memory Care (IMC) is a comprehensive dementia care model where patients and their family caregivers access dementia‐sensitive geriatric primary care.MethodsWe conducted a retrospective observational study of adult patients of IMC, Cognitive Neurology (CN), and Primary Care (PC) clinics aged 65 and older with a diagnosis of dementia in 2019‐2021. We matched patients by age, gender and race and measured the hospitalization, rate of deprescribing and inappropriate screening test referrals using logistic regressions controlling for clinic. Additionally, we conducted a regression adjusted for state of illness (proxied by activities of daily living (ADL)) for the IMC and CN clinics.ResultsOverall, 509 patients seen in IMC were matched with 490 CN patients and 509 PC patients. Most patients were female and white and aged 70‐85. IMC patients had higher overall ADL scores than CN indicating more functional dependence.IMC patients had higher odds of deprescribing high dose Antipsychotics (OR: 4.383, CI:1.405,13.677), benzodiazepines (OR: 3.338, CI: 1.541,7.231) and Opiates (OR: 1.004, CI: 0.415, 2.431) when compared to CN patients. After adjusting for ADL scores, the odds ratios were 4.952 (1.509,16.25), 3.434 (1.573, 7.494) and 0.991 (0.408, 2.404) respectively.IMC also had higher odds of deprescribing high dose Antipsychotics (OR 5.538 CI: 1.21,25.359), benzodiazepines (2.632, CI: 1.297, 5.341) and Opiates (1.424, CI: 0.571, 3.55) when compared to PC patients.ConclusionsPatients managed in a dementia‐sensitive primary care practice were deprescribed high‐risk medications after one‐year of management, reducing avoidable adverse events.","PeriodicalId":7471,"journal":{"name":"Alzheimer's & Dementia","volume":"35 1","pages":""},"PeriodicalIF":14.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937055","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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