Consensus Statement on Dementia Education and Training in Europe

OBJECTIVES: The aim of the current statement is to agree on: (1) what is the current situation with education and training on dementia in Europe; (2) what are the minimum educational requirements for professionals (neurologists, psychiatrists, primary care providers, nurses, biologists, neuroradiologists, etc.) regarding Alzheimer's disease and dementia, and (3) how to start a course of action for the future. DESIGN: In 2005, a simple questionnaire was sent to members of the European Alzheimer's Disease Consortium (EADC) concerning the education and training on dementia in their countries. Fourteen universities of the respective countries responded to this simple questionnaire. The answers varied, and the conclusion of this effort was that little was done concerning the training of students and health professionals on dementia. In 2008, another more structured and specified questionnaire was sent to professors in different universities of the same countries. RESULTS: The answers obtained were different from those of the previous questionnaire and demonstrated that it is very difficult to know about training and education in the field of dementia in every European country. CONCLUSION: From the data collected, it seems that although in the recent past little had been done concerning training on dementia, nowadays training has been developed in most European countries, and relevant educational projects exist both for medical students and doctors during their specialty training. Our main purpose is to develop training material or develop specific courses to improve the professional knowledge about dementia so that best medical and non-medical practice is implemented

Impatiens glandulifera royle op het eiland van Dordrecht

In de zomer van 1941 zaaide ik deze plant voor het eerst in onze tuin (1/2 ha. groot) te Dordrecht uit. Het zaad was afkomstig uit een tuin in den Haag (Prinsevinkenpark). Gedurende de latere oorlogsjaren werd onze tuin door de bezetters aan verdere waarnemingen onttrokken. Toen we in 1945 weer de vrije beschikking over huis en tuin kregen, bleek I. glandulifera zich sterk uitgebreid te hebben; zij groeide zelfs in dichte massa’s boven op de schuilkelders. Momenteel komt deze plant hier nog voor, echter “geciviliseerd”. Bij mijn onderzoek naar de hommelsoorten in de Bieshosch heb ik op verschillende plaatsen in dit gebied deze plant uitgezaaid: 1) Aloyse griend (1951 ). Deze binnendijkse griend is als verlandingsgebied te beschouwen (Epilobium hirsutum, Phragmites communis. Iris pseudacorus, Salix spec.), deels ook als ruderaal terrein (men stort er vuil). De plant (±3O ex.) breidt zich hier langzaam uit. 2) In een griend langs het Moldiep (1953). Hier probeert zij een wedloop met de wilg aan te sommige planten zijn wel 22½ à 3 m hoog. Op open plaatsen zijn zij opmerkelijk lager. Deze planten zullen de vier-jaarlijkse kap van de wilg in het voorjaar ongetwijfeld overleven. Hun aantal schat ik op ± 100 ex. 3) Twee griendketen langs het Moldiep (1955). Deze terreinen zijn niet verder nagegaan. Doordat hier veel rijshout wordt opgeslagen zullen deze standplaatsen niet blijvend zijn. 4) Ook in de grienden bij de Tongplaat (1957) zijn ze uitgezaaid; verdere gegevens hierover ontbreken nog

The predictive value of memory strategies for Alzheimer's disease in subjects with mild cognitive impairment

Subjects with Alzheimer's disease (AD) show impaired learning strategies. Whether impaired learning strategies are already present in subjects with prodromal AD remains unknown. The aim of the present study was to investigate the predictive accuracy of learning strategies for AD in subjects with Mild Cognitive Impairment (MCI). Subjects with MCI (n = 202) were selected from the Maastricht Memory Clinic. Subjects were reassessed over a period of 10 years. Fifty-five of the 202 subjects converted to AD. Learning strategies investigated were subjective organization and serial clustering. Lower scores of subjective organization were associated with a higher risk for AD (OR = 2.1, p =. 002). Serial clustering did not predict AD. Prodromal AD is characterized by a decreased use of effortful learning strategies. This finding may have implications for the early detection of AD in MCI subjects and for the development of cognitive training programs

Unraveling the contributions to the neuromelanin-MRI contrast

© 2020, The Author(s). The Locus Coeruleus (LC) and the Substantia Nigra (SN) are small brainstem nuclei that change with aging and may be involved in the development of various neurodegenerative and psychiatric diseases. Magnetization Transfer (MT) MRI has been shown to facilitate LC and the SN visualization, and the observed contrast is assumed to be related to neuromelanin accumulation. Imaging these nuclei may have predictive value for the progression of various diseases, but interpretation of previous studies is hindered by the fact that the precise biological source of the contrast remains unclear, though several hypotheses have been put forward. To inform clinical studies on the possible biological interpretation of the LC- and SN contrast, we examined an agar-based phantom containing samples of natural Sepia melanin and synthetic Cys-Dopa-Melanin and compared this to the in vivo human LC and SN. T1 and T2* maps, MT spectra and relaxation times of the phantom, the LC and the SN were measured, and a two-pool MT model was fitted. Additionally, Bloch simulations and a transient MT experiment were conducted to confirm the findings. Overall, our results indicate that Neuromelanin-MRI contrast in the LC likely results from a lower macromolecular fraction, thus facilitating interpretation of results in clinical populations. We further demonstrate that in older individuals T1 lengthening occurs in the LC11sci

Adalimumab combined with ciprofloxacin is superior to adalimumab monotherapy in perianal fistula closure in Crohn's disease: a randomised, double-blind, placebo controlled trial (ADAFI).

OBJECTIVE: To assess whether a combination of adalimumab and superior to adalimumab alone in the treatment of perianal fistulising disease (CD). DESIGN: Randomised, double-blind, placebo controlled trial Dutch hospitals. In total, 76 CD patients with active perianal disease were enrolled. After adalimumab induction therapy (160/80 mg patients received 40 mg every other week together with ciprofloxacin 500 placebo twice daily for 12 weeks. After 12 weeks, adalimumab was Follow-up was 24 weeks. Primary endpoint (clinical response) was defined reduction of fistulas from baseline to week 12. Secondary endpoints remission (closure of all fistulas), Perianal Crohn's Disease Activity Crohn's Disease Activity Index (CDAI) and Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTS: Clinical response was observed in 71% of treated with adalimumab plus ciprofloxacin and in 47% treated with plus placebo (p=0.047). Likewise, remission rate at week 12 was higher (p=0.009) in the combination group (65%) compared with adalimumab placebo (33%). Combination treatment was associated with a higher mean change and mean IBDQ change at week 12 (p=0.005 and p=0.009, week 24, no difference in clinical response between the two treatment observed (p=0.22). No difference in safety issues was observed. Combination therapy of adalimumab and ciprofloxacin is more effective adalimumab monotherapy to achieve fistula closure in CD. However, after discontinuation of antibiotic therapy, the beneficial effect of initial coadministration is not maintained. TRIAL REGISTRATION: Identifier: NCT00736983

Psychological and personality factors in type 2 diabetes mellitus, presenting the rationale and exploratory results from The Maastricht Study, a population-based cohort study

BACKGROUND: Strong longitudinal evidence exists that psychological distress is associated with a high morbidity and mortality risk in type 2 diabetes. Little is known about the biological and behavioral mechanisms that may explain this association. Moreover, the role of personality traits in these associations is still unclear. In this paper, we first describe the design of the psychological part of The Maastricht Study that aims to elucidate these mechanisms. Next, we present exploratory results on the prevalence of depression, anxiety and personality traits in type 2 diabetes. Finally, we briefly discuss the importance of these findings for clinical research and practice. METHODS: We measured psychological distress and depression using the MINI diagnostic interview, the PHQ-9 and GAD-7 questionnaires in the first 864 participants of The Maastricht Study, a large, population-based cohort study. Personality traits were measured by the DS14 and Big Five personality questionnaires. Type 2 diabetes was assessed by an oral glucose tolerance test. Logistic regression analyses were used to estimate the associations of depression, anxiety and personality with type 2 diabetes, adjusted for age, sex and education level. RESULTS: Individuals with type 2 diabetes had higher levels of depressive and anxiety symptoms, odds ratios (95 % CI) were 3.15 (1.49; 6.67), 1.73 (0.83-3.60), 1.50 (0.72-3.12), for PHQ-9 >/= 10, current depressive disorder and GAD-7 >/= 10, respectively. Type D personality, social inhibition and negative affectivity were more prevalent in type 2 diabetes, odds ratios were 1.95 (1.23-3.10), 1.35 (0.93-1.94) and 1.70 (1.14-2.51), respectively. Individuals with type 2 diabetes were less extraverted, less conscientious, less agreeable and less emotionally stable, and similar in openness to individuals without type 2 diabetes, although effect sizes were small. CONCLUSIONS: Individuals with type 2 diabetes experience more psychological distress and have different personality traits compared to individuals without type 2 diabetes. Future longitudinal analyses within The Maastricht Study will increase our understanding of biological and behavioral mechanisms that link psychological distress to morbidity and mortality in type 2 diabetes

Adalimumab combined with ciprofloxacin is superior to adalimumab monotherapy in perianal fistula closure in Crohn's disease: A randomised, double-blind, placebo controlled trial (ADAFI)

Objective: To assess whether a combination of adalimumab and ciprofloxacin is superior to adalimumab alone in the treatment of perianal fistulising Crohn's disease (CD). Design: Randomised, double-blind, placebo controlled trial in eight Dutch hospitals. In total, 76 CD patients with active perianal fistulising disease were enrolled. After adalimumab induction therapy (160/80 mg week 0, 2), patients received 40 mg every other week together with ciprofloxacin 500 mg or placebo twice daily for 12 weeks. After 12 weeks, adalimumab was continued. Follow-up was 24 weeks. Primary endpoint (clinical response) was defined as 50% reduction of fistulas from baseline to week 12. Secondary endpoints included remission (closure of all fistulas), Perianal Crohn's Disease Activity Index, Crohn's Disease Activity Index (CDAI) and Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Clinical response was observed in 71% of patients treated with adalimumab plus ciprofloxacin and in 47% treated with adalimumab plus placebo (p=0.047). Likewise, remission rate at week 12 was significantly higher (p=0.009) in the combination group (65%) compared with adalimumab plus placebo (33%). Combination treatment was associated with a higher mean CDAI change and mean IBDQ change at week 12 (p=0.005 and p=0.009, respectively). At week 24, no difference in clinical response between the two treatment groups was observed (p=0.22). No difference in safety issues was observed. Conclusions: Combination therapy of adalimumab and ciprofloxacin is more effective than adalimumab monotherapy to achieve fistula closure in CD. However, after discontinuation of antibiotic therapy, the beneficial effect of initial coadministration is not maintained. Trial registration: ClinicalTrials.gov Identifier: NCT00736983