The role of dyadic cognitive report and subjective cognitive decline in early ADRD clinical research and trials: Current knowledge, gaps, and recommendations.

Efficient identification of cognitive decline and Alzheimer's disease (AD) risk in early stages of the AD disease continuum is a critical unmet need. Subjective cognitive decline is increasingly recognized as an early symptomatic stage of AD. Dyadic cognitive report, including subjective cognitive complaints (SCC) from a participant and an informant/study partner who knows the participant well, represents an accurate, reliable, and efficient source of data for assessing risk. However, the separate and combined contributions of self- and study partner report, and the dynamic relationship between the two, remains unclear. The Subjective Cognitive Decline Professional Interest Area within the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment convened a working group focused on dyadic patterns of subjective report. Group members identified aspects of dyadic-report information important to the AD research field, gaps in knowledge, and recommendations. By reviewing existing data on this topic, we found evidence that dyadic measures are associated with objective measures of cognition and provide unique information in preclinical and prodromal AD about disease stage and progression and AD biomarker status. External factors including dyad (participant-study partner pair) relationship and sociocultural factors contribute to these associations. We recommend greater dyad report use in research settings to identify AD risk. Priority areas for future research include (1) elucidation of the contributions of demographic and sociocultural factors, dyad type, and dyad relationship to dyad report; (2) exploration of agreement and discordance between self- and study partner report across the AD syndromic and disease continuum; (3) identification of domains (e.g., memory, executive function, neuropsychiatric) that predict AD risk outcomes and differentiate cognitive impairment due to AD from other impairment; (4) development of best practices for study partner engagement; (5) exploration of study partner report as AD clinical trial endpoints; (6) continued development, validation, and optimization, of study partner report instruments tailored to the goals of the research and population

Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit

ObjectivesTo assess the ABC2-SPH score in predicting COVID-19 in-hospital mortality, during intensive care unit (ICU) admission, and to compare its performance with other scores (SOFA, SAPS-3, NEWS2, 4C Mortality Score, SOARS, CURB-65, modified CHA2DS2-VASc, and a novel severity score).Materials and methodsConsecutive patients (≥ 18 years) with laboratory-confirmed COVID-19 admitted to ICUs of 25 hospitals, located in 17 Brazilian cities, from October 2020 to March 2022, were included. Overall performance of the scores was evaluated using the Brier score. ABC2-SPH was used as the reference score, and comparisons between ABC2-SPH and the other scores were performed by using the Bonferroni method of correction. The primary outcome was in-hospital mortality.ResultsABC2-SPH had an area under the curve of 0.716 (95% CI 0.693–0.738), significantly higher than CURB-65, SOFA, NEWS2, SOARS, and modified CHA2DS2-VASc scores. There was no statistically significant difference between ABC2-SPH and SAPS-3, 4C Mortality Score, and the novel severity score.ConclusionABC2-SPH was superior to other risk scores, but it still did not demonstrate an excellent predictive ability for mortality in critically ill COVID-19 patients. Our results indicate the need to develop a new score, for this subset of patients

The impact of SARS-CoV-2 in dementia across Latin America : A call for an urgent regional plan and coordinated response

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks

Dementia in Latin America : paving the way towards a regional action plan

Regional challenges faced by Latin American and Caribbean countries (LACs) to fight dementia, such as heterogeneity, diversity, political instabilities, and socioeconomic disparities, can be addressed more effectively grounded in a collaborative setting based on the open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking and translational research) and align them to current global strategies to translate regional knowledge into actions with transformative power. Then, by characterizing genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions and mapping these to the above challenges, we provide the basic mosaics of knowledge that will pave the way towards a KtAF. We describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF

Estudo dos fatores psicossociais, comorbidades clínicas e polimorfismos funcionais dos genes BDNF, COMT, 5HTT e APOE no binômio depressão-demência no idoso

