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Importance: Lack of a US dementia surveillance system hinders efforts to support and address disparities among persons living with Alzheimer disease and related dementias (ADRD). Objective: To review diagnosis and prescription drug code ADRD identification algorithms to develop and implement case definitions for national surveillance. Design, Setting, and Participants: In this cross-sectional study, a systematic literature review was conducted to identify unique International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and prescription drug codes used by researchers to identify ADRD in administrative records. Code frequency of use, characteristics of beneficiaries identified by codes, and expert and author consensus around code definitions informed code placement into categories indicating highly likely, likely, and possible ADRD. These definitions were applied cross-sectionally to 2017 to 2019 Medicare fee-for-service (FFS) claims and Medicare Advantage (MA) encounter data to classify January 2019 Medicare enrollees. Data analysis was conducted from September 2022 to March 2024. Exposures: ICD-10-CM and national drug codes in FFS claims or MA encounters. Main Outcomes and Measures: The primary outcome was counts and rates of beneficiaries meeting each case definition. Category-specific age, sex, race and ethnicity, MA enrollment, dual-eligibility, long-term care utilization, mortality, and rural residence distributions, as well as frailty scores and FFS monthly expenditures were also analyzed. Beneficiary characteristics were compared across categories, and age-standardized to minimize confounding by age. Results: Of the 60â¯000â¯869 beneficiaries included (50â¯853â¯806 aged 65 years or older [84.8%]; 32â¯567â¯891 female [54.3%]; 5â¯555â¯571 Hispanic [9.3%]; 6â¯318â¯194 non-Hispanic Black [10.5%]; 44â¯384â¯980 non-Hispanic White [74.0%]), there were 4â¯312â¯496 (7.2%) with highly likely ADRD, 1â¯124â¯080 (1.9%) with likely ADRD, and 2â¯572â¯176 (4.3%) with possible ADRD, totaling more than 8.0 million with diagnostic evidence of at least possible ADRD. These beneficiaries were older, more frail, more likely to be female, more likely to be dual-eligible, more likely to use long-term care, and more likely to die in 2019 compared with beneficiaries with no evidence of ADRD. These differences became larger when moving from the possible ADRD group to the highly likely ADRD group. Mean (SD) FFS monthly spending was $2966 ($4921) among beneficiaries with highly likely ADRD compared with $936 ($2952) for beneficiaries with no evidence of ADRD. Differences persisted after age standardization. Conclusions and Relevance: This cross-sectional study of 2019 Medicare beneficiaries identified more than 5.4 million Medicare beneficiaries with evidence of at least likely ADRD in 2019 using the diagnostic case definition. Pending validation against clinical and other methods of ascertainment, this approach can be adopted provisionally for national surveillance.
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Enfermedad de Alzheimer , Demencia , Medicare , Humanos , Estados Unidos/epidemiología , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/epidemiología , Estudios Transversales , Anciano , Femenino , Masculino , Medicare/estadística & datos numéricos , Demencia/epidemiología , Demencia/diagnóstico , Clasificación Internacional de Enfermedades , Anciano de 80 o más Años , Planes de Aranceles por Servicios/estadística & datos numéricosRESUMEN
BACKGROUND AND OBJECTIVES: It remains unknown whether the associations between protective lifestyles and sporadic dementia risk reported in observational studies also affect age at symptom onset (AAO) in autosomal dominant Alzheimer disease (ADAD) with predominant genetic influences. We investigated the associations between resilience-related life experiences and interindividual AAO variability in ADAD. METHODS: We performed a longitudinal and confirmatory analysis of the Dominantly Inherited Alzheimer Network prospective observational cohort (January 2009-June 2018, follow-up duration 2.13 ± 2.22 years), involving clinical, CSF, and lifestyle/behavioral assessments. We performed a 2-pronged comprehensive resilience assessment in each cohort. Cohort 1, incorporating the general resilience definition (cognitive maintenance [Clinical Dementia Rating = 0] despite high pathology), included carriers during the periods of significant CSFp-tau181 variability and grouped into resilience/resistance outcome bins according to the dichotomous pathologic and cognitive statuses, subcategorized by the estimated years from expected symptom onset (EYO). Cohort 2, focused on ADAD-specific genetically determined time frame characterizing the onset predictability, included asymptomatic participants with available preclinical lifestyle data and AAO outcomes and grouped into delayed or earlier AAO relative to the parental AAO. Associations of cognitive, CSFp-tau181, and lifestyle/behavioral predictors with binary outcomes were investigated using logistic regression. RESULTS: Of 320 carriers (age 38.19 ± 10.94 years, female 56.25%), cohort 1 included 218 participants (39.00 ± 9.37 years, 57.34%) and cohort 2 included 28 participants (43.34 ± 7.40 years, 71.43%). In cohort 1, 218 carriers after -20 EYO, when the interindividual variability (SD) of CSFp-tau181 first became more than twice greater in carriers than in noncarriers, were grouped into low-risk control (asymptomatic, low pathology, n = 103), high-resilience (asymptomatic despite high pathology, n = 60), low-resilience (symptomatic despite low pathology, n = 15), and susceptible control (symptomatic, high pathology, n = 40) groups. Multivariable predictors of high resilience, controlling for age and depression, included higher conscientiousness (odds ratio 1.051 [95% CI 1.016-1.086], p = 0.004), openness to experience (1.068 [1.005-1.135], p = 0.03) (vs. susceptible controls), and agreeableness (1.082 [1.015-1.153], p = 0.02) (vs. low resilience). From 1 to 3 years before parental AAO (cohort 2), the multivariable predictor of delayed AAO, controlling for CSFp-tau181, was higher conscientiousness (0.916 [0.845-0.994], p = 0.036). DISCUSSION: Among the cognitively and socially integrated life experiences associated with resilience, measures of conscientiousness were useful indicators for evaluating resilience and predicting future dementia onset in late preclinical ADAD.
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Edad de Inicio , Enfermedad de Alzheimer , Resiliencia Psicológica , Humanos , Femenino , Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/psicología , Enfermedad de Alzheimer/epidemiología , Masculino , Persona de Mediana Edad , Adulto , Estudios Longitudinales , Estudios de Cohortes , Estudios Prospectivos , Proteínas tau/genética , Estilo de Vida , Acontecimientos que Cambian la Vida , AncianoRESUMEN
Alzheimer's disease (AD), the most prevalent form of dementia, requires early prediction for timely intervention. Current deep learning approaches, particularly those using traditional neural networks, face challenges such as handling high-dimensional data, interpreting complex relationships, and managing data bias. To address these limitations, we propose a framework utilizing graph neural networks (GNNs), which excel in modeling relationships within graph-structured data. Our study employs GNNs on data from the Alzheimer's Disease Neuroimaging Initiative for binary and multi-class classification across the three stages of AD: cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD). By incorporating comorbidity data derived from electronic health records, we achieved the most effective multi-classification results. Notably, the GNN model (Chebyshev Convolutional Neural Networks) demonstrated superior performance with a 0.98 accuracy in multi-class classification and 0.99, 0.93, and 0.94 in the AD/CN, AD/MCI, and CN/MCI binary tasks, respectively. The model's robustness was further validated using the Australian Imaging, Biomarker & Lifestyle dataset as an external validation set. This work contributes to the field by offering a robust, accurate, and cost-effective method for early AD prediction (CN vs. MCI), addressing key challenges in existing deep learning approaches.
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Enfermedad de Alzheimer , Disfunción Cognitiva , Comorbilidad , Redes Neurales de la Computación , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/diagnóstico por imagen , Humanos , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/clasificación , Anciano , Femenino , Masculino , Neuroimagen/métodos , Aprendizaje Profundo , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Sleep apnea (SA) has been linked to an increased risk of dementia in numerous observational studies; whether this is driven by neurodegenerative, vascular, or other mechanisms is not clear. We sought to examine the bidirectional causal relationships between SA, Alzheimer disease (AD), coronary artery disease (CAD), and ischemic stroke using Mendelian randomization. METHODS AND RESULTS: Using summary statistics from 4 recent, large genome-wide association studies of SA (n=523 366), AD (n=94 437), CAD (n=1 165 690), and stroke (n=1 308 460), we conducted bidirectional 2-sample Mendelian randomization analyses. Our primary analytic method was fixed-effects inverse variance-weighted (IVW) Mendelian randomization; diagnostics tests and sensitivity analyses were conducted to verify the robustness of the results. We identified a significant causal effect of SA on the risk of CAD (odds ratio [ORIVW]=1.35 per log-odds increase in SA liability [95% CI=1.25-1.47]) and stroke (ORIVW=1.13 [95% CI=1.01-1.25]). These associations were somewhat attenuated after excluding single-nucleotide polymorphisms associated with body mass index (ORIVW=1.26 [95% CI=1.15-1.39] for CAD risk; ORIVW=1.08 [95% CI=0.96-1.22] for stroke risk). SA was not causally associated with a higher risk of AD (ORIVW=1.14 [95% CI=0.91-1.43]). We did not find causal effects of AD, CAD, or stroke on risk of SA. CONCLUSIONS: These results suggest that SA increased the risk of CAD, and the identified causal association with stroke risk may be confounded by body mass index. Moreover, no causal effect of SA on AD risk was found. Future studies are warranted to investigate cardiovascular pathways between sleep disorders, including SA, and dementia.
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Enfermedad de Alzheimer , Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , Síndromes de la Apnea del Sueño , Humanos , Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/diagnóstico , Síndromes de la Apnea del Sueño/genética , Síndromes de la Apnea del Sueño/epidemiología , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/diagnóstico , Factores de Riesgo , Polimorfismo de Nucleótido Simple , Medición de Riesgo/métodos , Enfermedad de la Arteria Coronaria/genética , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico , Predisposición Genética a la Enfermedad , Enfermedades Cardiovasculares/genética , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Accidente Cerebrovascular Isquémico/genética , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/etiologíaRESUMEN
The two major determining factors for Alzheimer's disease (AD) are genetics and lifestyle. Alleles of the apolipoprotein E (APOE) gene play important roles in the development of late-onset AD, with APOEÉ4 increasing risk, APOEÉ3 being neutral, and APOEÉ2 reducing risk. Several modifiable lifestyle factors have been studied in terms of how they can modify the risk of AD. Among these factors are dietary pattern, nutritional supplements such as omega-3 fatty acids, and B vitamins, physical exercise, and obesity, and vitamin D. The Western diet increases risk of AD, while dietary patterns such as the Mediterranean and vegetarian/vegan diets reduce risk. Foods associated with reduced risk include coffee, fruits and vegetables, whole grains and legumes, and fish, while meat and ultraprocessed foods are associated with increased risk, especially when they lead to obesity. In multi-country ecological studies, the amount of meat in the national diet has the highest correlation with risk of AD. The history of research regarding dietary patterns on risk of AD is emphasized in this review. The risk of AD can be modified starting at least by mid-life. People with greater genetic risk for AD would benefit more by choosing lifestyle factors to reduce and/or delay incidence of AD.
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Enfermedad de Alzheimer , Dieta , Estilo de Vida , Humanos , Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/historia , Factores de Riesgo , Apolipoproteínas E/genética , Predisposición Genética a la EnfermedadRESUMEN
Background: Dementia prevalence is expected to increase as populations grow and age. Therefore, additional resources will be needed to meet the global demand for care for Alzheimer's disease and related dementias (ADRD). Objective: Estimate global and country-level health care spending attributable to ADRD and the cost of informal care for people living with ADRD. Methods: We gathered data from three systematic literature reviews and the Global Burden of Disease 2019 study. We used spatiotemporal Gaussian process regression to impute estimates for the many countries without underlying data. We projected future costs to 2050 based on past trends in costs, diagnosis rates, and institutionalization rate. Results: We estimated that in 2019, the direct health care spending attributable to ADRD across 204 countries reached $260.6 billion (95% uncertainty interval [UI] 131.6-420.4) and the cost of informal ADRD care was $354.1 billion (95% UI 190.0-544.1). On average, informal care represents 57% (95% UI 38-75%) of the total cost of care. We estimated that direct health care spending attributable to ADRD will reach $1.6 trillion (95% UI 0.6-3.3) in 2050, or 9.4% (95% UI 3.9-19.6%) of projected health spending worldwide. We estimated the cost of informal care will reach $0.9 trillion (95% UI 0.3-1.7) in 2050. Conclusions: These cost estimates underscore the magnitude of resources needed to ensure sufficient resources for people living with ADRD and highlight the role that informal care plays in provision of their care. Incorporating informal care cost estimates is critical to capture the social cost of ADRD.
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Costo de Enfermedad , Demencia , Costos de la Atención en Salud , Humanos , Demencia/economía , Demencia/epidemiología , Demencia/terapia , Costos de la Atención en Salud/tendencias , Costos de la Atención en Salud/estadística & datos numéricos , Carga Global de Enfermedades/tendencias , Salud Global/economía , Gastos en Salud/tendencias , Gastos en Salud/estadística & datos numéricos , Enfermedad de Alzheimer/economía , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/terapiaRESUMEN
BACKGROUND: Increasing evidence supports the association between body mass index (BMI), Alzheimer's disease, and vascular markers. Recently, metabolically unhealthy conditions have been reported to affect the expression of these markers. We aimed to investigate the effects of BMI status on Alzheimer's and vascular markers in relation to metabolic health status. METHODS: We recruited 1,736 Asians without dementia (71.6 ± 8.0 years). Participants were categorized into underweight, normal weight, or obese groups based on their BMI. Each group was further divided into metabolically healthy (MH) and unhealthy (MU) groups based on the International Diabetes Foundation definition of metabolic syndrome. The main outcome was Aß positivity, defined as a Centiloid value of 20.0 or above and the presence of vascular markers, defined as severe white matter hyperintensities (WMH). Logistic regression analyses were performed for Aß positivity and severe WMH with BMI status or interaction terms between BMI and metabolic health status as predictors. Mediation analyses were performed with hippocampal volume (HV) and baseline Mini-Mental State Examination (MMSE) scores as the outcomes, and linear mixed models were performed for longitudinal change in MMSE scores. RESULTS: Being underweight increased the risk of Aß positivity (odds ratio [OR] = 2.37, 95% confidence interval [CI] 1.13-4.98), whereas obesity decreased Aß positivity risk (OR = 0.63, 95% CI 0.50-0.80). Especially, obesity decreased the risk of Aß positivity (OR = 0.38, 95% CI 0.26-0.56) in the MH group, but not in the MU group. Obesity increased the risk of severe WMH (OR = 1.69, 1.16-2.47). Decreased Aß positivity mediate the relationship between obesity and higher HV and MMSE scores, particularly in the MH group. Obesity demonstrated a slower decline in MMSE (ß = 1.423, p = 0.037) compared to being normal weight, especially in the MH group. CONCLUSIONS: Our findings provide new evidence that metabolic health has a significant effect on the relationship between obesity and Alzheimer's markers, which, in turn, lead to better clinical outcomes.
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Enfermedad de Alzheimer , Índice de Masa Corporal , Obesidad , Humanos , Masculino , Enfermedad de Alzheimer/epidemiología , Femenino , Anciano , Biomarcadores , Imagen por Resonancia Magnética , Persona de Mediana Edad , Péptidos beta-Amiloides/metabolismo , Hipocampo/patología , Hipocampo/diagnóstico por imagen , Hipocampo/metabolismo , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Anciano de 80 o más Años , Delgadez/epidemiología , Pruebas de Estado Mental y Demencia , Síndrome Metabólico/epidemiologíaRESUMEN
Natural polyamines, including spermidine (SPD), spermine (SPM) and putrescine (PUT), are evolutionarily conserved endogenous molecules crucially involved in central cellular processes. Their physiological importance may extend to the maintenance of cognitive function during aging. However, limited population-based epidemiological studies have explored the link between dietary polyamines and dementia risk. This study was a prospective analysis of 77,092 UK Biobank participants aged ≥ 60 years without dementia at baseline. We used Cox proportional hazard regression models to explore the associations between dietary polyamines and the risk of dementia, and restricted cubic splines to test the non-linear relationships. During a median follow-up of 12 years, 1087 incidents of all-cause dementia cases occurred, including 450 Alzheimer's disease (AD) cases and 206 vascular dementia (VD) cases. The fully adjusted hazard ratios (HRs) for the upper fourth quintile of dietary SPD, in comparison with the lowest quintile of intake, were 0.68 (95% confidence interval [95% CI]: 0.66-0.83) for the risk of all-cause dementia, 0.62 (95% CI: 0.45-0.85) for AD and 0.56 (95% CI: 0.36-0.88) for VD, respectively. A 26% reduction in dementia risk [HR: 0.74, (95% CI: 0.61-0.89)] and a 47% reduction in AD [HR: 0.53, (95%CI: 0.39-0.72)] were observed comparing the third with the lowest quintiles of dietary SPM. Dietary PUT was only associated with a reduced risk of all-cause dementia in the fourth quintile [HR (95% CI): 0.82 (0.68-0.99)]. Reduced risk was not found to be significant across all quintiles. There were 'U'-shaped relationships found between dietary polyamines and all-cause dementia, AD and VD. Stratification by genetic predisposition showed no significant effect modification. Optimal intake of polyamines was linked to a decreased risk of dementia, with no modification by genetic risk. This potentially suggests cognitive benefits of dietary natural polyamines in humans.
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Bancos de Muestras Biológicas , Demencia , Dieta , Poliaminas , Humanos , Femenino , Masculino , Anciano , Demencia/epidemiología , Demencia/etiología , Demencia/prevención & control , Persona de Mediana Edad , Poliaminas/administración & dosificación , Estudios Prospectivos , Reino Unido/epidemiología , Factores de Riesgo , Incidencia , Espermidina/administración & dosificación , Modelos de Riesgos Proporcionales , Demencia Vascular/epidemiología , Demencia Vascular/etiología , Demencia Vascular/prevención & control , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/etiología , Putrescina/administración & dosificación , Estudios de Cohortes , Dinámicas no Lineales , Biobanco del Reino UnidoRESUMEN
Alzheimer disease and allergic diseases are common health problems. The aim of the study was to check the hypothesis that older patients with IgE-mediated allergies have a higher prevalence of Alzheimer disease. It was a retrospective, multicenter cohort observation. In total, 7129 people were examined, including 3566 women and 2558 men (mean 64.9±6.9 y). The diagnosis of Alzheimer disease is based on the ICD-10 code and appropriate medical documentation. The proportion of patients with confirmed Alzheimer disease in the group of patients with diagnosed allergy compared to the group of those without allergy was as follows: 13.9% (168) versus 8.2% (484) with P=0.001. There was a positive correlation between the presence of Alzheimer disease and high serum total IgE, eosinophilia, and asthma or the presence of atopic polymorphic disease (P<0.05). IgE-dependent allergic diseases, in particular allergic asthma, and the presence of high serum IgE levels may favor the development of Alzheimer disease.
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Enfermedad de Alzheimer , Hipersensibilidad , Inmunoglobulina E , Humanos , Enfermedad de Alzheimer/epidemiología , Femenino , Masculino , Inmunoglobulina E/sangre , Estudios Retrospectivos , Persona de Mediana Edad , Hipersensibilidad/epidemiología , Hipersensibilidad/inmunología , Anciano , PrevalenciaRESUMEN
BACKGROUND: As a currently incurable but preventable disease, the prevention and early diagnosis of Alzheimer's disease (AD) has long been a research hotspot. Amyloid deposition has been shown to be a major pathological feature of AD. Notably, not all the people with amyloid-beta (Aß) pathology will have significant cognitive declines and eventually develop AD. Therefore, the aim of this study was to explore the risk factors for cognitive decline in Aß-positive participants. METHODS: We included 650 non-demented participants who were Aß-positive at baseline from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Mixed effects and COX regression models were applied to assess 37 potential risk factors. Mixed effects models were employed to assess the temporal associations between potential risk factors and four cognitive assessment scales. COX regression models were used to assess the impact of potential risk factors on cognitive diagnosis conversion. Univariate and multivariate analyses were applied to the above models. Additionally, we used the Cochran-Armitage trend test to examine whether the incidence of cognitive decline increased with the number concurrent of risk factors. RESULTS: Six factors (low diastolic pressure, low body mass index, retired status, a history of drug abuse, Parkinsonism, and depression) were the identified risk factors and four factors (a history of urinary disease, musculoskeletal diseases, no major surgical history, and no prior dermatologic-connective tissue diseases) were found to be suggestive risk factors. The incidence of cognitive decline in the Aß-positive participants gradually increased as the number of concurrent risk factors increased (p for trend = 0.0005). CONCLUSIONS: Our study may facilitate the understanding of the potential pathological processes in AD and provide novel targets for the prevention of cognitive decline among participants with Aß positivity.
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Péptidos beta-Amiloides , Disfunción Cognitiva , Humanos , Femenino , Masculino , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/metabolismo , Factores de Riesgo , Péptidos beta-Amiloides/metabolismo , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/epidemiología , Pruebas NeuropsicológicasRESUMEN
As China faces demographic shifts and socioeconomic changes, the burden of Alzheimer's disease (AD) and associated cognitive impairments is increasing dramatically, with significant implications for public health and the economy. This systematic review and meta-analysis aims to provide a comprehensive assessment of the prevalence and incidence of AD across China. Drawing from an extensive search of international and Chinese databases up to August 27, 2023, including PubMed, Embase, and the Cochrane Library, we synthesized data from 105 studies. Our analysis reveals a combined prevalence of AD of 3.48% within a sample of 626,276 elderly individuals and an incidence rate of 7.90 per 1000 person-years. Subgroup and meta-regression analyses highlight age and gender as pivotal factors influencing these epidemiological patterns. Notably, significant heterogeneity exists due to variations in diagnostic criteria and study quality, impacting the comparability of findings. This meta-analysis underscores the need for continued research into demographic and modifiable risk factors influencing AD, while emphasizing standardized reporting practices to address these limitations and improve the understanding of AD's challenge in China.
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Enfermedad de Alzheimer , Anciano , Femenino , Humanos , Masculino , Enfermedad de Alzheimer/epidemiología , China/epidemiología , Incidencia , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: We aimed to investigate the association between OA and treatment with dementia risk and structural brain abnormalities. METHODS: We recruited a total of 466,460 individuals from the UK Biobank to investigate the impact of OA on the incidence of dementia. Among the total population, there were 63,081 participants diagnosed with OA. We subsequently categorised the OA patients into medication and surgery groups based on treatment routes. Cox regression models explored the associations between OA/OA treatment and dementia risk, with the results represented as hazard ratios (HRs) and 95% confidence intervals (95% CI). Linear regression models assessed the associations of OA/OA therapy with alterations in cortical structure. RESULTS: During an average of 11.90 (± 1.01) years of follow-up, 5,627 individuals were diagnosed with all-cause dementia (ACD), including 2,438 AD (Alzheimer's disease), and 1,312 VaD (vascular dementia) cases. Results revealed that OA was associated with the elevated risk of ACD (HR: 1.116; 95% CI: 1.039-1.199) and AD (HR: 1.127; 95% CI: 1.013-1.254). OA therapy lowered the risk of dementia in both medication group (HR: 0.746; 95% CI: 0.652-0.854) and surgery group (HR: 0.841; 95% CI: 0.736-0.960). OA was negatively associated with cortical area, especially precentral, postcentral and temporal regions. CONCLUSIONS: Osteoarthritis increased the likelihood of developing dementia, and had an association with regional brain atrophy. OA treatment lowered the dementia risk. OA is a promising modifiable risk factor for dementia.
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Demencia , Osteoartritis , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Alzheimer/epidemiología , Demencia/epidemiología , Demencia Vascular/epidemiología , Demencia Vascular/diagnóstico , Incidencia , Modelos Lineales , Imagen por Resonancia Magnética , Osteoartritis/epidemiología , Osteoartritis/terapia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Biobanco del Reino Unido , Reino Unido/epidemiologíaRESUMEN
INTRODUCTION: Research efforts to characterize and evaluate care delivery and outcomes for older adults with cancer and comorbid dementia are limited by varied methods used to classify Alzheimer's disease and related dementias (ADRD). The purpose of this study is to evaluate differences in demographic, clinical, and cancer characteristics of people newly diagnosed with cancer and concomitant dementia comparing two common methods to identify ADRD using administrative claims data. MATERIALS AND METHODS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Our sample included adults aged 66 years and older with a first primary diagnosis of lung or colorectal cancer between 2011 and 2017. For each cancer diagnosis, we constructed analytical cohorts using the Center for Medicare and Medicaid Services' Chronic Condition Warehouse (CCW) flag and the Bynum-Standard one- and three-year algorithms to capture diagnosed ADRD. We estimated ADRD prevalence using the algorithms and compared Bynum and CCW cohorts on demographic, clinical, and cancer characteristics at cancer diagnosis and survival for lung and colorectal cancer separately. RESULTS: Among older adults with lung cancer, ADRD prevalence was 4.7% with the one-year Bynum, 6.5% with the three-year Bynum, and 12.5% using the CCW flag. In the colorectal cohort, ADRD prevalence was 5.6% with the one-year Bynum, 7.6% with the three-year Bynum, and 14.1% with the CCW flag. Demographic characteristics were similar across ADRD cohorts. The Bynum cohorts identified higher proportions of individuals with moderate to severe dementia (13.8% and 11.2% versus 7.1% CCW in lung cancer; 13.1% and 10.6% versus 6.8% CCW in colorectal cancer), higher frailty rates (27.4% and 22.7% versus 15.0% CCW in lung cancer; 26.4% and 22.3% versus 14.8% CCW in colorectal cancer). Median survival was lower for the Bynum cohorts compared to the CCW, regardless of cancer type. DISCUSSION: Findings demonstrate that ADRD prevalence and certain clinical characteristics vary based on dementia ascertainment method and observation period used to classify individuals with ADRD. Considering differences in the cohorts of registry cases generated by the identification method used is essential when interpreting findings related to treatment, utilization, and outcomes within and across cancer cohorts.
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Enfermedad de Alzheimer , Neoplasias Colorrectales , Demencia , Neoplasias Pulmonares , Medicare , Programa de VERF , Humanos , Anciano , Masculino , Femenino , Estudios Retrospectivos , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/diagnóstico , Anciano de 80 o más Años , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/diagnóstico , Estados Unidos/epidemiología , Medicare/estadística & datos numéricos , Demencia/epidemiología , Demencia/diagnóstico , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidad , Prevalencia , Comorbilidad , Algoritmos , Neoplasias/epidemiologíaRESUMEN
PURPOSE: To study the effects of benign prostatic hyperplasia treatments, namely: alpha-adrenergic receptor blockers, 5-alpha-reductase inhibitors and phosphodiesterase-5 inhibitors on the risk of Parkinson's disease, Alzheimer's disease and mortality. MATERIALS AND METHODS: All male Medicare enrollees aged 65 or above who were diagnosed with benign prostatic hyperplasia and received one of the study drugs between 2007-2020 were followed-up for the three outcomes. We used Cox regression analysis to assess the relative risk of each of the outcomes for each study drug compared to the most prescribed drug, tamsulosin, while controlling for demographic, socioeconomic and comorbidity factors. RESULTS AND CONCLUSIONS: The study analyzed 1.1 million patients for a mean follow-up period of 3.1 years from being prescribed one of the study drugs. For all outcomes, patients on tamsulosin were used as the reference for comparison. For mortality, alfuzosin was associated with 27% risk reduction (HR 0.73, 95%CI 0.68-0.78), and doxazosin with 6% risk reduction (HR 0.94, 95%CI 0.91-0.97). For Parkinson's disease, terazosin was associated with 26% risk reduction (HR 0.74, 95%CI 0.66-0.83), and doxazosin with 21% risk reduction (HR 0.79, 95%CI 0.72-0.88). For Alzheimer's disease, terazosin was associated with 27% risk reduction (HR 0.73, 95%CI 0.65-0.82), and doxazosin with 16% risk reduction (HR 0.84, 95%CI 0.76-0.92). Tadalafil was associated with risk reduction (27-40%) in all 3 outcomes. More research is needed to elucidate the underlying mechanisms of these observations. Given the availability of safer alternatives for treating benign prostatic hyperplasia, caution should be exercised when using tamsulosin in elderly patients, especially those with an increased risk of developing neurodegenerative diseases.
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Enfermedad de Alzheimer , Medicare , Enfermedad de Parkinson , Hiperplasia Prostática , Tamsulosina , Humanos , Masculino , Tamsulosina/uso terapéutico , Tamsulosina/efectos adversos , Anciano , Hiperplasia Prostática/tratamiento farmacológico , Hiperplasia Prostática/mortalidad , Hiperplasia Prostática/epidemiología , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/mortalidad , Enfermedad de Alzheimer/epidemiología , Medicare/estadística & datos numéricos , Estados Unidos/epidemiología , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/mortalidad , Enfermedad de Parkinson/epidemiología , Anciano de 80 o más Años , Estudios de Cohortes , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Antagonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Inhibidores de 5-alfa-Reductasa/uso terapéutico , Inhibidores de 5-alfa-Reductasa/efectos adversos , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Inhibidores de Fosfodiesterasa 5/efectos adversosRESUMEN
This is the first comprehensive national and subnational epidemiological study reporting the incidence of Alzheimer disease and related dementias (ADRD) in Iran from 2010 to 2019 and predictions for 2024. We extracted age-standardized incidence stratified by sex and provinces from the Institute for Health Measurement and Evaluation (IHME). Arc Map GIS was used to report the geographical distribution, and the Cochran-Armitage test was used for prediction. Predictions showed that the incidence of ADRD would reach 118 (women) and 109 (men) cases per 100,000 population in Iran in 2024. The most increasing incidence from 2010 to 2019 was reported among women in Qom, while Yazd had the most incidences among men and women in 2019. The results showed an increase in the incidence of ADRD in Iran in recent years, and the increase in life expectancy and population aging can be considered as an influential factor.
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Enfermedad de Alzheimer , Demencia , Humanos , Irán/epidemiología , Enfermedad de Alzheimer/epidemiología , Masculino , Femenino , Incidencia , Demencia/epidemiología , Anciano , Persona de Mediana Edad , Anciano de 80 o más AñosRESUMEN
Background: Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) have increased in prevalence. Objective: This article describes the Add Health Parent Study (AHPS) Phase 2, a study of social, behavioral, and biological factors influencing healthy aging and risk for AD/ADRD, in a national sample of adults aged 58-90. Methods: Sample members are parents of the National Longitudinal Study of Adolescent to Adult Health (Add Health) cohort, initially interviewed in Add Health in midlife (1994-95). AHPS Phase 1 (2015-17) collected longitudinal data on a random subsample of parents and their spouse/partners, who were mostly Non-Hispanic (NH) White. AHPS Phase 2 will collect the same longitudinal socio-behavioral, and health survey data on all remaining NH Black and Hispanic parents (Black and Hispanic Supplement, BHS). Additionally, Phase 2 will collect cognitive and DNA data from AHPS Phase 1 and BHS sample parents and their current spouse/partners. Results: Funded by the National Institute on Aging, recruitment will occur between June 2025 and May 2026, producing an expected total AHPS sample of 5506 parents and their spouse/partners. Conclusions: The AHPS will be the first longitudinal cohort study powered to address multigenerational racial/ethnic disparities in AD/ADRD risk and protective factors across race/ethnic groups and socioeconomic strata.
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Enfermedad de Alzheimer , Padres , Humanos , Enfermedad de Alzheimer/etnología , Enfermedad de Alzheimer/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Longitudinales , Padres/psicología , Anciano de 80 o más Años , Estados Unidos/epidemiología , Hispánicos o Latinos/estadística & datos numéricos , Demencia/etnología , Demencia/epidemiología , Etnicidad , Disparidades en el Estado de Salud , Adulto , Estudios de Cohortes , Negro o AfroamericanoRESUMEN
Cancer is considered a risk factor for COVID-19 mortality, yet several countries have reported that deaths with a primary code of cancer remained within historic levels during the COVID-19 pandemic. Here, we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US. We compared pandemic-related mortality patterns from underlying and multiple cause (MC) death data for six types of cancer, diabetes, and Alzheimer's. Any pandemic-related changes in coding practices should be eliminated by study of MC data. Nationally in 2020, MC cancer mortality rose by only 3% over a pre-pandemic baseline, corresponding to ~13,600 excess deaths. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematological, 2-7%) than cancers with a poor survival rate (lung and pancreatic, 0-1%). In comparison, there was substantial elevation in MC deaths from diabetes (37%) and Alzheimer's (19%). To understand these differences, we simulated the expected excess mortality for each condition using COVID-19 attack rates, life expectancy, population size, and mean age of individuals living with each condition. We find that the observed mortality differences are primarily explained by differences in life expectancy, with the risk of death from deadly cancers outcompeting the risk of death from COVID-19.
Establishing the true death toll of a pandemic like COVID-19 is difficult, as laboratory testing is generally too limited to directly count the number of deaths that can be attributed to a particular pathogen. To overcome this, researchers analyse excess mortality that is, they compare the observed number of deaths with the expected level based on trends in prior years. These techniques have been used for over 100 years to estimate the burden of pandemic influenza and became a popular way to estimate deaths due to the COVID-19 pandemic. Excess mortality can also reveal the impact of COVID-19 on sub-populations with chronic conditions. For example, previous studies showed that deaths with diabetes, heart disease and Alzheimer's disease listed as the primary cause of death increased during waves of COVID-19. Cancer deaths did not show such a pattern, however, despite some epidemiological studies identifying cancer as a risk factor for COVID-19 mortality. To understand why this may be the case, Hansen et al. reviewed death certificates from different states in the United States during the first year of the pandemic. Their analyses of multiple-cause death records (listing cancer anywhere on the death certificate, not just as the primary cause of death) showed that death certificate coding practices during the pandemic did not explain the absence of excess cancer mortality. While a low level of excess mortality was detectable for cancers with longer life expectancy (breast cancer, for example), no elevation was observed for cancers with lower life expectancy, such as pancreatic cancer. The analyses demonstrate that the lack of excess mortality for especially deadly cancers can be explained through competing risks in other words, the high risk of dying from the cancer itself vastly outweighs the additional risk posed by COVID-19. These findings shed light on how competing mortality risks might mask the true impact of COVID-19 on cancer mortality and explain the apparent discrepancy between cohort studies and excess mortality studies. To fully comprehend the impact of COVID-19 on patients living with cancers, future research should look at the possibility of longer-term increases in cancer mortality due to late diagnosis during pandemic lockdowns, and an elevated risk of severe illness.
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COVID-19 , Neoplasias , COVID-19/mortalidad , COVID-19/epidemiología , Humanos , Neoplasias/mortalidad , Estados Unidos/epidemiología , Masculino , Femenino , Anciano , SARS-CoV-2 , Factores de Riesgo , Persona de Mediana Edad , Diabetes Mellitus/mortalidad , Diabetes Mellitus/epidemiología , Anciano de 80 o más Años , Enfermedad de Alzheimer/mortalidad , Enfermedad de Alzheimer/epidemiología , Adulto , PandemiasRESUMEN
BACKGROUND: The impact of thyroid function on the risk of various types of dementia, including Alzheimer's disease (AD) and vascular dementia (VD), remains unclear. This meta-analysis investigates the association between thyroid dysfunction and the risk of these dementia types, aiming to inform strategies for dementia prevention. METHODS: A comprehensive search was conducted in PubMed, Embase, and the Cochrane Library for studies published up to February 2023, focusing on the risk of thyroid dysfunction in dementia. We excluded duplicates, studies without full text, those with incomplete data, animal studies, case reports, and reviews. Data analysis was performed using STATA 15.1 software. RESULTS: Our analysis indicated that overt hyperthyroidism significantly increases the risk of all studied dementia types (ORâ =â 1.18, 95% CI: 1.04-1.35). In contrast, overt hypothyroidism was associated with a decreased risk of AD (ORâ =â 0.73, 95% CI: 0.55-0.98) and VD (ORâ =â 0.71, 95% CI: 0.62-0.82). Subclinical hyperthyroidism also showed a significant association with an increased risk of any dementia (ORâ =â 1.26, 95% CI: 1.09-1.46) and specifically VD (ORâ =â 6.70; 95% CI: 1.38-32.58). CONCLUSION: This study suggests that overt hypothyroidism may reduce the risk of dementia, including AD and VD, whereas overt and subclinical hyperthyroidism are linked to an increased risk. These findings highlight the importance of monitoring thyroid function as a preventative measure against dementia.
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Demencia , Hipertiroidismo , Humanos , Hipertiroidismo/complicaciones , Demencia/epidemiología , Demencia/etiología , Factores de Riesgo , Hipotiroidismo/epidemiología , Hipotiroidismo/complicaciones , Enfermedad de Alzheimer/epidemiología , Demencia Vascular/epidemiología , Demencia Vascular/etiología , Demencia Vascular/prevención & controlRESUMEN
Background: Alzheimer's disease and related dementias (ADRD) prevalence varies geographically in the United States. Objective: To assess whether the geographic variation of ADRD in Central Appalachia is explained by county-level sociodemographics or access to care. Methods: Centers for Medicare and Medicaid Services Public Use Files from 2015- 2018 were used to estimate county-level ADRD prevalence among all fee-for-service (FFS) beneficiaries with≥1 inpatient, skilled nursing facility, home health agency, hospital outpatient or Carrier claim with a valid ADRD ICD-9/10 code over three-years in Central Appalachia (Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia). Negative binomial regression was used to estimate prevalence overall, by Appalachian/non-Appalachian designation, and by rural/urban classification. Models were then adjusted for county-level: 1) FFS demographics (age, gender, and Medicaid eligibility), comorbidities; 2) population sociodemographics (race/ethnicity, education, aging population distribution, and renter-occupied housing); and 3) diagnostic access (PCP visits, neurology visits, and imaging scans). Results: Across the 591 counties in the Central Appalachian region, the average prevalence of ADRD from 2015- 2018 was 11.8%. ADRD prevalence was modestly higher for Appalachian counties both overall (PR: 1.03; 95% CI: 1.02, 1.04) and after adjustment (PR: 1.02; 95% CI: 1.00, 1.03) compared to non-Appalachian counties. This difference was similar among rural and urban counties (pâ=â0.326) but varied by state (pâ=â0.004). Conclusions: The relative variation in ADRD prevalence in the Appalachian region was smaller than hypothesized. The case mixture of the dual eligible population, accuracy of the outcome measurement, and impact of educational attainment in this region may contribute to this observation.
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Enfermedad de Alzheimer , Humanos , Femenino , Enfermedad de Alzheimer/epidemiología , Masculino , Prevalencia , Anciano , Región de los Apalaches/epidemiología , Anciano de 80 o más Años , Demencia/epidemiología , Estados Unidos/epidemiología , Población Rural/estadística & datos numéricos , Medicare/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricosRESUMEN
This paper presents data analysis of a large dataset of outpatient records for the purpose of establishing accurate prevalence rates of dementia and Alzheimer's disease in Bulgaria. The research is motivated by the lack of accurate prevalence data as well as statistics about the actual number of people affected by dementia at national level. Health data from pseudonymized outpatient records (1,378,355) of 642,013 unique patients (Male 39.88%, Female 61.67%) with visits to neurologists and psychiatrists in 2018 was mapped to an OMOP CDM relational database. The size of this dataset is one of largest in the EU context. Prevalence of dementia for all age groups [30,100+] years is 1.61% (Male 0.62%, Female 0.99%) and Alzheimer' disease prevalence is 0.39% (Male 0.15%, Female 0.24%), where 24.34% of all the patients with dementia suffer Alzheimer's disease. The mean prevalence rates of dementia and Alzheimer's disease for ages above 64 are 9.52% (CI 95%, [6.98%, 12.04%]) and 1.04 % (CI 95%, [0.84%, 1.27%,]). A comparison with EU statistics yields 0.07% difference for dementia prevalence, while data visualization confirms the known patterns of prevalence with aging and gender specifics These results stimulate further research and support the development of a national strategy for dementia and Alzheimer's disease.