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Journal of Medical Imaging and... Jun 2024There is a lack of evidence about the experiences of radiographers providing care to people living with dementia (PLWD). This study explored the perceptions and...
INTRODUCTION
There is a lack of evidence about the experiences of radiographers providing care to people living with dementia (PLWD). This study explored the perceptions and experiences of radiography practitioners when delivering person-centred dementia care (PCDC) in both diagnostic imaging and radiotherapy departments.
METHODS
A two-phase qualitative multi-method study was conducted. For phase 1, fifteen diagnostic and two therapeutic radiography practitioners from across the UK participated with online focus group discussions. For phase 2, four key stakeholders involved with the development of the UK Society of College of Radiographers Caring for People with Dementia practice guidelines for diagnostic and therapeutic radiography practitioners took part with individual semi-structured interviews.
RESULTS
Participants from both phases identified enablers and barriers to providing person-centred care to individuals living with dementia. Three themes were identified that were linked to (1) Time and workload pressures in delivering person-centred dementia care, (2) Workplace practice and norms, and (3) Areas for improvement in delivering person-centred dementia care.
DISCUSSION
Delivering PCDC can be challenging in practice. This is often due to workplace cultures where time and resources linked to productivity and waiting lists are the norms and impact on the delivery of PCDC. Leaders and managers of departments were thought to not always value a culture of PCDC but were seen as key influencers in supporting change and impact in delivering PCDC. Radiography practitioners were not always aware that a patient had dementia prior to their attendance in the department making it difficult to prepare ahead of appointments. Care partners were identified as having the potential to help alleviate some challenges radiographers faced. Findings also suggest a need for more education and training linked to dementia awareness. Further research is warranted in this area.
PubMed: 38943280
DOI: 10.1016/j.jmir.2024.101441 -
Acta Neuropathologica Communications Jun 2024The relationship between amyloidosis and vasculature in cognitive impairment and Alzheimer's disease (AD) pathogenesis is increasingly acknowledged. We conducted a...
The relationship between amyloidosis and vasculature in cognitive impairment and Alzheimer's disease (AD) pathogenesis is increasingly acknowledged. We conducted a quantitative and topographic assessment of retinal perivascular amyloid plaque (AP) distribution in individuals with both normal and impaired cognition. Using a retrospective dataset of scanning laser ophthalmoscopy fluorescence images from twenty-eight subjects with varying cognitive states, we developed a novel image processing method to examine retinal peri-arteriolar and peri-venular curcumin-positive AP burden. We further correlated retinal perivascular amyloidosis with neuroimaging measures and neurocognitive scores. Our study unveiled that peri-arteriolar AP counts surpassed peri-venular counts throughout the entire cohort (P < 0.0001), irrespective of the primary, secondary, or tertiary vascular branch location, with a notable increase among cognitively impaired individuals. Moreover, secondary branch peri-venular AP count was elevated in the cognitively impaired (P < 0.01). Significantly, peri-venular AP count, particularly in secondary and tertiary venules, exhibited a strong correlation with clinical dementia rating, Montreal cognitive assessment score, hippocampal volume, and white matter hyperintensity count. In conclusion, our exploratory analysis detected greater peri-arteriolar versus peri-venular amyloidosis and a marked elevation of amyloid deposition in secondary branch peri-venular regions among cognitively impaired subjects. These findings underscore the potential feasibility of retinal perivascular amyloid imaging in predicting cognitive decline and AD progression. Larger longitudinal studies encompassing diverse populations and AD-biomarker confirmation are warranted to delineate the temporal-spatial dynamics of retinal perivascular amyloid deposition in cognitive impairment and the AD continuum.
Topics: Humans; Male; Female; Aged; Cognitive Dysfunction; Hippocampus; Atrophy; Amyloidosis; Aged, 80 and over; Retrospective Studies; Middle Aged; Plaque, Amyloid; Retinal Diseases; Retinal Vessels; Ophthalmoscopy
PubMed: 38943220
DOI: 10.1186/s40478-024-01810-2 -
Alzheimer's Research & Therapy Jun 2024Amyloid-β (Aβ) and tau are brain hallmarks of Alzheimer's disease (AD), also present in blood as soluble biomarkers or encapsulated in extracellular vesicles (EVs).... (Comparative Study)
Comparative Study
BACKGROUND
Amyloid-β (Aβ) and tau are brain hallmarks of Alzheimer's disease (AD), also present in blood as soluble biomarkers or encapsulated in extracellular vesicles (EVs). Our goal was to assess how soluble plasma biomarkers of AD pathology correlate with the number and content of EVs.
METHODS
Single-molecule enzyme-linked assays were used to quantify Aβ42/40 and tau in plasma samples and neurally-derived EVs (NDEVs) from a cohort of APOE ε4- (n = 168) and APOE ε4+ (n = 68) cognitively normal individuals and AD patients (n = 55). The ratio of CD56 (Neuronal cell-adhesion molecule) to CD81 signal measured by ELISA-DELFIA was used for the relative quantification of NDEVs in plasma samples.
RESULTS
The soluble plasma Aβ42/40 ratio is decreased in AD patients compared to cognitively normal individuals. The amount and content (Aβ40, Aβ42, tau) of plasma NDEVs were similar between groups. Plasma NDEVs quantity remain consistent with aging and between AD and CN individuals. However, the quantity of soluble biomarkers was negatively correlated to NDEVs number in cognitively normal individuals, while in AD patients, this correlation is lost, suggesting a shift in the mechanism underpinning the production and the release of these biomarkers in pathological conditions.
CONCLUSION
Soluble plasma Aβ42/40 ratio is the most robust biomarker to discriminate between AD patients and CN individuals, as it normalizes for the number of NDEVs. Analysis of NDEVs and their content pointed toward peculiar mechanisms of Aβ release in AD. Further research on independent cohorts can confirm our findings and assess whether plasma Aβ and tau need correction by NDEVs for better AD risk identification in CN populations.
Topics: Humans; Alzheimer Disease; Extracellular Vesicles; Biomarkers; Female; Male; Amyloid beta-Peptides; Aged; tau Proteins; Peptide Fragments; Aged, 80 and over; Middle Aged; Cohort Studies; Apolipoprotein E4
PubMed: 38943196
DOI: 10.1186/s13195-024-01508-6 -
Trials Jun 2024Isolated REM sleep behavior disorder (iRBD) is an early α-synucleinopathy often accompanied by incipient cognitive impairment. As executive dysfunctions predict earlier...
Cognitive training and promoting a healthy lifestyle for individuals with isolated REM sleep behavior disorder: study protocol of the delayed-start randomized controlled trial CogTrAiL-RBD.
BACKGROUND
Isolated REM sleep behavior disorder (iRBD) is an early α-synucleinopathy often accompanied by incipient cognitive impairment. As executive dysfunctions predict earlier phenotypic conversion from iRBD to Parkinson's disease and Lewy body dementia, cognitive training focusing on executive functions could have disease-modifying effects for individuals with iRBD.
METHODS
The study CogTrAiL-RBD investigates the short- and long-term effectiveness and the feasibility and underlying neural mechanisms of a cognitive training intervention for individuals with iRBD. The intervention consists of a 5-week digital cognitive training accompanied by a module promoting a healthy, active lifestyle. In this monocentric, single-blinded, delayed-start randomized controlled trial, the intervention's effectiveness will be evaluated compared to an initially passive control group that receives the intervention in the second, open-label phase of the study. Eighty individuals with iRBD confirmed by polysomnography will be consecutively recruited from the continuously expanding iRBD cohort at the University Hospital Cologne. The evaluation will focus on cognition and additional neuropsychological and motor variables. Furthermore, the study will examine the feasibility of the intervention, effects on physical activity assessed by accelerometry, and interrogate the intervention's neural effects using magnetic resonance imaging and polysomnography. Besides, a healthy, age-matched control group (HC) will be examined at the first assessment time point, enabling a cross-sectional comparison between individuals with iRBD and HC.
DISCUSSION
This study will provide insights into whether cognitive training and psychoeducation on a healthy, active lifestyle have short- and long-term (neuro-)protective effects for individuals with iRBD.
TRIAL REGISTRATION
The study was prospectively registered in the German Clinical Trial Register (DRKS00024898) on 2022-03-11, https://drks.de/search/de/trial/DRKS00024898 .
PROTOCOL VERSION
V5 2023-04-24.
Topics: Humans; Single-Blind Method; REM Sleep Behavior Disorder; Healthy Lifestyle; Randomized Controlled Trials as Topic; Executive Function; Cognition; Time Factors; Polysomnography; Treatment Outcome; Cognitive Behavioral Therapy; Male; Germany; Middle Aged; Exercise; Female; Aged; Feasibility Studies; Cognitive Training
PubMed: 38943191
DOI: 10.1186/s13063-024-08265-9 -
Alzheimer's Research & Therapy Jun 2024The research criteria for subjective cognitive decline (SCD) exclude mild cognitive impairment (MCI), but do not stipulate the use of specific MCI criteria. This study...
BACKGROUND
The research criteria for subjective cognitive decline (SCD) exclude mild cognitive impairment (MCI), but do not stipulate the use of specific MCI criteria. This study compared different approaches to defining (i.e., excluding) MCI during the ascertainment of SCD, focusing on the impact on dementia incidence rates in SCD.
METHODS
This cohort study utilized routine healthcare data collected in the Essex Memory Clinic from 1999 to 2023. Two different operationalizations of the SCD criteria were used to categorize the cohort into two SCD patient samples. One sample was based on local clinical practice - MCI was excluded according to the Winblad criteria (this sample was termed SCD). The other sample was created via the retrospective application of the Jak/Bondi criteria for the exclusion of MCI (termed SCD). Only patients aged ≥ 55 years at baseline with ≥ 12 months follow-up were considered for inclusion. The initial clinical/demographic characteristics of the samples were compared. Rates of incident dementia were calculated for each sample, and unadjusted and Mantel-Haenszel-adjusted incidence rate ratios were calculated to compare dementia incidence between the SCD samples.
RESULTS
The Essex Memory Clinic database included 2,233 patients in total. The SCD and study eligibility criteria were used to select SCD (n = 86) and SCD (n = 185) samples from the database. Median follow-up (3 years) did not differ between the two samples. The SCD sample was significantly older than the SCD at first assessment (median age: 74 versus 70 years) and had poorer scores on tests of global cognition, immediate and delayed verbal recall, and category fluency. Following adjustment for age, the dementia incidence rate ratio [95% confidence interval] was 3.7 [1.5 to 9.3], indicating a significantly greater rate of progression to dementia in SCD.
CONCLUSIONS
This study highlights that the approach used to ascertain SCD has important implications for both SCD phenotypes and prognosis. This underscores the importance of how MCI is operationalized within SCD studies. More broadly, the findings add to a growing body of work indicating that objective cognition should not be overlooked in SCD, and offer a potential explanation for the heterogeneity across the SCD prognostic literature.
Topics: Humans; Cognitive Dysfunction; Female; Male; Aged; Incidence; Dementia; Middle Aged; Cohort Studies; Retrospective Studies; Neuropsychological Tests; Aged, 80 and over
PubMed: 38943160
DOI: 10.1186/s13195-024-01516-6 -
BMC Palliative Care Jun 2024People with dementia and their family caregivers often encounter challenges in engaging in advance care planning (ACP), such as a lack of information and difficulties in...
BACKGROUND
People with dementia and their family caregivers often encounter challenges in engaging in advance care planning (ACP), such as a lack of information and difficulties in engaging in ACP conversations. Using a user-centred design, we developed two interactive web-based tools as part of an ACP support website to stimulate ACP reflection and communication: (1) the 'Thinking Now About Later' tool, with open-ended questions about 'what matters most', and (2) a digital version of the 'Life Wishes Cards', a card tool with pre-formulated statements that prompt reflection about wishes for future care. This study aimed to evaluate the use of and experiences with two web-based tools by people with dementia and their family caregivers.
METHODS
During an eight-week period, people with dementia and family caregivers were invited to use the ACP support website in the way they preferred. The mixed-methods evaluation of the ACP tools involved capturing log data to assess website use and semi-structured qualitative interviews to capture experiences. Analyses included descriptive statistics of log data and framework analysis for qualitative data.
RESULTS
Of 52 participants, 21 people had dementia and 31 were family caregivers. The 'Thinking Now About Later' tool and 'Life Wishes Cards' were accessed 136 and 91 times respectively, with an average session duration of 14 minutes (SD = 27.45 minutes). 22 participants actively engaged with the tools, with the majority using the tools once, and seven revisiting them. Those who used the tools valued the guidance it provided for ACP conversations between people with dementia and their family caregivers. Participants reported that people with dementia experienced barriers to using the tools on their own, hence family caregivers usually facilitated the use and participation of people with dementia. Some highlighted not knowing what next steps to take after completing the tools online.
CONCLUSIONS
Although less than half the people used the ACP tools, those who used them found them helpful to facilitate communication between people with dementia and their family. Family caregivers of people with dementia played a crucial role in facilitating the use of the web-based tools.
Topics: Humans; Advance Care Planning; Dementia; Caregivers; Male; Female; Aged; Middle Aged; Internet; Aged, 80 and over; Communication; Qualitative Research; Adult
PubMed: 38943119
DOI: 10.1186/s12904-024-01486-4 -
BMC Geriatrics Jun 2024Critical wandering occurs when an individual living with dementia leaves a location and is unaware of place or time. Critical wandering incidents are expected to...
BACKGROUND
Critical wandering occurs when an individual living with dementia leaves a location and is unaware of place or time. Critical wandering incidents are expected to increase with the growing prevalence of persons living with dementia worldwide. We investigated the association between demographic, psychopathological, and environmental factors and a history of critical wandering among Medic-Alert subscribers, both with and without dementia.
METHODS
Our retrospective study included data of 25,785 Canadian Medic-Alert subscribers who were aged 40 years or older. We used multivariable logistic regression analysis to examine the associations between a history of critical wandering and dementia status as psychopathological independent variable, controlled by demographic (age, ethnic background, sex at birth, Canadian languages spoken) and environmental (living arrangement, population density) factors.
RESULTS
The overall study sample comprised of mainly older adults (77.4%). Medic-Alert subscribers who were older, male sex at birth, living with dementia, of a minority ethnic group and who did not have proficiency in an official Canadian language had a higher likelihood of a history of critical wandering. Residing in an urban environment, in an institution or with a family member, were environmental factors associated with a higher likelihood of a history of critical wandering.
CONCLUSIONS
People living with dementia experience a higher likelihood of a history of critical wandering compared to those without dementia. Medic-Alert and similar organizations can develop algorithms based on the associated factors that can be used to flag risks of critical wandering. This can inform preventative strategies at the individual and community levels.
Topics: Humans; Male; Female; Retrospective Studies; Aged; Dementia; Aged, 80 and over; Middle Aged; Wandering Behavior; Adult; Risk Factors; Canada
PubMed: 38943089
DOI: 10.1186/s12877-024-05162-3 -
Scientific Reports Jun 2024While there are currently over 40 replicated genes with mapped risk alleles for Late Onset Alzheimer's disease (LOAD), the Apolipoprotein E locus E4 haplotype is still...
While there are currently over 40 replicated genes with mapped risk alleles for Late Onset Alzheimer's disease (LOAD), the Apolipoprotein E locus E4 haplotype is still the biggest driver of risk, with odds ratios for neuropathologically confirmed E44 carriers exceeding 30 (95% confidence interval 16.59-58.75). We sought to address whether the APOE E4 haplotype modifies expression globally through networks of expression to increase LOAD risk. We have used the Human Brainome data to build expression networks comparing APOE E4 carriers to non-carriers using scalable mixed-datatypes Bayesian network (BN) modeling. We have found that VGF had the greatest explanatory weight. High expression of VGF is a protective signal, even on the background of APOE E4 alleles. LOAD risk signals, considering an APOE background, include high levels of SPECC1L, HLA-DRA and RANBP3L. Our findings nominate several new transcripts, taking a combined approach to network building including known LOAD risk loci.
Topics: Humans; Alzheimer Disease; Genetic Predisposition to Disease; Apolipoprotein E4; HLA-DR alpha-Chains; Female; Male; Aged; Adaptor Proteins, Signal Transducing; Alleles; Haplotypes; Bayes Theorem; Risk Factors; Nuclear Proteins; Aged, 80 and over
PubMed: 38942763
DOI: 10.1038/s41598-024-65010-7 -
Radiography (London, England : 1995) Jun 2024Alzheimer's disease (AD), the most common cause of dementia, presents a global health crisis with its prevalence expected to triple worldwide by 2050, emphasizing the...
INTRODUCTION
Alzheimer's disease (AD), the most common cause of dementia, presents a global health crisis with its prevalence expected to triple worldwide by 2050, emphasizing the urgent need for early diagnosis to delay progression and improve patient quality of life. Our project aims to detect AD in its early phase by identifying subtle neuroanatomical changes with Radiomics features, offering a more accurate diagnosis.
METHODS
The AssemblyNet segmentation model was used to analyze brain changes by employing anonymized T1 MRI scans from 416 patients. For each segmented label we extracted Radiomic features. After preprocessing of Radiomic features we trained four models, Gradient Booster, Random Forest, Support Vector Classifier, and XGBoost, in a 70%/20%/10% train, validation and test split. All models were hyperparameter tuned with GridSearch, Cross validation and evaluated with accuracy on the test data.
RESULTS
208 T1-weighted MRI scans were segmented, with 132 segmentation labels per patient, 1130 Radiomic features per segmentation, totalling in over 31 million features. For all four models we achieved accuracies between 0.71 and 0.86, and the machine learning model with highest accuracy were XGBoost, achieving an accuracy at 0.86 on the segmentation of the left inferior lateral ventricle.
CONCLUSION
Our study's use of segmentation on T1-weighted MRI scans resulted promising accuracies for early AD diagnosis with the machine learning model XGBoost, peaking at 0.86 accuracy. Future research should aim to expand datasets and refine methodologies for broader applicability.
IMPLICATION FOR PRACTICE
Implementing Radiomics for early AD detection using T1-weighted MRI scans could substantially improve diagnostic accuracy, enabling earlier interventions that may delay disease progression and improve outcomes, thereby requiring radiographers to adopt more advanced imaging techniques and analysis tools, as well as additional training to effectively interpret complex Radiomic data.
PubMed: 38942647
DOI: 10.1016/j.radi.2024.06.016 -
Aging Jun 2024Down Syndrome (DS) is a common genetic disorder characterized by an extra copy of chromosome 21, leading to dysregulation of various metabolic pathways. Oxidative stress...
Down Syndrome (DS) is a common genetic disorder characterized by an extra copy of chromosome 21, leading to dysregulation of various metabolic pathways. Oxidative stress in DS is associated with neurodevelopmental defects, neuronal dysfunction, and a dementia onset resembling Alzheimer's disease. Additionally, chronic oxidative stress contributes to cardiovascular diseases and certain cancers prevalent in DS individuals. This study investigates the impact of ageing on oxidative stress and liver fibrosis using a DS murine model (Ts2Cje mice). Our results show that DS mice show increased liver oxidative stress and impaired antioxidant defenses, as evidenced by reduced glutathione levels and increased lipid peroxidation. Therefore, DS liver exhibits an altered inflammatory response and mitochondrial fitness as we showed by assaying the expression of HMOX1, CLPP, and the heat shock proteins Hsp90 and Hsp60. DS liver also displays dysregulated lipid metabolism, indicated by altered expression of PPARα, PPARγ, FATP5, and CTP2. Consistently, these changes might contribute to non-alcoholic fatty liver disease development, a condition characterized by liver fat accumulation. Consistently, histological analysis of DS liver reveals increased fibrosis and steatosis, as showed by Col1a1 increased expression, indicative of potential progression to liver cirrhosis. Therefore, our findings suggest an increased risk of liver pathologies in DS individuals, particularly when combined with the higher prevalence of obesity and metabolic dysfunctions in DS patients. These results shed a light on the liver's role in DS-associated pathologies and suggest potential therapeutic strategies targeting oxidative stress and lipid metabolism to prevent or mitigate liver-related complications in DS individuals.
PubMed: 38942607
DOI: 10.18632/aging.205970