Exportado OPUSMade available in DSpace on 2019-08-12T13:43:09Z (GMT). No. of bitstreams: 1 tese.pdf: 1951489 bytes, checksum: 67301d9dab80e079a681af6c6777a1ae (MD5) Previous issue date: 29A doença de Alzheimer (DA) e o transtorno depressivo maior são doenças altamente prevalentes na população idosa e que determinam elevadas taxas de incapacidades. As duas doenças encontram-se intimamente relacionadas e estudos prévios sugerem que a depressão, principalmente a depressão de início tardio, possa representar um fator de risco para a DA ou uma manifestação precoce da mesma. Depressão e DA, habitualmente, apresentam co-morbidades associadas principalmente fatores de risco vasculares, como diabetes mellitus (DM), dislipidemia, hipertensão arterial sistêmica (HAS) e doença arterial coronariana. A DA e a depressão são doenças complexas que envolvem múltiplos mecanismos fisiopatológicos. Vários polimorfismos parecem estar implicados na fisiopatologia de ambas as doenças. O único polimorfismo inquestionavelmente envolvido com a DA é o alelo 4 do gene da Apolipoproteina E (APOE). Entretanto diversos estudos sugerem a participação de outros genes na DA. Por tratar-se de doença cujo tratamento ainda apresenta eficácia modesta, de elevado custo e com efeitos colaterais significativos, aliado ao fato de acometer um número significativo de indivíduos idosos, determinando incapacidade irreversível, faz-se necessário esclarecer melhor os mecanismos envolvidos na origem e progressão da doença. Realizamos um estudo transversal envolvendo 406 idosos, subdivididos em: grupo controle (97 indivíduos), DA sem sintomas comportamentais e psicológicos da demência (Behavioral Psychological Symptoms of Dementia - BPSD) (75 indivíduos), DA com BPSD (94 indivíduos), depressão de início tardio (140 pacientes). Analisamos co-variáveis sócio-demográficas, clínicas e genotipagem dos polimorfismos funcionais dos genes BDNF, APOE, COMT e 5-HTTLPR. Analisamos as frequências alélicas, genotípicas, haplotípica e interações entre os genes comparando os três grupos de pacientes com o grupo controle. Nossos resultados mostraram associação entre o sexo feminino e as duas doenças; entre baixa escolaridade e DA; DA e depressão; forte associação entre DA e depressão; DM e dislipidemi correlacionaram-se apenas com DA com BPSD. A APOE 4 associou-se fortemente com o diagnóstico de DA com e sem BPSD e com idade de início mais precoce da doença. Observamos que a depressão está associada ao alelo Met do rs6265 e apresentou interação sinérgica entre 5-HTTLPR e rs4680. Na DA ocorreu interação sinérgica entre rs6265 e rs429358 e apenas uma tendência ao sinergismo (estatisticamente não significativa) entre rs6265 e rs7124442. Os fatores psicossociais estavam associados com DA com BPSD e depressão de início tardio. Esse estudo nos permite relacionar alguns fatores sócio-demográficos, psicossociais, genéticos e clínicos envolvidas no binômio depressão-demência no idoso.Alzheimer's disease (AD) and major depressive disorders are highly prevalent diseases in the population with high rates of disability. These two diseases are closely related and previous studies suggest that depression, particularly late-onset depression, may represent a risk factor for AD or an early manifestation of disease. Depression and AD usually have comorbidities associated with vascular risk factors such as diabetes mellitus (DM), dyslipidemia, hypertension (HBP) and coronary artery disease. AD and depression are complex diseases that involve multiple causes. Several polymorphisms seem to be implicated in the pathophysiology of both diseases. The only polymorphism unquestionably involved with the AD is the APOE 4. However, several studies suggest the involvement of other genes in AD. Because it is a disease whose treatment is still very inefficient, with high cost and significant side effects, and the fact that affects a significant number of elderly individuals, determining irreversible disability, it is necessary to clarify the mechanisms involved in its etiology and disease progression. We conducted a cross-sectional study involving 406 elderly divided into control group (97 subjects), AD without behavioral and psychological symptoms of dementia (BPSD) (75 subjects), DA with BPSD (94 individuals), late onset depression (140 patients). We analyzed the socio-demographic and clinical co-variables, as well as genotyping of functional polymorphisms of BDNF, APOE, COMT and 5-HTTLPR genes. We analyzed allele frequencies, genotypes, haplotypes and interactions between genes by comparing the three groups of patients with the control group. Our results showed an association between female sex and the two diseases; between low schooling and DA; smoking DA and depression; a strong association between AD and depression; diabetes and dyslipidemia were correlated only with AD with BPSD. The APOE4 was strongly associated with the diagnosis of AD with and without BPSD and earlier age of onset. We observed that depression is associated with the Met allele of rs6265 and showed synergistic interaction between 5-HTTLPR and rs4680. There was an association between DA and rs6265 and rs429358 and only a tendency for synergism (not statistically significant) between rs6265 and rs7124442. Psychosocial factors were associated with AD with BPSD and late onset depression. This study allows us to correlate some socio-demographic, psychosocial, genetic and clinical data involved in depression-dementia in the elderly

Efetividade da reabilitação vestibular no equilíbrio, tontura, funcionalidade e sintomas depressivos em idosos

RESUMO Objetivo Avaliar a efetividade da reabilitação vestibular na funcionalidade, ganho dos canais semicirculares ao Video Head Impulse Test (v-HIT), nas respostas ao Potencial Evocado Miogênico Vestibular (VEMP), sintomas depressivos, equilíbrio e tontura em idosos. Métodos Estudo longitudinal, quase experimental e analítico, realizado entre dezembro de 2019 e julho de 2022, com 50 idosos com disfunção vestibular, submetidos à reabilitação vestibular e à aplicação dos exames VEMP, v-HIT, dos questionários e escalas Escala Visual Analógica, Dizziness Handicap Inventory e Escala de Equilíbrio de Berg, além do Questionário de Atividades Funcionais de Pfeffer e Escala de Depressão Geriátrica. Todos os exames e questionários foram aplicados antes e após oito sessões semanais de reabilitação vestibular. A análise estatística foi realizada pelo programa SPSS, por meio do teste Wilcoxon (p<0,05). Resultados Observou-se melhora do ganho do canal semicircular anterior direito (0,71/0,78), redução do incômodo da tontura (7/5), do impacto da tontura na qualidade de vida (35/15), melhora do equilíbrio (45/51), além de melhora da funcionalidade (2/1) e redução dos sintomas depressivos (5/3). Conclusão Idosos com disfunção vestibular submetidos à reabilitação vestibular apresentaram melhora do ganho do reflexo vestíbulo-ocular, do equilíbrio, da funcionalidade, redução do impacto da tontura na qualidade de vida e dos sintomas depressivos

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents