12 research outputs found

    Nurses Addressing the Knowledge Gap in Advance Care Planning

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    Background: Advance care planning allows people autonomy about values and preferences related to care at the EOL. Engaging in advance care planning enables one to consider decisions about medical treatment at the EOL and informing significant others, including health care providers, about preferences (National Institute on Aging [NIA], 2018). Methods: In this QI project, the intervention will be a one-time ZOOM® meeting between nurse leaders and participating church members. The nurse leader will present the 5 Wishes curriculum and lead a question-and-answer portion at the end of the ZOOM® meeting. Participants will be asked to complete a short survey before and after the ZOOM® meeting. A comprehensive explanation for completion of the living will and health care proxy is explained during the 5 Wishes presentation. Nurse leaders will be available after the video presentation to respond to follow-up questions and provide further information about advance care planning to participating community members. Outcomes: This project had 38 participants (n = 38) and two nurse leaders. 60% of the participants were female, predominantly white, between the ages 60 to 69 with a college education. The intervention did increase participants’ knowledge of how to create a living will and the purpose of a living will. Conclusions: The findings of this project demonstrate the feasibility and efficacy of a church based educational program promoting advanced directive awareness and completion. 66% of the projects participants already had completed advanced directives prior to participating in this project. However, the participants generally had a poor level of understanding of their documents and how they were to be used. At the conclusion of the Zoom® meeting, statistical analysis demonstrated that participants had a better understanding of the purpose of their advanced directives and how to make changes to their advanced directive documents if needed

    Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

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    Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

    New insights into the genetic etiology of Alzheimer’s disease and related dementias

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    Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele