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Yang Y, Matuskey D, Benjamin CFA, Fesharaki-Zadeh A. Self-Inflicted Head Injury in Behavioral Variant Frontotemporal Dementia with Compulsive Behaviors: A Case Report. Cogn Behav Neurol 2025:00146965-990000000-00087. [PMID: 40298273 DOI: 10.1097/wnn.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/17/2024] [Indexed: 04/30/2025]
Abstract
Here we present the case of a 56-year-old right-handed White male who developed osteomyelitis and empyema after repetitive compulsive excoriation rituals. His recent history included profound personality changes, apathy, loss of empathy, limited insight, behavioral agitation, and episodic memory loss. In addition to these progressive behavioral deficits, he had significant difficulties with executive functioning, leading to the loss of his job and inability to independently perform instrumental activities of daily living. Brain MRI showed asymmetric enlargement of the right lateral ventricle and mild asymmetric parenchymal volume loss in the right hippocampus. 18F-FDG PET imaging revealed severe hypometabolism in the right hemisphere. Based on this individual's clinical presentation, reported history, and neuroimaging findings, we concluded that his condition was most consistent with a diagnosis of behavioral variant frontotemporal dementia (bvFTD), rather than another psychiatric diagnosis. This case illustrates the importance of differentiating between bvFTD and other psychiatric disorders, as well as the need for further studies to improve clinicians' ability to do so at earlier stages.
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Affiliation(s)
| | - David Matuskey
- Departments of Radiology and Biomedical Imaging
- Neurology
- Psychiatry
| | - Christopher F A Benjamin
- Departments of Radiology and Biomedical Imaging
- Neurology
- Neurosurgery and Psychology, Yale University, New Haven, Connecticut
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2
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Liu Z, Hu B, Tang J, Liu X, Cheng B, Jia C, Zhang L. Frontiers and hotspots evolution between air pollution and Alzheimer's disease: A bibliometric analysis from 2013 to 2023. J Alzheimers Dis 2024; 102:257-274. [PMID: 39573870 DOI: 10.1177/13872877241289381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024]
Abstract
In recent years, the study of air pollution has received increasing attention from researchers, but a summary of Alzheimer's disease (AD) and air pollution is missed. Through combing the documents in the core dataset of Web of Science, this study analyzes current research based on specific keywords. CiteSpace and VOSviewer perform statistical analysis of measurement metrics to visualize a network of relevant content elements. The research devotes discussion to the relationship between air pollution and AD. Keyword hotspots include AD, children, oxidative stress, and system inflammation. Overall, 304 documents on air pollution and AD from 2013 to 2023 were retrieved from Web of Science. One hundred twenty-two journals published relevant articles, and the number of articles has increased gradually since the past decade. Research and development in AD and air pollution are progressing rapidly, but there is still a need for more connections with multidisciplinary technologies to explore cutting-edge hotspots.
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Affiliation(s)
- Zhirong Liu
- Department of General Surgery, The Affiliated Hospital of Chengdu Medical College, Chengdu Second People's Hospital, Chengdu, China
| | - BingShuang Hu
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Ju Tang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - XinLian Liu
- Development and Regeneration Key Laboratory of Sichuan Province, Institute of Neuroscience, Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - BaoJing Cheng
- President Office, Chengdu Medical College, Chengdu, China
| | - Cui Jia
- Development and Regeneration Key Laboratory of Sichuan Province, Institute of Neuroscience, Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - LuShun Zhang
- Development and Regeneration Key Laboratory of Sichuan Province, Institute of Neuroscience, Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
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Vázquez-Durán DL, Ortega A, Rodríguez A. Amino Acid Transporters Proteins Involved in the Glutamate-Glutamine Cycle and Their Alterations in Murine Models of Alzheimer's Disease. Mol Neurobiol 2024; 61:6077-6088. [PMID: 38273046 DOI: 10.1007/s12035-024-03966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
The brain's ability to integrate external stimuli and generate responses is highly complex. While these mechanisms are not completely understood, current evidence suggests that alterations in cellular metabolism and microenvironment are involved in some dysfunctions as complex as Alzheimer's disease. This pathology courses with defects in the establishment of chemical synapses, which is dependent on the production and supply of neurotransmitters like glutamate and its recycling through the glutamate-glutamine cycle. Alterations in the expression and function of the amino acid transporters proteins involved in this cycle have recently been reported in different stages of Alzheimer's disease. Most of these data come from patients in advanced stages of the disease or post-mortem, due to the ethical and technical limitations of human studies. Therefore, genetically modified mouse models have been an excellent tool to analyze metabolic and even behavioral parameters that are very similar to those that develop in Alzheimer's disease, even at presymptomatic stages. Hence, this paper analyzes the role of glutamate metabolism and its intercellular trafficking in excitatory synapses from different approaches using transgenic mouse models; such an analysis will contribute to our present understanding of AD.
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Affiliation(s)
| | - Arturo Ortega
- Departamento de Toxicología, Cinvestav- IPN, Mexico City, México
| | - Angelina Rodríguez
- Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Santiago de Querétaro, México.
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Hillari L, Frank P, Cadar D. Systemic inflammation, lifestyle behaviours and dementia: A 10-year follow-up investigation. Brain Behav Immun Health 2024; 38:100776. [PMID: 38706574 PMCID: PMC11068506 DOI: 10.1016/j.bbih.2024.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/17/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives Lifestyle behaviours have been linked to dementia incidence, but their cumulative impact on dementia and the underlying mechanisms remain poorly understood. This study investigated the association of co-occurring lifestyle behaviours with dementia incidence and the mediating role of systemic inflammation in this association. Methods The sample comprised 3131 participants (55.2% female) from the English Longitudinal Study of Ageing aged 52-92 years at baseline (2008/09). Self-reported baseline lifestyle behaviours (alcohol intake, fruit and vegetable consumption, smoking, physical activity, sleep duration, social engagement, and cognitive activity) were summed to derive an index of lifestyle behaviours, ranging from 0 to 7, with higher scores denoting a higher number of health-risk behaviours. Incident dementia cases (n = 130, 4.2%) were identified through doctor-diagnosed dementia, informant interviews, and health records between 2014/15 and 2018/19. Systemic inflammation was measured through fasting plasma concentrations of C-reactive protein in 2012/13. Results Binary logistic regression models indicated that the odds of subsequent dementia increased by 1.19 for each additional health-risk behaviour (95% confidence intervals: 1.04, 1.37, p = 0.014) after adjusting for age, sex, ethnicity, wealth, education, marital status, body mass index, coronary heart disease, hypertension, stroke, and depression. However, this association was not mediated by C-reactive protein. Conclusions Co-occurring health-risk behaviours were associated with higher dementia incidence up to 10 years later, underscoring the importance of modifying health-risk behaviours for the prevention of dementia. Systemic inflammation did not explain the association between behaviours and dementia.
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Affiliation(s)
- Leah Hillari
- Behavioural Science and Health, University College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Philipp Frank
- Behavioural Science and Health, University College London, London, UK
- UCL Brain Sciences, University College London, London, UK
| | - Dorina Cadar
- Behavioural Science and Health, University College London, London, UK
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
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Alzola P, Carnero C, Bermejo-Pareja F, Sánchez-Benavides G, Peña-Casanova J, Puertas-Martín V, Fernández-Calvo B, Contador I. Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights. J Clin Med 2024; 13:3442. [PMID: 38929971 PMCID: PMC11204334 DOI: 10.3390/jcm13123442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.
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Affiliation(s)
- Patricia Alzola
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
| | - Cristóbal Carnero
- Neurology Department, Granada University Hospital Complex, 18014 Granada, Spain
| | - Félix Bermejo-Pareja
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | | | | | | | | | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
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Lu Q, Lv H, Liu X, Zang L, Zhang Y, Meng Q. Lithium Therapy's Potential to Lower Dementia Risk and the Prevalence of Alzheimer's Disease: A Meta-Analysis. Eur Neurol 2024; 87:93-104. [PMID: 38657568 DOI: 10.1159/000538846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Dementia is a neurodegenerative disease with insidious onset and progressive progression, of which the most common type is Alzheimer's disease (AD). Lithium, a trace element in the body, has neuroprotective properties. However, whether lithium can treat dementia or AD remains a highly controversial topic. Therefore, we conducted a meta-analysis. METHODS A systematic literature review was conducted on PubMed, Embase, and Web of Science. Comparison of the effects of lithium on AD or dementia in terms of use, duration, and dosage, and meta-analysis to test whether lithium therapy is beneficial in ameliorating the onset of dementia or AD. Sensitivity analyses were performed using a stepwise exclusion method. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of included studies. We determined the relative risk (RR) between patient groups using a random-effects model. RESULTS A total of seven studies were included. The forest plot results showed that taking lithium therapy reduced the risk of AD (RR 0.59, 95% confidence interval [CI]: 0.44-0.78) and is also protective in reducing the risk of dementia (RR 0.66, 95% CI: 0.56-0.77). The duration of lithium therapy was able to affect dementia incidence (RR 0.70, 95% CI: 0.55-0.88); however, it is unclear how this effect might manifest in AD. It is also uncertain how many prescriptions for lithium treatment lower the chance of dementia development. CONCLUSION The duration of treatment and the usage of lithium therapy seem to lower the risk of AD and postpone the onset of dementia.
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Affiliation(s)
- Qiuying Lu
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Huijing Lv
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Xiaotong Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Lili Zang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yue Zhang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Qinghui Meng
- School of Nursing, Shandong Second Medical University, Weifang, China
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Miao X, Wu Q, Du S, Xiang L, Zhou S, Zhu J, Chen Z, Wang H, Pan X, Fan Y, Zhang L, Qian J, Xing Y, Xie Y, Hu L, Xu H, Wang W, Wang Y, Huang Z. SARM1 Promotes Neurodegeneration and Memory Impairment in Mouse Models of Alzheimer's Disease. Aging Dis 2024; 15:390-407. [PMID: 37307837 PMCID: PMC10796105 DOI: 10.14336/ad.2023.0516-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023] Open
Abstract
Neuroinflammation plays a crucial role in the pathogenesis and progression of Alzheimer's disease (AD). The Sterile Alpha and Toll Interleukin Receptor Motif-containing protein 1 (SARM1) has been shown to promote axonal degeneration and is involved in neuroinflammation. However, the role of SARM1 in AD remains unclear. In this study, we found that SARM1 was reduced in hippocampal neurons of AD model mice. Interestingly, conditional knockout (CKO) of SARM1 in the central nervous system (CNS, SARM1Nestin-CKO mice) delayed the cognitive decline in APP/PS1 AD model mice. Furthermore, SARM1 deletion reduced the Aβ deposition and inflammatory infiltration in the hippocampus and inhibited neurodegeneration in APP/PS1 AD model mice. Further investigation into the underlying mechanisms revealed that the signaling of tumor necrosis factor-α (TNF-α) was downregulated in the hippocampus tissues of APP/PS1;SARM1Nestin-CKO mice, thereby alleviating the cognitive decline, Aβ deposition and inflammatory infiltration. These findings identify unrecognized functions of SARM1 in promoting AD and reveal the SARM1-TNF-α pathway in AD model mice.
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Affiliation(s)
- Xuemeng Miao
- College of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China.
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Qian Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Siyu Du
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Ludan Xiang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Siyao Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Junzhe Zhu
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Zirun Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Hui Wang
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Xuyi Pan
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Yiren Fan
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Lihan Zhang
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Jingkang Qian
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Yuxuan Xing
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Yiyang Xie
- School of the First Clinical Medical Sciences, School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325205, China.
| | - Lixin Hu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Haiyun Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Wei Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Ying Wang
- Clinical Research Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.
| | - Zhihui Huang
- College of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China.
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
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Conde R, Oliveira N, Morais E, Amaral AP, Sousa A, Graça G, Verde I. NMR analysis seeking for cognitive decline and dementia metabolic markers in plasma from aged individuals. J Pharm Biomed Anal 2024; 238:115815. [PMID: 37952448 DOI: 10.1016/j.jpba.2023.115815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Blood biomarkers can improve the ability to diagnose dementia, providing new information to better understand the pathophysiology and causes of the disease. Some studies with patients have already shown changes in metabolic profiles among patients with pathological cognitive decline or Alzheimer's disease, when compared to individuals with normal cognition. METHODS To search for new metabolic biomarkers of dementia, we analyzed serum levels of several metabolites, measured by nuclear magnetic resonance spectroscopy, in elderly individuals, a group with normal cognitive decline (control), and three other groups with cognitive decline. pathological (low, moderate, and severe). RESULTS Decreased plasma levels of tyrosine, glutamate, valine, leucine, and isoleucine are associated with worsening of pathological cognitive decline. However, the area under analysis of receptor operating characteristics suggests that tyrosine and glutamate have low specificity and sensitivity. Valine, leucine, and isoleucine are influenced by blood glucose or diabetes, but these conditions do not seem to be of great influence in the differences observed. Isobutyrate, histidine, acetone and unknown-1 metabolite also decrease their plasma levels with increasing CD. Isobutyrate ad histidine could have neuroprotective and antioxidant actions, respectively. To elucidate the role of decreased unknown metabolite-1 as a CD biomarker, it will be necessary to previously investigate its identity. To define and elucidate the role of acetone in pathological CD, additional laboratory and clinical studies must be performed. All these metabolites together may constitute a set of biomarkers with capability to identify pathological CD or dementia. SIGNIFICANCE AND NOVELTY Decrease of glutamate, tyrosine, valine, leucine, isoleucine, histidine, isobutyrate, acetone and unknown-1 metabolite together are a set of biomarkers able to identify pathological CD or dementia. Histidine, isobutyrate, acetone and unknown-1 metabolite are more specific biomarkers of CD.
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Affiliation(s)
- Ricardo Conde
- Health Sciences Research Centre (CICS-UBI), University of Beira Interior (UBI), Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Nádia Oliveira
- Health Sciences Research Centre (CICS-UBI), University of Beira Interior (UBI), Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Elisabete Morais
- Health Sciences Research Centre (CICS-UBI), University of Beira Interior (UBI), Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Ana Paula Amaral
- Health Sciences Research Centre (CICS-UBI), University of Beira Interior (UBI), Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Adriana Sousa
- Health Sciences Research Centre (CICS-UBI), University of Beira Interior (UBI), Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Gonçalo Graça
- Section of Bioinformatics, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London SW7 2AZ, UK
| | - Ignacio Verde
- Health Sciences Research Centre (CICS-UBI), University of Beira Interior (UBI), Av. Infante D. Henrique, 6200-506 Covilhã, Portugal.
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Petrova NN. [Comorbidity of depression and dementia: epidemiological, biological and therapeutic aspects]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:113-121. [PMID: 39690558 DOI: 10.17116/jnevro2024124111113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
The literature review is devoted to the problem of the relationship between dementia and depression, the role of depression as a risk factor for dementia and the place of depression in the structure of neurocognitive disorders in dementia. Epidemiological data are presented and the mechanisms of interrelation of disorders are considered. The search for sources included only qualitative research, meta-analyses, full-text articles and was conducted in the PubMed, Google system using the keywords «dementia, depression». The presented epidemiological and biological data indicate that depression increases the risk of dementia, confirming the hypothesis of a causal factor. The main directions of research on the relationship between depression and dementia in the context of Alzheimer's disease prevention are given.
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Affiliation(s)
- N N Petrova
- Saint Petersburg State University, St. Petersburg, Russia
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10
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Gómez-Guijarro MD, Álvarez-Bueno C, Saz-Lara A, Sequí-Domínguez I, Lucerón-Lucas-Torres M, Cavero-Redondo I. Association between severe hypoglycaemia and risk of dementia in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Res Rev 2023; 39:e3610. [PMID: 36649373 DOI: 10.1002/dmrr.3610] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 10/04/2022] [Accepted: 11/22/2022] [Indexed: 01/19/2023]
Abstract
The aim of this systematic review was to analyse whether there is an association between severe hypoglycaemia and the incidence of dementia in patients with type 2 diabetes mellitus. We systematically searched the MEDLINE, Scopus, and Cochrane databases from their inception until September 2022 for observational studies on the association between hypoglycaemia and the risk of dementia. The DerSimonian and Laird method was used to compute a pooled estimate of the risk for such association. Risk ratio (RR) and its respective 95% confidence interval (95% CI). Two analyses were performed to estimate the risk of dementia: (i) any hypoglycaemia versus no hypoglycaemia and (ii) a dose-response analysis for one, two, or more than three hypoglycemic events versus no hypoglycaemia. PROSPERO registration number CRD42020219200. Seven studies were included. The pooled RR for the association of severe hypoglycaemia and risk of dementia was 1.47 (95% CI: 1.24-1.74). When the dose-response trend was analysed, the pooled RR for the risk of dementia was increased according to the hypoglycaemia events as follows: 1.29 (95% CI: 1.15-1.44) for one hypoglycemic event; 1.68 (95% CI: 1.38-2.04) for two hypoglycemic events; and 1.99 (95% CI: 1.48-2.68) for three or more hypoglycemic events. Our study demonstrates a 54% higher risk of dementia among people who suffer a hypoglycaemia event compared to nonhypoglycaemia. Considering our results and the prevalence of people suffering from diabetes mellitus, health education for both newly diagnosed and already diagnosed people could be a useful tool for glycaemic control, thus avoiding hypoglycaemic events.
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Affiliation(s)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
- Universidad Politécnica y artística del Paraguay, Asunción, Paraguay
| | - Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
| | - Irene Sequí-Domínguez
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
| | | | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla - La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Jónsdóttir MK, Pálsdóttir EB, Hannesdóttir SÝ, Karlsson T. Lay Knowledge About Dementia in Iceland: Symptoms and Risk and Protective Factors. Gerontol Geriatr Med 2022; 8:23337214221142937. [PMID: 36568486 PMCID: PMC9780762 DOI: 10.1177/23337214221142937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
No studies are available on the lay knowledge about dementia in Nordic countries. A survey was sent to 829 Icelanders aged 25 to 65 (61.2% female). 60.8% resided in the capital area of Reykjavik. About 90% or more recognized eight of eleven dementia symptoms, with females recognizing them proportionally more often than males. About 50% believed that an individual's risk of developing dementia could be modified. For individual risk factors, agreement ranged from 4% (hearing loss) to 75.1% (history of brain injury). Knowledge about cardiovascular risk factors ranged from 24.8% (obese) to 43.6% (high blood pressure). Participants acknowledged the importance of a healthy diet and an active lifestyle, but only 8% identified a low education level as a risk factor. Public health campaigns and educational efforts about dementia should focus on the whole lifespan targeting all risk and protective factors operating throughout the lifespan.
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Affiliation(s)
- María K. Jónsdóttir
- Reykjavík University, Iceland,Landspitali—The National University Hospital of Iceland (Memory Clinic), Reykjavík, Iceland,María K. Jónsdóttir, Department of Psychology, Reykjavík University, Menntavegur 1, 102 Reykjavík, Iceland.
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Bellomo G, Piscopo P, Corbo M, Pupillo E, Stipa G, Beghi E, Vanacore N, Lacorte E. A systematic review on the risk of neurodegenerative diseases and neurocognitive disorders in professional and varsity athletes. Neurol Sci 2022; 43:6667-6691. [PMID: 35976476 PMCID: PMC9663371 DOI: 10.1007/s10072-022-06319-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/01/2022] [Indexed: 01/01/2023]
Abstract
Abstract
Objective
The aim of this systematic review (SR) was to gather all available epidemiological evidence on former participation in any type of sport, at a professional and varsity level, as a potential risk factor for neurodegenerative diseases (NDs) and neurocognitive disorders (NCDs).
Design
Systematic searches were performed on PubMed, the Cochrane databases, and the ISI Web of Knowledge databases. Included studies were assessed using the NOS checklist.
Eligibility criteria for selecting studies
All epidemiological studies reporting data on the possible association between a clinical diagnosis of amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND), dementia or mild cognitive impairment (MCI), Parkinson’s disease (PD), chronic traumatic encephalopathy (CTE) at any stage and with any clinical pattern and the former participation in any types of sport at a varsity and professional level were included.
Results
Data from the 17 included studies showed a higher frequency of NDs and NCDs in former soccer and American football players. Updating the previous SR confirmed a higher frequency of ALS/MND in former soccer players. Data reported a significantly higher risk of dementia/AD in former soccer players, and of MCI in former American football players. Results also showed a significantly higher risk of PD in former soccer and American football players, and a significantly higher risk of CTE in former boxers and American football players.
Summary/conclusions
This SR confirmed a higher risk of NDs and NCDs in former professional/varsity athletes. However, the pathological mechanisms underlying this association remain unclear, and further high-quality studies should be performed to clarify whether the association could be sport specific.
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Affiliation(s)
- G Bellomo
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | - P Piscopo
- Department of Neurosciences, Italian National Institute of Health, Rome, Italy
| | - M Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
| | - E Pupillo
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Stipa
- Clinical Neurophysiology Division, Neuroscience Department, S. Maria University Hospital, Terni, Italy
| | - E Beghi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - N Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - E Lacorte
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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13
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Liu Z, Wei S, Chen X, Liu L, Wei Z, Liao Z, Wu J, Li Z, Zhou H, Wang D. The Effect of Long-Term or Repeated Use of Antibiotics in Children and Adolescents on Cognitive Impairment in Middle-Aged and Older Person(s) Adults: A Cohort Study. Front Aging Neurosci 2022; 14:833365. [PMID: 35401157 PMCID: PMC8984107 DOI: 10.3389/fnagi.2022.833365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives We evaluated the effects of long-term/recurrent use of antibiotics in childhood on developing cognitive impairment in middle and old age from UK Biobank Database. Methods UK Biobank recruited participants aged 37-73 years. Cognitive impairment was ascertained by fluid intelligence questionnaire. Primary outcome was the occurrence of cognitive impairment in middle and old age. Multivariate logistic regression models were used to explore the relationship between long-term/recurrent use of antibiotics and cognitive impairment. Results Over 3.8-10.8 years' follow-up, 4,781 of the 35,921 participants developed cognitive impairment. The odds of cognitive impairment in middle and old age among long-term/recurrent use of antibiotics in childhood were increased by 18% compared with their counterparts (adjusted odd ratio 1.18, 95% confidence interval 1.08-1.29, p < 0.01). The effect of long-term/recurrent use of antibiotics in childhood on cognitive impairment was homogeneous across different categories of various subgroup variables such as sex, age, APOE4, ethnic groups, income before tax, smoking status, alcohol status, BMI, hypertension and diabetes but the effect of long-term/recurrent use of antibiotics in childhood was modified by the educational qualification (p-value for interaction <0.05). Conclusion Long-term/recurrent use of antibiotics in childhood may increase the risk of cognitive impairment in middle and old age.
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Affiliation(s)
- Zhou Liu
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Department of Neurology, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Shouchao Wei
- Department of Neurology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
| | - Xiaoxia Chen
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Department of Neurology, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lingying Liu
- Department of Neurology, Chenzhou No. 1 People’s Hospital, Chenzhou, China
| | - Zhuangsheng Wei
- Department of Neurology, Huizhou Municipal Central Hospital, Huizhou, China
| | - Zhimin Liao
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Department of Neurology, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiayuan Wu
- Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhichao Li
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Department of Neurology, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haihong Zhou
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Department of Neurology, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Duolao Wang
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Department of Neurology, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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14
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Tudor A, Vasile AI, Trifu SC, Cristea MB. Morphological classification and changes in dementia (Review). Exp Ther Med 2022; 23:33. [PMID: 34824641 PMCID: PMC8611489 DOI: 10.3892/etm.2021.10955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/06/2022] Open
Abstract
The progressive functional decline that involves both cognitive and neuropsychiatric symptoms characteristic to dementia is one of the leading research topics. The risk for dementia is an intertwined mix between aging, genetic risk factors, and environmental influences. APOEε4, which is one of the apolipoprotein E (APOE) alleles, is the major genetic risk factor for late-onset of the most common form of dementia, Alzheimer's. Advances in machine learning have led to the development of artificial intelligence (AI) algorithms to help diagnose dementia by magnetic resonance imaging (MRI) in order to detect it in the preclinical stage. The basis of the determinations starts from the morphometry of cerebral atrophies. The present review focused on MRI techniques which are a leading tool in identifying cortical atrophy, white matter dysfunctionalities, cerebral vessel quality (as a factor for cognitive impairment) and metabolic asymmetries. In addition, a brief overview of Alzheimer's disease was presented and recent neuroimaging in the field of dementia with an emphasis on structural MR imaging and more powerful methods such as diffusion tensor imaging, quantitative susceptibility mapping, and magnetic transfer imaging were explored in order to propose a simple systematic approach for the diagnosis and treatment of dementia.
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Affiliation(s)
- Alexandra Tudor
- Department of Psychiatry, ‘Prof. Dr. Alex. Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Antonia Ioana Vasile
- Department of General Medicine, Medical Military Institute, 010919 Bucharest, Romania
| | - Simona Corina Trifu
- Department of Clinical Neurosciences, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihai Bogdan Cristea
- Department of Morphological Sciences, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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15
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Guo L, Xu J, Du Y, Wu W, Nie W, Zhang D, Luo Y, Lu H, Lei M, Xiao S, Liu J. Effects of gut microbiota and probiotics on Alzheimer’s disease. Transl Neurosci 2021; 12:573-580. [PMID: 35070441 PMCID: PMC8713066 DOI: 10.1515/tnsci-2020-0203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022] Open
Abstract
Alzheimer’s disease (AD) is a progressive neurodegenerative disease with high morbidity, disability, and fatality rate, significantly increasing the global burden of public health. The failure in drug discovery over the past decades has stressed the urgency and importance of seeking new perspectives. Recently, gut microbiome (GM), with the ability to communicate with the brain bidirectionally through the microbiome–gut–brain axis, has attracted much attention in AD-related studies, owing to their strong associations with amyloids, systematic and focal inflammation, impairment of vascular homeostasis and gut barrier, mitochondrial dysfunction, etc., making the regulation of GM, specifically supplementation of probiotics a promising candidate for AD treatment. This article aims to review the leading-edge knowledge concerning potential roles of GM in AD pathogenesis and of probiotics in its treatment and prevention.
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Affiliation(s)
- Libing Guo
- Department of Neurology, Foshan Third People’s Hospital , No. 102 Jinlan South Road , Foshan , Guangdong , China
| | - Jiaxin Xu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , No. 107 Yanjiang West Road, Guangzhou , Guangdong , China
| | - Yunhua Du
- Department of Neurology, Foshan Third People’s Hospital , No. 102 Jinlan South Road , Foshan , Guangdong , China
| | - Weibo Wu
- Department of Neurology, Foshan Third People’s Hospital , No. 102 Jinlan South Road , Foshan , Guangdong , China
| | - Wenjing Nie
- Department of Neurology, Foshan Third People’s Hospital , No. 102 Jinlan South Road , Foshan , Guangdong , China
| | - Dongliang Zhang
- Department of Neurology, Foshan Third People’s Hospital , No. 102 Jinlan South Road , Foshan , Guangdong , China
| | - Yuling Luo
- Department of Neurology, Foshan Third People’s Hospital , No. 102 Jinlan South Road , Foshan , Guangdong , China
| | - Huixian Lu
- Department of Neurology, Foshan Third People’s Hospital , No. 102 Jinlan South Road , Foshan , Guangdong , China
| | - Ming Lei
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , No. 107 Yanjiang West Road, Guangzhou , Guangdong , China
| | - Songhua Xiao
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , No. 107 Yanjiang West Road, Guangzhou , Guangdong , China
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University , Guangzhou , China
| | - Jun Liu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , No. 107 Yanjiang West Road, Guangzhou , Guangdong , China
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University , Guangzhou , China
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16
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Baldi S, Mundula T, Nannini G, Amedei A. Microbiota shaping - the effects of probiotics, prebiotics, and fecal microbiota transplant on cognitive functions: A systematic review. World J Gastroenterol 2021; 27:6715-6732. [PMID: 34754163 PMCID: PMC8554405 DOI: 10.3748/wjg.v27.i39.6715] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dementia is a chronic progressive neurological disease affecting millions of people worldwide, and represents a relevant economic burden for healthcare systems. Although its pathogenesis is still unknown, recent findings have reported that a dysregulated gut-brain axis communication, a fundamental relationship mediated by several host and microbial molecules, is associated with cognitive disorders. In addition, gut microbiota manipulation reduces neuroinflammation, improving cognitive function by restoring the functional gut-brain axis. AIM To better define the effects of probiotics, prebiotics, synbiotics, and fecal microbiota transplant (FMT) on cognitive function. METHODS We performed a literature search of human randomized clinical trials to examine the effects of the administration of probiotics, prebiotics, synbiotics, or FMT on cognition outcomes in healthy or sick people of every age, sex, and nationality. We systematically searched Embase, Medline/PubMed, Cochrane Library, central and clinicaltrials.gov databases with a combination of comprehensive terms related to cognition and gut microbiota manipulation. Then we carefully reviewed and synthesized the data by type of study design and setting, characteristics of the studied population, kind of intervention (strain type or mixture type, dosage, and frequency of administration), control treatment, inclusion and exclusion criteria, follow-up duration, and cognitive or memory outcomes. RESULTS After examining the titles and abstracts, the initial literature screening identified 995 articles, but we added 23 papers in our systematic review. The analyses of these selected studies highlighted that both probiotic supplementation and FMT improved cognitive function regardless of the type and posology of administration and the adopted cognitive tests and questionnaires. We found that most of the studies conducted in healthy people showed a significant positive effect of the intervention on at least one of the performed cognitive tests. Regarding unhealthy subjects, while FMT and especially probiotic administration had multiple beneficial effects on different cognitive functions, supplementation with prebiotics did not provide any cognitive improvement. CONCLUSION Probiotic supplementation and FMT may represent a promising strategy to restore gut eubiosis and enhance the cognitive functions of healthy people and patients with neurological disorders.
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Affiliation(s)
- Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Tiziana Mundula
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
- SOD of Interdisciplinary Internal Medicine, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
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17
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Schepici G, Contestabile V, Valeri A, Mazzon E. Ginger, a Possible Candidate for the Treatment of Dementias? Molecules 2021; 26:5700. [PMID: 34577171 PMCID: PMC8470323 DOI: 10.3390/molecules26185700] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 12/17/2022] Open
Abstract
As the human life expectancy increases, age-linked diseases have become more and more frequent. The worldwide increment of dementia cases demands medical solutions, but the current available drugs do not meet all the expectations. Recently the attention of the scientific community was attracted by natural compounds, used in ancient medicine, known for their beneficial effects and high tolerability. This review is focused on Ginger (Zingiber officinale) and explore its properties against Alzheimer's Disease and Vascular Dementia, two of the most common and devastating forms of dementia. This work resumes the beneficial effects of Ginger compounds, tested in computational in vitro and in vivo models of Alzheimer's Disease and Vascular Dementia, along with some human tests. All these evidences suggest a potential role of the compounds of ginger not only in the treatment of the disease, but also in its prevention.
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Affiliation(s)
| | | | | | - Emanuela Mazzon
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (G.S.); (V.C.); (A.V.)
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18
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Karnatz T, Monsees J, Wucherer D, Michalowsky B, Zwingmann I, Halek M, Hoffmann W, René Thyrian J. Burden of caregivers of patients with frontotemporal lobar degeneration - a scoping review. Int Psychogeriatr 2021; 33:891-911. [PMID: 30982478 DOI: 10.1017/s1041610219000176] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is the second-most common cause of young-onset dementia. Personality and behavior changes lead to high caregiver stress and burden, but little support is available. Our aim is to present the evidence on the characteristics, challenges and unmet needs of caregivers as well as on possible interventions. METHODS We conducted a scoping review on caregiver burden using PubMed, Web of Science and ScienceDirect. A total of 69 articles were considered eligible and were analyzed in the present study. RESULTS Through the analysis of 69 empirical articles, our results show that caregivers of patients with FTLD are often younger in age, have children and find behavioral disturbances to be the most burdensome. Nine studies assessed the needs of and support for caregivers. Ten studies compared the burden in different forms of FTLD, 19 compared FTLD to other types of dementia, and one compared the caregiver burden between two countries. Eight studies reported on interventions for caregivers or interventions taking burden into account. One study assessed the support structure for caregivers of FTLD patients. Five case reports, eight research overviews and three reviews addressed specific needs and challenges. CONCLUSIONS Further research should reproduce and validate efficacious interventions and focus on underage children of FTLD patients and findings from non-Western countries. Additionally, support structures for FTLD caregivers should be assessed and extended. Awareness both in the wider population and among healthcare professionals is an urgent need for the future.
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Affiliation(s)
- Tina Karnatz
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
- Department for Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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19
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Stefanac S, Grabovac I, Andrews MR, Oppenauer C, Ramos R, Reichardt B, Stögmann E, Stamm T. Utilization of occupational therapy services and relation to survival in people taking dementia-specific medication in Austria-A retrospective population-based study with a 13-year observation period. Int J Geriatr Psychiatry 2021; 36:1179-1187. [PMID: 33565100 PMCID: PMC8359268 DOI: 10.1002/gps.5506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Evidence-based treatment of dementia includes pharmacological and non-pharmacological methods of which psycho-social interventions are an important component, commonly administered by occupational therapists. The aim of this study was to investigate the utilization of occupational therapy (OT) services and its association with survival in people taking dementia-specific medication in a population-based Austrian dataset compared to a two times as large control group without dementia-specific medication. METHODS/DESIGN A retrospective study with a 13-year observation period (2003-2016) was conducted on real-world data. Two stratifications were done and we used descriptive statistics, Chi-squared/Fisher's Exact Tests and survival analyses including three Cox models. RESULTS Data from 286,553 participants were analysed. Only 4.5% (n = 12,950) received OT services. In the dementia-medication group (n = 111,033), participants who received OT services (3.6%; n = 4032) had significantly more comorbidities (4.7%) compared to those without OT (3.5%; p < 0.001) and were also more likely to be male (4 vs. 3.5%; p < 0.001). While persons taking dementia-specific medication showed a slightly reduced survival with OT (p < 0.001) compared to those without, the result in the control group without dementia-specific medication showed a slightly better result of the participants who received OT (p < 0.001). The reduced survival in the dementia-medication group with OT is likely to be related to the higher number of comorbidities in this group. CONCLUSION People receiving dementia-specific medication were more likely to receive OT if they had additional comorbidities, however our analysis showed that utilization of OT services in Austria was very low indicating an overall insufficient accessibility of OT services for patients who needed it.
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Affiliation(s)
- Sinisa Stefanac
- Ludwig Boltzmann Institute for Arthritis and RehabilitationViennaAustria,Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Igor Grabovac
- Department of Social and Preventive MedicineCentre for Public HealthMedical University of ViennaViennaAustria
| | - Margaret R. Andrews
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Claudia Oppenauer
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Romualdo Ramos
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | | | | | - Tanja Stamm
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
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20
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Liu TT, Pang SJ, Jia SS, Man QQ, Li YQ, Song S, Zhang J. Association of Plasma Phospholipids with Age-Related Cognitive Impairment: Results from a Cross-Sectional Study. Nutrients 2021; 13:2185. [PMID: 34201969 PMCID: PMC8308406 DOI: 10.3390/nu13072185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 01/14/2023] Open
Abstract
Decreased concentration of phospholipids were observed in brain tissue from individuals with dementia compared with controls, indicating phospholipids might be a key variable in development of age-related cognitive impairment. The reflection of these phospholipid changes in blood might provide both reference for diagnosis/monitoring and potential targets for intervention through peripheral circulation. Using a full-scale targeted phospholipidomic approach, 229 molecular species of plasma phospholipid were identified and quantified among 626 senile residents; the association of plasma phospholipids with MoCA score was also comprehensively discussed. Significant association was confirmed between phospholipid matrix and MoCA score by a distance-based linear model. Additionally, the network analysis further observed that two modules containing PEs were positively associated with MoCA score, and one module containing LPLs had a trend of negative correlation with MoCA score. Furthermore, 23 phospholipid molecular species were found to be significantly associated with MoCA score independent of fasting glucose, lipidemia, lipoproteins, inflammatory variables and homocysteine. Thus, the decreased levels of pPEs containing LC-PUFA and the augmented levels of LPLs were the most prominent plasma phospholipid changes correlated with the cognitive decline, while alterations in plasma PC, PS and SM levels accompanying cognitive decline might be due to variation of lipidemia and inflammatory levels.
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Affiliation(s)
- Ting-Ting Liu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing 100050, China; (T.-T.L.); (S.-S.J.); (Q.-Q.M.); (Y.-Q.L.); (J.Z.)
| | - Shao-Jie Pang
- Institute of Grain Quality and Nutrition Research, Academy of National Food and Strategic Reserves Administration, Beijing 100037, China;
| | - Shan-Shan Jia
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing 100050, China; (T.-T.L.); (S.-S.J.); (Q.-Q.M.); (Y.-Q.L.); (J.Z.)
| | - Qing-Qing Man
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing 100050, China; (T.-T.L.); (S.-S.J.); (Q.-Q.M.); (Y.-Q.L.); (J.Z.)
| | - Yu-Qian Li
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing 100050, China; (T.-T.L.); (S.-S.J.); (Q.-Q.M.); (Y.-Q.L.); (J.Z.)
| | - Shuang Song
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing 100050, China; (T.-T.L.); (S.-S.J.); (Q.-Q.M.); (Y.-Q.L.); (J.Z.)
| | - Jian Zhang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing 100050, China; (T.-T.L.); (S.-S.J.); (Q.-Q.M.); (Y.-Q.L.); (J.Z.)
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21
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Dong X, Zheng D, Nao J. Circulating Exosome microRNAs as Diagnostic Biomarkers of Dementia. Front Aging Neurosci 2020; 12:580199. [PMID: 33093831 PMCID: PMC7506134 DOI: 10.3389/fnagi.2020.580199] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 12/28/2022] Open
Abstract
Dementia is a syndrome of acquired cognitive impairment that leads to a significant decline in a patient’s daily life, ability to learn, and the ability to communicate with others. Dementia occurs in many diseases, including Alzheimer’s disease (AD), dementia with Lewy bodies, frontotemporal dementia, and Parkinson’s disease dementia (PDD). Although the analysis of biomarkers in the cerebrospinal fluid (CSF) and peripheral blood physicochemical analysis can indicate neurological impairment, there are currently no sensitive biomarkers for early clinical diagnosis of dementia or for identifying the cause of dementia. Previous studies have suggested that circulating micro (mi)RNAs may be used as biomarkers for diagnosing neurological disorders. However, miRNAs are susceptible to interference by other components in the peripheral circulation, bringing into question the diagnostic value of circulating miRNAs. Exosomes secreted by most cell types contain proteins, mRNAs, and miRNAs that are closely associated with changes in cellular functions. Exosome miRNAs (ex-miRNAs) are highly stable and resistant to degradation. Therefore, these may serve as useful biomarkers for the early clinical diagnosis of dementia. Here, we review studies of ex-miRNAs that commonly cause clinical dementia and explore whether ex-miRNAs may be used as early diagnostic biomarkers of dementia.
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Affiliation(s)
- Xiaoyu Dong
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongming Zheng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianfei Nao
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
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22
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Nonaka N, Banks WA, Shioda S. Pituitary adenylate cyclase-activating polypeptide: Protective effects in stroke and dementia. Peptides 2020; 130:170332. [PMID: 32445876 DOI: 10.1016/j.peptides.2020.170332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 01/05/2023]
Abstract
Evidence shows that pituitary adenylate cyclase-activating polypeptide (PACAP) improves stroke outcomes and dementia. The blood-brain barrier (BBB) controls the peptide and regulatory protein exchange between the central nervous system and the blood; the transport of these regulatory substances across the BBB has been altered in animal models of stroke and Alzheimer's disease (AD). PACAP is a powerful neurotrophin that can cross the BBB, which may aid in the therapy of neurodegenerative diseases, including stroke and AD. PACAP may function as a potential drug in the treatment, prevention, or management of stroke and AD and other neurodegenerative conditions. Here, we review the effects of PACAP in studies on stroke and dementias.
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Affiliation(s)
- Naoko Nonaka
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry, Shinagawa-ku, Tokyo, Japan.
| | - William A Banks
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Seiji Shioda
- Global Research Center for Innovative Life Science, Peptide Drug Innovation, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, Shinagawa-ku, Tokyo, Japan.
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23
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Leardini-Tristão M, Andrade G, Garcia C, Reis PA, Lourenço M, Moreira ETS, Lima FRS, Castro-Faria-Neto HC, Tibirica E, Estato V. Physical exercise promotes astrocyte coverage of microvessels in a model of chronic cerebral hypoperfusion. J Neuroinflammation 2020; 17:117. [PMID: 32299450 PMCID: PMC7161182 DOI: 10.1186/s12974-020-01771-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/12/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Brain circulation disorders such as chronic cerebral hypoperfusion have been associated with a decline in cognitive function during the development of dementia. Astrocytes together with microglia participate in the immune response in the CNS and make them potential sentinels in the brain parenchyma. In addition, astrocytes coverage integrity has been related to brain homeostasis. Currently, physical exercise has been proposed as an effective intervention to promote brain function improvement. However, the neuroprotective effects of early physical exercise on the astrocyte communication with the microcirculation and the microglial activation in a chronic cerebral hypoperfusion model are still unclear. The aim of this study was to investigate the impact of early intervention with physical exercise on cognition, brain microcirculatory, and inflammatory parameters in an experimental model of chronic cerebral hypoperfusion induced by permanent bilateral occlusion of the common carotid arteries (2VO). METHODS Wistar rats aged 12 weeks were randomly divided into four groups: Sham-sedentary group (Sham-Sed), Sham-exercised group (Sham-Ex), 2VO-sedentary group (2VO-Sed), and 2VO-exercised group (2VO-Ex). The early intervention with physical exercise started 3 days after 2VO or Sham surgery during 12 weeks. Then, the brain functional capillary density and endothelial-leukocyte interactions were evaluated by intravital microscopy; cognitive function was evaluated by open-field test; hippocampus postsynaptic density protein 95 and synaptophysin were evaluated by western blotting; astrocytic coverage of the capillaries, microglial activation, and structural capillary density were evaluated by immunohistochemistry. RESULTS Early moderate physical exercise was able to normalize functional capillary density and reduce leukocyte rolling in the brain of animals with chronic cerebral hypoperfusion. These effects were accompanied by restore synaptic protein and the improvement of cognitive function. In addition, early moderate exercise improves astrocytes coverage in blood vessels of the cerebral cortex and hippocampus, decreases microglial activation in the hippocampus, and improves structural capillaries in the hippocampus. CONCLUSIONS Microcirculatory and inflammatory changes in the brain appear to be involved in triggering a cognitive decline in animals with chronic cerebral ischemia. Therefore, early intervention with physical exercise may represent a preventive approach to neurodegeneration caused by chronic cerebral hypoperfusion.
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Affiliation(s)
- Marina Leardini-Tristão
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Giulia Andrade
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Celina Garcia
- Laboratory of Glial Cell Biology, Biomedical Sciences Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia A Reis
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Millena Lourenço
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Emilio T S Moreira
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Flavia R S Lima
- Laboratory of Glial Cell Biology, Biomedical Sciences Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hugo C Castro-Faria-Neto
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Eduardo Tibirica
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Vanessa Estato
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Abstract
BACKGROUND There are differences among the outcomes regarding cognitive impairment in heart failure (HF) because the evidence is fragmented and sample size is small. Therefore we aimed to systematically review and analyze the available evidence about the association between HF and dementia. METHODS In the present study, we searched for articles published until August 2019 in the following databases: PubMed, Web of Science, EMBASE, Medline and Google Scholar. The pooled multivariate odds ratio (OR) or relative risk (RR) and 95% confidence intervals (CI) were obtained by the use of STATA 12.0 software. RESULTS The meta-analysis showed a positive association between HF and risk of all-cause dementia (OR/RR = 1.28, 95% CI 1.15 to 1.43, I = 70.0%, P < 0.001). Additionally, the study showed no significant association between HF and risk of Alzheimer's disease (AD) (OR/RR = 1.38, 95% CI 0.90 to 2.13, I = 74.8%, P = 0.008). CONCLUSION In conclusion, HF was associated with an increased risk of developing dementia. In addition, large scale prospective studies are essential to explore the associations between HF and risk of AD.
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Neuroimaging in dementia. Clinical–radiological correlation. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Álvarez-Linera Prado J, Jiménez-Huete A. Neuroimaging in dementia. Clinical-radiological correlation. RADIOLOGIA 2018; 61:66-81. [PMID: 30482502 DOI: 10.1016/j.rx.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 07/19/2018] [Accepted: 08/20/2018] [Indexed: 12/30/2022]
Abstract
Dementia is a syndrome characterised by chronic, multi-domain, acquired cognitive impairment that causes significant functional limitations. MRI is the standard imaging study for these cases, since it enables detection of the atrophy patterns of the various neurodegenerative diseases (Alzheimer's disease, frontotemporal degeneration, Lewy body dementia), the vascular lesions associated with vascular dementia, and various potentially reversible diseases (for example, tumours, hydrocephaly) or diseases that require special management measures (for example, prion diseases). In certain cases other imaging methods can be used, such as CT, functional MRI, HMPAO SPECT or dopaminergic markers and FDG PET, amyloid markers or dopaminergic markers. The indications for these methods have not yet been clearly established, and therefore should be used in multidisciplinary dementia units.
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Affiliation(s)
| | - A Jiménez-Huete
- Departamento de Neurología, Hospital Ruber Internacional, Madrid, España
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Irwin K, Sexton C, Daniel T, Lawlor B, Naci L. Healthy Aging and Dementia: Two Roads Diverging in Midlife? Front Aging Neurosci 2018; 10:275. [PMID: 30283329 PMCID: PMC6156266 DOI: 10.3389/fnagi.2018.00275] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
Dementia, particularly Alzheimer’s disease (AD), is a growing pandemic that presents profound challenges to healthcare systems, families, and societies throughout the world. By 2050, the number of people living with dementia worldwide could almost triple, from 47 to 132 million, with associated costs rising to $3 trillion. To reduce the future incidence of dementia, there is an immediate need for interventions that target the disease process from its earliest stages. Research programs are increasingly starting to focus on midlife as a critical period for the beginning of AD-related pathology, yet the indicators of the incipient disease process in asymptomatic individuals remain poorly understood. We address this important knowledge gap by examining evidence for cognitive and structural brain changes that may differentiate, from midlife, healthy aging and pathological AD-related processes. This review crystallizes emerging trends for divergence between the two and highlights current limitations and opportunities for future research in this area.
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Affiliation(s)
- Katie Irwin
- Department of Neuroscience, University of Georgia, Athens, GA, United States
| | - Claire Sexton
- Memory and Aging Center, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tarun Daniel
- Department of Neuroscience, University of Georgia, Athens, GA, United States
| | - Brian Lawlor
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland.,The Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Lorina Naci
- The Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,School of Psychology, Trinity College Dublin, Dublin, Ireland
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Moreira SV, Justi FRDR, Moreira M. Can musical intervention improve memory in Alzheimer's patients? Evidence from a systematic review. Dement Neuropsychol 2018; 12:133-142. [PMID: 29988347 PMCID: PMC6022981 DOI: 10.1590/1980-57642018dn12-020005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Treatment with music has shown effectiveness in the treatment of general behavioural and cognitive symptoms of patients with various types of dementia. Objective To assess the effectiveness of treatment with music on the memory of patients with Alzheimer's disease (AD). Methods A systematic search was performed on PubMed (Medline), Cochrane Library, PsycINFO and Lilacs databases up to June 2017 and included all randomized controlled trials that assessed memory using musical interventions in patients with AD. Results Forty-two studies were identified, and 24 studies were selected. After applying the exclusion criteria, four studies involving 179 patients were included. These studies showed the benefits of using music to treat memory deficit in patients with AD. Conclusion To the best of our knowledge, this is the first systematic review focusing on randomized trials found in the literature that analysed the role of musical interventions specifically in the memory of patients with AD. Despite the positive outcome of this review, the available evidence remains inconsistent due to the small number of randomized controlled trials.
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Affiliation(s)
- Shirlene Vianna Moreira
- Graduate Program in Psychology, Department of Psychology, Institute of Human Sciences, Federal University of Juiz de Fora, MG, Brazil.,Unit of Cognitive and Behavioral Disorders (UNICOG), Hospital Maternidade Therezinha de Jesus (HMTJ), Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), MG, Brazil
| | - Francis Ricardo Dos Reis Justi
- Graduate Program in Psychology, Department of Psychology, Institute of Human Sciences, Federal University of Juiz de Fora, MG, Brazil
| | - Marcos Moreira
- Unit of Cognitive and Behavioral Disorders (UNICOG), Hospital Maternidade Therezinha de Jesus (HMTJ), Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), MG, Brazil
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Bernardes C, Massano J, Freitas A. Hospital admissions 2000-2014: A retrospective analysis of 288 096 events in patients with dementia. Arch Gerontol Geriatr 2018; 77:150-157. [PMID: 29775774 DOI: 10.1016/j.archger.2018.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Dementia is a leading cause of disability worldwide. It is associated with an increased risk of hospitalization, imposing a significant burden on healthcare systems. The evidence on the long-term evolution of this issue and broadly on healthcare systems is currently limited. This study aims to describe the hospitalizations of people who received a diagnosis of dementia admitted to public general hospitals in a western European country with universal health coverage, over more than a decade. METHODS This retrospective observational study analyzed all inpatient episodes from 2000 to 2014 with a primary or secondary diagnosis of dementia using a national hospitalization database from mainland Portuguese public hospitals. RESULTS A total of 288 096 hospital admissions were registered. Hospitalization rates increased 4.7 times throughout the study period. Pneumonia and urinary tract infections were the most frequent main diagnoses, while dementia itself was the cause of admission in a minority (6.8%) of cases. Cerebrovascular disease, diabetes without chronic complications, and congestive heart failure were the most prevalent comorbidities; 5.9% of patients with dementia admitted to hospital underwent a surgical procedure, orthopedic surgeries being the most frequent. The median length of hospital stay was 8.0 days, and in-hospital mortality rate was 16.1%. CONCLUSIONS Dementia patients represent a significant amount of hospital admissions. Most leading causes of hospital admissions are preventable if timely diagnosed and could be effectively managed in the outpatient setting. These findings may be useful for healthcare resource planning and allocation. Further research should drive evidence-based reorganization of health care systems.
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Affiliation(s)
- Catarina Bernardes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Portugal
| | - João Massano
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Portugal; Department of Neurology, Centro Hospitalar de São João, Porto, Portugal.
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, University of Porto, Portugal
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