Disease Dementia Research Articles

Burden of Cardio-Cerebrovascular and Renal Diseases Attributable to Systolic Hypertension in France in 2021.

Hypertension is the most common chronic disease and a major modifiable risk factor for cardio-cerebrovascular and renal diseases. This study estimated the national burden of hypertension, defined as systolic blood pressure ≥140 mm Hg, on morbidity and mortality in 2021 in France. For all diseases causally associated with hypertension (cardiovascular diseases, chronic kidney diseases, and dementia), the number and proportion of cases attributable to hypertension in adults aged ≥35 years were estimated using population attributable fractions. Age- and sex-specific population attributable fractions were computed using the distribution of hypertension in the French population. These population attributable fractions were applied to nationwide statistics for mortality, hospitalizations, disease prevalence, years of life lost, years of life lived with disability, and disability-adjusted years of life. The largest population attributable fractions were for ischemic heart disease and hemorrhagic stroke, with over 40% of cases attributable to hypertension. Overall, >385 000 patients were hospitalized due to hypertension, with 3.7 million hospitalizations and 6.2 million hospital days (all hospitalizations, including 3.4 million for chronic kidney disease) and including 390 000 overnight hospitalization. In 2021, >1.15 million individuals lived with ischemic heart disease attributable to hypertension, 1.26 million with chronic kidney diseases, and 358 033 with heart failure. Among 184 059 annual deaths from cardiovascular diseases, dementia, and chronic kidney diseases, 30% (55 280 deaths) were attributable to hypertension. Hypertension accounted for 8.5% of all deaths and 498 052 years of life lost. In France, despite near-universal health coverage and free health care access, the burden attributable to hypertension remains high.

Communicative and Methodological Challenges Related to Collecting Data with Older Adults with Dementia in Senior Living Communities During the COVID-19 Pandemic.

The COVID-19 pandemic presented significant challenges to researchers collecting data with older adults, particularly older adults with Alzheimer's disease and related dementias (ADRD). The goal of this article is to articulate the communicative and methodological challenges and lessons learned from collecting data with older adults in senior living communities with mild cognitive impairment and ADRD and their adult children (who were geographically separated) during the pandemic. Communication was much more than what we were studying; it was essential to the success and ethical implementation of our research. We were working with a vulnerable population during a pandemic where recruitment, consent, and data collection required heightened and adapted communication strategies to reduce confusion, promote safety, and ensure data could be collected in an effective manner. The way we communicated with the participants, their networks, and the senior living communities was crucial to establishing strong human connections and subsequently successful data collection.

Ultrastructural features of the brain of patients with cognitive impairment in Alzheimer’s disease and vascular dementia

BACKGROUND: Nowadays, due to the increase in life expectancy, the problem of cognitive disorders, quite often found in elderly people and being a formidable syndrome of a number of neurodegenerative diseases, is extremely relevant. According to epidemiological data, the most common causes of cognitive dysfunction are Alzheimer’s disease and cerebrovascular diseases, accounting for about 90% of all cases. AIM: to investigate the morphological features underlying the development of cognitive disorders in Alzheimer’s disease and cerebrovascular pathology. MATERIALS AND METHODS: According to our developed and patented method of preparation of sectional material for electron microscopy а detailed study of the brain of elderly patients with Alzheimer’s disease and cerebrovascular pathology was carried out using electron microscopy on autopsy material. RESULTS: Electron microscopy of the brains of patients with Alzheimer’s disease often reveals large extracellular reticulate-fiber structures closely adjacent to myelin fibers, which are part of a fibrous plaque. In vascular dementia, irregularly shaped hyperchromic masses with heterogeneous contents are found in the neuropil, which may represent future so-called “diffuse” plaques. In Alzheimer’s disease, fragments of future “diffuse” plaques are also observed in the cytoplasm of some cortical oligodendrocytes. In all deceased with Alzheimer’s disease, synaptic changes were found in the form of roughly granular disintegration of the entire synaptocomplex, i.e., synaptic vesicles, mitochondria, and the synaptic cleft proper. CONCLUSION: This study provides an opportunity to take a new look at some questions of etiology and pathogenesis of such a disease as cognitive disorders, which is not easy to diagnose and treat.

PROCESSOS PSICOTERAPÊUTICOS: SUAS CONTRIBUIÇÕES NA QUALIDADE DE VIDA DA PESSOA COM DEMÊNCIA E ALZHEIMER

This study aims to elucidate and collect data on: “Psychotherapeutic Processes: Their contributions to the quality of life of people with dementia and Alzheimer’s”. It is understood that Dementia represents a cognitive disorder that causes the gradual impoverishment of brain function, affecting the ability to judge, memory, language and other cognitive processes, occurring more frequently in elderly individuals and the prevalence of dementia doubles every five years. years from the age of 65, based on this context, this article aims to present how psychotherapeutic processes can alleviate symptoms and improve the quality of life of people with dementia and Alzheimer's. Aiming to understand the causes and development of dementia and Alzheimer's disease, identifying factors that contribute to the physical and psychological burden on family members and their caregivers. The investigation is based on the CBT approach, Cognitive Behavioral Therapy, which specifically expresses its therapeutic mechanisms of action. It also hears contributions from the TAC approach. Behavioral Analytical Therapy that made it possible to understand the patient in their context. Therefore, this study was guided by a bibliographical research methodology, exploratory in nature, with a qualitative, field and descriptive approach, hypothetical-deductive and non-experimental. I understand that this line of research and approach is the most viable for the study for now. Therefore, the results contextualized here can be considered satisfactory to those initially proposed in this psychotherapeutic study. There are still clearly several aspects and possibilities to be analyzed in future studies, and, therefore, in more depth.

Association between dietary inflammatory index score and incident dementia.

We evaluated whether higher Dietary Inflammatory Index (DII) scores were associated with increased incidence of all-cause dementia and Alzheimer's disease (AD) dementia over 22.3 years of follow-up in the community-based Framingham Heart Study Offspring cohort. One thousand four hundred eighty-seven participants (mean±standard deviation, age in years 69±6) completed food frequency questionnaires (FFQs) and had incident all-cause dementia and AD surveillance data available. Two hundred forty-six participants developed all-cause dementia (including AD, n=187) over a median follow-up time of 13.1 years. Higher DII scores, averaged across a maximum of three timepoints, were associated with an increased incidence of all-cause dementia and AD after adjustment for demographic, lifestyle, and clinical covariates (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.10-1.33, P<0.001; HR 1.20, 95% CI: 1.07-1.34d, P=0.001, respectively). Higher DII scores were associated with a higher risk of incident all-cause dementia and AD. Although these promising findings need to be replicated and further validated, our results suggest that diets that correlate with low DII scores may prevent late-life dementia. Higher Dietary Inflammatory Index (DII) scores were associated with an increased incidence of all-cause dementia. Higher DII scores were associated with an increased incidence of Alzheimer's disease dementia. Diets that correlate with low DII scores may prevent late-life dementia.

Developing and applying potentially scalable recruitment strategies to accelerate ADRD research participation of Black adults.

More than 2 million older Americans from underrepresented racial and ethnic minority groups (URGs) have early-stage Alzheimer's disease and related dementias (ADRD). There are very few scalable recruitment strategies, particularly for Black older adults, to accelerate participation in ADRD research. The Indiana Alzheimer's Disease Research Center (IADRC) and its Community Advisory Board developed and implemented the innovative RAAISE-D Framework. This Framework informed the creation of community-first recruitment strategies designed to accelerate participation of Black older adults in ADRD research. Preliminary outcomes from its implementation included the doubling of Black adult enrollment (46, 13.4% to 101, 26.9%) from April 2020 to April 2024. Black adults were more likely to have normal cognition, be female, and ≤12 years of education than non-Hispanic White adults. The RAAISE-D Framework identified key concepts for URG focused recruitment strategies which successfully accelerated enrollment of Black adults in ADRD research and could be generalized to other URGs. HIGHLIGHTS: RAAISE-D Framework provides adaptable URG recruitment strategies. IADRC CAB-researcher partnership was the foundation of community-first methodology. RAAISE-D Framework doubled the Black enrollment in the IADRC in 4 years.

The Promising Potency of Sodium–Glucose Cotransporter 2 Inhibitors in the Prevention of and as Treatment for Cognitive Impairment Among Type 2 Diabetes Patients

Type 2 diabetes mellitus (T2DM), accounting for the majority of diabetes mellitus prevalence, is associated with an increased risk of cognition decline and deterioration of cognition function in diabetic patients. The sodium–glucose cotransporter 2 (SGLT2), located in the renal proximal tubule, plays a role in urine glucose reabsorption. SGLT2 inhibitors (SGLT2i), have shown potential benefits beyond cardiac and renal improvement in preventing and treating cognitive impairment (CI), including mild cognitive impairment, Alzheimer’s disease and vascular dementia in T2DM patients. Studies suggest that SGLT2i may ameliorate diabetic CI through metabolism pathways, inflammation, oxidative stress, neurotrophic factors and AChE inhibition. Clinical trials and meta-analyses have reported significant and insignificant results. Given their vascular effects, SGLT2i may offer unique protection against vascular CI. This review compiles mechanisms and clinical evidence, emphasizing the need for future analysis, evaluation, trials and meta-analyses to verify and recommend optimal SGLT2i selection and dosage for specific patients.

Social worlds of Appalachian women caregivers of older relatives living with dementia

RationaleOver 11 million people in the United States provide care for an older family member with dementia, with this responsibility primarily falling on daughters and wives. In Appalachia, a mountainous region in the U.S characterized by close families, family members were crucial to ensuring that care needs were met for people living with dementia during the COVID-19 pandemic. However, we know little about the well-being of family caregivers during the public health crisis. Guided by a Limited Future Time Perspective postulate, which posits that as people age they begin to prioritize emotionally meaningful relationships over instrumental goals, we asked how dementia caregiving changes the social lives of family caregivers situated within kin networks; and how a public health crisis (i.e., COVID-19 pandemic) affects caregivers who are already at risk for social isolation and feelings of loneliness.MethodsParticipants were recruited from a regional health care system and four Area Agencies on Aging. In our longitudinal study we invited family caregivers to be interviewed at multiple time points over a 4-year period. The sample for this study was women caregivers interviewed (N = 27; age range 32–81, m = 63). Interviewers followed a semi-structured protocol with questions designed to elicit descriptions about (a) changes in formal and informal support over time, (b) the person living with dementia's symptoms and disease progression, and (c) how the pandemic affected caregivers’ and persons living with dementia's social worlds.FindingsWe found three types of caregivers: (1) caregivers who had social lives interdependent with their relative with dementia, (2) caregivers and persons living with dementia whose social lives were restricted due to dementia symptoms and caregiving demands, and (3) caregivers and their relative living with dementia who maintained separate social lives. Dementia symptoms more than social distancing measures contributed to caregivers’ shrinking social worlds particularly for those with interdependent social lives despite living amongst kin.ConclusionsThis study is important in understanding how women in Appalachia fared during a pandemic in the context of dementia caregiving. This research supports the need for respite services and dementia care training for respite workers.

Action observation treatment may improve daily living activities and verb recovery in Parkinson’s disease-dementia: findings from a preliminary randomized controlled trial

Background and objectivesAction observation treatment (AOT) is a novel rehabilitation approach aimed to the recovery of both motor and linguistic deficits in subjects with brain lesions. The aim of the present randomized controlled study was to assess the benefits of AOT treatment in the activities of daily living (ADLs) and in the linguistic abilities of the patients with Parkinson’s disease dementia (PDD) at mild–moderate stage (Hoehn &amp;amp; Yahr’s stage scale: 2–3).MethodsTwenty patients were enrolled and randomly assigned to an experimental group (submitted to AOT) or to a control group. The experimental group (AOT-group) underwent the vision of a video containing 6 complex ADLs, while the control group (C-group) was subjected to a video-clip regarding semantic information of a geographical-naturalistic type without motor content. The treatment duration was 4 weeks. All patients underwent assessment before and after the treatment by the following tools: Unified Parkinson’s Disease Rating Scale Part III (UPDRS-Part III), Alzheimer’s Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL), Direct Assessment of Functional Status (DAFS) and subtest Verb Naming of Analysis of Aphasic Deficit Battery (BADA). Paired samples t test was performed to compare all the variables of interest in the time, dividing by groups. p-value&amp;lt;0.05 was considered significant in all analyses.ResultsAOT-group showed an improvement from baseline to the end of study in ADCS-ADL (p = 0.001), BADA (p = 0.011) and DAFS (p = 0.005), while C-group did not change significantly in the time.ConclusionThese preliminary results suggest the potential efficacy of AOT in rehabilitation of ADLs and verb retrieval in people with PD. Further studies will be necessary to verify these findings.

Telemedicine in Alzheimer's disease and other dementias: Where we are?

The prevalence and global health burden of dementia including Alzheimer's disease (AD) is rising, while patients living in remote and underserved areas face significant challenges in reaching specialized care. Telemedicine offers a valuable solution in bridging this widening gap, by providing equal and timely access to tertiary-specialized centers. Accumulating evidence highlights that most parts of the remote neuropsychological and neurological evaluation are feasible, with patients, healthcare professionals and caregivers being generally satisfied with this means of care. Herein, we provide an updated overview of the available evidence on the use of telemedicine for patients with cognitive disorders, focusing on the different applications and settings, the remote, video-based neurological and neuropsychological assessment, current recommendations, non-pharmacological interventions, as well as legal and ethical considerations. Based on the literature review and our three-year experience in the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network" in the Aiginition University Hospital of Athens, we propose a brief guide for assessing patients with cognitive impairment via telemedicine and suggest future research directions for the more effective and appropriate use of telemedicine in dementia assessment and care.

Utilization and perceived usefulness of monitoring technology for family caregivers of people living with Alzheimer's disease and related dementias.

Caregivers of people living with dementia (PLWD) often experience burden based on their care recipients' symptoms of wandering, disorientation, and agitation. To examine the utilization and perceived value of technology-based solutions for caregiving among caregivers of PLWD. In collaboration with three Texas sites, PLWD and family caregiver dyads were recruited from clinical and community sites to assess the feasibility of a caregiving technology. PLWDs were asked to wear a GPS-based wearable device, which was paired with caregivers' smartphone application, that enabled location monitoring and was equipped with call functions. After three months, researchers called caregivers to ask about their utilization of the "system" (i.e., wearable paired with smartphone application) and the perceived value of this technology. Forty-one caregivers completed follow-up telephone interviews. About 70% of caregivers reported their care recipient wore the wearable device daily, and 39.1% used the smartphone application daily. Approximately 31% of caregivers reported daily use of the tracking feature, 30.8% reported daily use of the "safe zone" feature (i.e., geo-fencing), and 17.1% reported daily use of the two-way calling feature. About 39% of caregivers were extremely satisfied with the "system," 43.6% found it extremely easy to use, and 46.2% found it extremely useful for caregiving. On average, caregivers with higher baseline Zarit Burden Interview scores found the "system" to be more useful with their caregiving (f = 5.97, p = 0.006) and were more satisfied with the "system" (f = 3.75, p = 0.034). Findings suggest caregiver burden may drive the perceived usefulness of, and satisfaction with, technology-based solutions.

Corrigendum: Mechanisms of mitophagy and oxidative stress in cerebral ischemia–reperfusion, vascular dementia, and Alzheimer's disease

Corrigendum: Mechanisms of mitophagy and oxidative stress in cerebral ischemia–reperfusion, vascular dementia, and Alzheimer's disease

The Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT) intervention: A personalized approach to dementia risk reduction.

Addressing modifiable risk factors such as physical inactivity and social isolation could reduce risk of Alzheimer's disease and all-cause dementia, but little is known about which factors individuals are most willing to address or how they prefer to address them. To examine and describe behavior change goals set by participants during the Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT). In SMARRT, older adults worked with a health coach and nurse over 2 years to set incremental, personalized goals to reduce dementia risk. We performed quantitative analyses to summarize the numbers of goals per risk factor and qualitative content analyses of health coach and nurse notes to describe types of goals and useful strategies. 82 dementia-free adults (70 to 89 years) with at least two dementia risk factors participated in the SMARRT intervention arm (mean age, 76 ± 5 years; 72% women; 11% Black/African American, 4% Asian, 3% Hispanic, 7% another non-White race). Participants set a median of 12 health coach goals and 1 nurse goals. The risk factors participants chose to work on most frequently were physical activity (95%), hypertension (72%), and cognitive activity (60%). Participants reported that the most useful strategies included support and accountability from the health coach/nurse, setting small goals, and learning to manage setbacks. When given support, older adults at increased risk for dementia set a wide range of goals to reduce dementia risk. A flexible, personalized approach that focuses on setting feasible goals and managing setbacks provides a useful framework for dementia risk reduction.

Implementing New Dementia Care Models in Practice.

Care for patients with Alzheimer disease and related neurodegenerative causes of dementia is in the midst of a transformation. Recent advancements in diagnostics and therapeutics reflect a rapidly evolving knowledge base and represent positive steps for patients and clinicians facing these progressive diseases; however, the complexities of emerging biomarkers and treatment options present challenges that will require systematic adaptations to routine care to facilitate effective incorporation of these options. This article reviews ongoing updates in the assessment and management of neurodegenerative causes of dementia, focusing on practical models for innovation that practices and health care systems can use to implement these new tools. In particular, sustainable adaptation in the field will benefit from a comprehensive approach implemented at local levels, including (1) education of clinicians and communities to refine perceptions about dementia care, (2) multifaceted stakeholder engagement to optimize infrastructure and workflows to the new era, and (3) investments in personnel to address existing and exacerbated gaps.

Risk factors for Alzheimer's disease and related dementias in U.S. honor cultures

Risk factors for Alzheimer's disease and related dementias in U.S. honor cultures

Impact of ambient temperatures on Alzheimer’s disease and other dementia mortality among elderly patients aged 60 years and older in China

Impact of ambient temperatures on Alzheimer’s disease and other dementia mortality among elderly patients aged 60 years and older in China

Vascular Cognitive Impairment

ABSTRACT OBJECTIVE Vascular cognitive impairment is a major contributor to age-associated cognitive decline, both independently and as a contributor to mixed dementia syndromes. This article reviews the current understanding of how vascular dysfunction contributes to cognitive impairment and dementia risk in older individuals and includes updated diagnostic criteria and treatment recommendations. LATEST DEVELOPMENTS Clinical and research criteria have been evolving to more accurately determine the full prevalence of vascular cognitive impairment. The Boston Criteria version 2.0 for cerebral amyloid angiopathy now includes multiple punctate MRI T2 white matter hyperintensities and MR-visible perivascular spaces in addition to previously described T2* hemorrhagic signatures. MR-visible perivascular spaces are associated with both vascular cognitive impairment and Alzheimer disease, potentially linking cerebrovascular dysfunction to neurodegenerative disorders through its role in brain waste clearance. The American Heart Association’s goal for cardiovascular health promotion, “Life’s Essential 8,” has been updated to include sleep health and acknowledges psychological well-being and social determinants of health as fundamental components necessary to achieve optimal cardiovascular health for all adults. ESSENTIAL POINTS Vascular cognitive impairment is a common and often underrecognized contributor to cognitive impairment in older individuals, with heterogeneous etiologies requiring individualized treatment strategies. Effective cerebrovascular disease risk factor modification starting in midlife is critical to reducing the risk of Alzheimer disease and related dementias, with the goal of preventing vascular brain injury and maintaining cognitive reserve in the presence of nonvascular age-related brain pathologies.

Genetics and Neuropathology of Neurodegenerative Dementias.

This article provides an overview of the current understanding of the genetic and pathologic features of neurodegenerative dementias, with an emphasis on Alzheimer disease and related dementias. In recent years, there has been substantial progress in genetic research, contributing significant knowledge to our understanding of the molecular risk factors involved in neurodegenerative dementia syndromes. Several genes have been linked to monogenic forms of dementia (eg, APP, PSEN1, PSEN2, SNCA, GRN, C9orf72, MAPT) and an even larger number of genetic variants are known to influence susceptibility for developing dementia. As anti-amyloid therapies for patients with early-stage Alzheimer disease have entered the clinical arena, screening for the apolipoprotein E ε4 high-risk allele has come into focus, emphasizing the importance of genetic counseling. Similarly, advances in the pathologic classifications of neurodegenerative dementia syndromes and molecular pathology highlight their heterogeneity and overlapping features and provide insights into the pathogenesis of these conditions. Recent progress in neurogenetics and molecular pathology has improved our understanding of the complex pathogenetic changes associated with neurodegenerative dementias, facilitating improved disease modeling, enhanced diagnostics, and individualized counseling. The hope is that this knowledge will ultimately pave the way for the development of novel therapeutics.

Beyond the blur: Scopolamine's utility and limits in modeling cognitive disorders across sexes - narrative review.

Scopolamine, widely regarded as the gold standard in preclinical studies of memory impairments, acts as a non-selective antagonist of central and peripheral muscarinic receptors. While its application in modeling dementia primarily involves antagonism at the M1 receptor, its non-selective peripheral actions may introduce adverse effects that influence behavioral test outcomes. This review analyzes preclinical findings to consolidate knowledge on scopolamine's use and elucidate potential mechanisms responsible for its amnestic effects. We focused on recognition, spatial and emotional memory processes, alongside executive functions such as attention, cognitive flexibility, and working memory. The cognitive effects of scopolamine are highly dose-dependent, influenced by factors such as species, age, and sex of subjects. Notably, scopolamine rapidly induces observable memory impairments across species, from fish to rodents and primates, often with deficits that can persist for days. However, the compound's broad action on muscarinic receptors and its peripheral side effects, including pupil dilation and reduced salivation, complicates result interpretation, particularly in tasks requiring visual discrimination or food intake. The review also highlights scopolamine's translational value in modeling dementia and Alzheimer's disease, emphasizing the importance of considering individual factors and task-specific designs. Despite its widespread use, scopolamine's limited specificity for cholinergic dysfunction and inability to fully mimic the complex pathophysiology of cognitive disorders like Alzheimer's and Parkinson's disease point to the need for complementary models. This review aims to guide researchers in using scopolamine for modeling cognitive impairments, ensuring attention to factors impacting experimental outcomes.

The Relationship between Framingham Stroke Risk Profile on Incident Dementia and Alzheimer's Disease: A 40-Year Follow-Up Study Highlighting Female Vulnerability.

Sex differences in the association between cardiovascular risk factors and the incident all-cause dementia and the subtype Alzheimer's disease (AD) risk are unclear. Framingham Heart Study (FHS) participants (n = 4,171, 54% women, aged 55 to 69 years) were included at baseline and followed up to 40 years. The Framingham Stroke Risk Profile (FSRP) was dichotomized into 2 levels (cutoff: 75th percentile of the FSRP z-scores). Cause-specific hazard models, with death as a competing event, and restricted mean survival time (RMST) model were used to analyze the association between FSRP levels and incident all-cause dementia and AD. Interactions between FSRP and sex were estimated, followed by a sex-stratified analysis to examine the sex modification effect. High FSRP was significantly associated with all-cause dementia (hazard ratio [HR] = 1.25, robust 95% confidence interval [CI] = 1.21 to 1.29, p < 0.001) and AD (HR = 1.58, robust 95% CI = 1.57 to 1.59, p < 0.001) in cause-specific hazard models. High FSRP was significantly associated with incident dementia (HR = 2.81, robust 95% CI = 2.75 to 2.87, p < 0.001) and AD (HR = 2.96, robust 95% CI = 2.36 to 3.71, p < 0.001) in women, but not in men. Results were consistent in the RMST models. Current diabetes and high systolic blood pressure as FSRP components were significantly associated with dementia and AD in women but not in men. High FSRP in mid- to early late life is a critical risk factor for all-cause dementia and AD, particularly in women. Sex-specific interventions and further research to elucidate underlying mechanisms are warranted. ANN NEUROL 2024;96:1124-1134.