Imaging biomarkers in neurodegeneration: current and future practices

Abstract: There is an increasing role for biological markers (biomarkers) in the understanding and diagnosis of neurodegenerative disorders. The application of imaging biomarkers specifically for the in vivo investigation of neurodegenerative disorders has increased substantially over the past decades and continues to provide further benefits both to the diagnosis and understanding of these diseases. This review forms part of a series of articles which stem from the University College London/University of Gothenburg course “Biomarkers in neurodegenerative diseases”. In this review, we focus on neuroimaging, specifically positron emission tomography (PET) and magnetic resonance imaging (MRI), giving an overview of the current established practices clinically and in research as well as new techniques being developed. We will also discuss the use of machine learning (ML) techniques within these fields to provide additional insights to early diagnosis and multimodal analysis

Examining the effects of cognitive training on levels of executive function in adults with down syndrome: A feasibility study

Introduction Individuals with Down syndrome are at much greater risk of developing AD, and one of the early clinical symptoms of AD is executive dysfunction. In the general population, cognitive training has shown some promising results in relation to maintaining or improving cognitive processes. There is currently a gap in the literature in relation to cognitive training for adults with DS. Aims The aim of the study is to assess the feasibility of using a cognitive training program with adults with Down syndrome and to examine the influence of training on levels of executive function in this population. Method A quasi-experimental mixed factorial design with partial crossover was used involving an eight week intervention period using a brain training program. Participants were matched on age and then randomly assigned to either the treatment group or the delayed control group. Forty adults with Down syndrome, aged between 30 and 49 and with a mild or moderate level of intellectual disability participated in the study. All participants completed baseline measures of executive function, using both neuropsychological assessments and a proxy rated measure of behavioural executive function. The active group first completed then training and then the delayed control group. Executive function assessments were repeated for both groups following the training. Results Based on a number of parameters to determine feasibility, from the point of view of both the person with DS and those caring for the person with DS, it was found that it was feasible to conduct such a program. The study also aimed to examine whether a cognitive training program could have an effect on levels of executive function. While, conclusions are limited due to small sample size, improvement was seen in neuropsychological assessments of executive function following cognitive training. Positive effects reflected in everyday behaviours were not as promising. These findings need further investigation with a larger sample size

61st Annual & Scientific Meeting of the Irish Gerontological Society

Multimorbidity (2 or more chronic conditions) is being widely studied in older populations and this study explores both the relevance of emerging conceptualizations and the extent to which multimorbidity is a feature of aging in persons with an intellectual disability. METHODS: Data was generated from wave one of the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) which included 753 persons with an ID aged 40 years and over. Information on the presence of 12 chronic conditions was collected using a standardized protocol administered in face to face interviews with persons with ID and/or their caregivers. Prevalence of multimorbidity was established and patterns were examined using logistic regression models. The patterns of multimorbidity for people with ID that emerged were then compared with those reported for other older adults. RESULTS: Multimorbidity was established for 71% of the IDS-TILDA sample with women at highest risk and rates of multimorbidity was high (63%) even among those aged 40-49 years. Eye disease and mental health problems were most often associated with a second condition and the most prevalent multimorbidity pattern was mental health/neurological disease. DISCUSSION: Further investigation, attention to mental health issues and the development of treatment guidelines that recognize chronic condition disease load are critical to mitigating the negative impact of multiple chronic conditions and preventing additional disability in adults with ID as they age

Patterns of multimorbidity in an older population of persons with an intellectual disability: results from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA).

Multimorbidity (2 or more chronic conditions) is being widely studied in older populations and this study explores both the relevance of emerging conceptualizations and the extent to which multimorbidity is a feature of aging in persons with an intellectual disability. Methods Data was generated from wave one of the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) which included 753 persons with an ID aged 40 years and over. Information on the presence of 12 chronic conditions was collected using a standardized protocol administered in face to face interviews with persons with ID and/or their caregivers. Prevalence of multimorbidity was established and patterns were examined using logistic regression models. The patterns of multimorbidity for people with ID that emerged were then compared with those reported for other older adults. Results Multimorbidity was established for 71% of the IDS-TILDA sample with women at highest risk and rates of multimorbidity was high (63%) even among those aged 40?49 years. Eye disease and mental health problems were most often associated with a second condition and the most prevalent multimorbidity pattern was mental health/neurological disease. Discussion Further investigation, attention to mental health issues and the development of treatment guidelines that recognize chronic condition disease load are critical to mitigating the negative impact of multiple chronic conditions and preventing additional disability in adults with ID as they age. Highlights ? 12 Chronic conditions and pairings of morbidity examined in national random sample. ? People with ID have higher levels of multimorbidity than general population reports. ? Mental health concerns are more significant for people with ID

Total tooth loss and complete denture use in older adults with intellectual disabilities in Ireland: Older adults with intellectual disabilities

Objectives The objectives of this study were to describe the reported dentate status and complete denture use of older people with intellectual disability (ID) and compare with those of older people in the general population in Ireland. Methods The first wave of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA) study provides opportunity to measure edentulism and complete denture use in a nationally representative sample of older people with ID in Ireland. Data drawn from the first wave of IDS-TILDA were matched using propensity score matching with data from The Irish Longitudinal Study on Ageing (TILDA), a study among older adults in Ireland. All IDS-TILDA variables showing significant association (P < 0.05) with edentulism were entered into a regression model to identify predictors of edentulism. Result The proportion of the 478 IDS-TILDA participants with no teeth was higher (34.1 percent) than the proportion of participants with no teeth in the 478 matched TILDA participants (14.9 percent). Only age was predictive of edentulism among older adults with ID. Edentulism was prevalent earlier for those with ID. Notably, 61.3 percent of edentulous older people with ID were without dentures. Conclusion Older people with ID are more likely to be edentulous than those without ID in Ireland and when they lose their teeth, they are unlikely to use dentures. This suggests a need for targeted measures to maintain the teeth of this group and, in the short term, the provision of replacement teeth in this population, where indicated

Influence of environment, predisposing, enabling and need variables on personal health choices of adults with intellectual disability.

Attention to disease and risk factor management is increasingly a feature of people with intellec- tual disability (ID) as an augmented life expec- tancy also exposes a growing number of age- related diseases. An additional concern is little attention to date to physical activity, nutrition, access to social support and other personal health choices and to environmental issues such as the impact of access to social support and the implications of individual?s living ar- rangements. Method: Using a sample of 753 persons with ID from the intellectual disability supplement to the Irish longitudinal study on ageing (IDS-TILDA), forty three variables were grouped into environmental, predisposing, ena- bling, need and personal health choices clusters and hierarchical ordinary least squares regres- sion examined the contribution of environmental, enabling, predisposing, need and all combina- tions of the sets of variables to personal health choices. Findings: Almost 32% of variance was explained primarily by need variables. Most sig- nificant relationships were with meeting up with family and friends (environmental), age, rating of health and worries about getting older (predis- posing), having public health insurance and nursing who come into the home (enabling) and presence of stroke, chronic constipation, func- tional limitations, high assistance needs with activities of daily living (need). Discussion: Taken together, the groupings of variables from the Anderson Model explained a modest amount of variance in the pursuit of positive personal health choices by people with ID. More work is clearly needed in developing evidence-based in- terventions and strategies, and in understand- ing the relationship between positive personal health choices of people with ID and health out- comes

Impact of COVID-19 Pandemic on Caregivers of People with an Intellectual Disability, in Comparison to Carers of Those with Other Disabilities and with Mental Health Issues: A Multicountry Study

Carers supporting people with an intellectual disability often rely on others to manage the burden of care. This research aims to compare the differences between carer groups and understand the predictors of loneliness changes and burden for carers of people with an intellectual disability. Data from the international CLIC study were analysed. In total, 3930 carers responded from four groups; people who care for those with mental health difficulties (n = 491), dementia (n = 1888), physical disabilities (n = 1147), and Intellectual disabilities (n = 404). Cross tabulation and the chi-squared test were used to compare group compositions and binary logistic regression to model predictors within the intellectual disability group. A total of 65% of those caring for people with an intellectual disability experienced increased burden, and 35% of carers of people with an intellectual disability and another condition experienced more severe loneliness. Becoming severely lonely was predicted by feeling burdened by caring (AOR, 15.89) and worsening mental health (AOR, 2.13) Feeling burden was predicted by being aged between 35 and 44 (AOR, 4.24), poor mental health (AOR, 3.51), and feelings of severe loneliness prior to the pandemic (AOR, 2.45). These findings demonstrate that those who were already struggling with caring experienced the greatest difficulties during the COVID-19 lockdowns

How best to support individuals with IDD

Background: While higher rates and earlier onset of frailty have been reported among adults with intellectual and developmental disabilities (IDD), research on how best to support these individuals is lacking. Method: An international consultation relied on three consensus building methods: the Nominal Group Technique, an NIH consensus conference approach, and a Delphi survey. Results: There is agreement that person-centered planning and aging in place should be guiding principles. Frailty must be considered earlier than in the general population with the recognition that improvement and maintenance are viable goals. Intersectoral collaboration is needed to coordinate assessments and actions. Safety and planning for the future are important planning considerations, as are the needs of caregivers. Ongoing research is needed. Conclusion: The statement offers guidance to respond to frailty among adults with IDD and fosters ongoing exchange internationally on best practice. As new evidence emerges, the statement should be revisited and revised

How best to support individuals with IDD as they become frail : Development of a consensus statement

Background: While higher rates and earlier onset of frailty have been reported among adults with intellectual and developmental disabilities (IDD), research on how best to support these individuals is lacking. Method: An international consultation relied on three consensus building methods: the Nominal Group Technique, an NIH consensus conference approach, and a Delphi survey. Results: There is agreement that person-centered planning and aging in place should be guiding principles. Frailty must be considered earlier than in the general population with the recognition that improvement and maintenance are viable goals. Intersectoral collaboration is needed to coordinate assessments and actions. Safety and planning for the future are important planning considerations, as are the needs of caregivers. Ongoing research is needed. Conclusion: The statement offers guidance to respond to frailty among adults with IDD and fosters ongoing exchange internationally on best practice. As new evidence emerges, the statement should be revisited and revised

COVID-19-related loneliness, social isolation and burden in informal caregivers worldwide

Background: Informal caregivers may experience high levels burden. Prior to COVID-19, loneliness and social isolation, and especially the discordance between them, were recognized for rapid aging-related cognitive decline. The COVID-19 has significantly increased social isolation and loneliness in caregivers. Thus, we aimed to explore the variables that were associated with higher care burden among all caregivers and only among caregivers for people living with dementia, and whether the increased burden could be associated with a discrepancy between loneliness and social isolation. Method: ‘Comparing Loneliness and Isolation in COVID-19’ was an online global survey of over 20,000 respondents, including 5243 caregivers across 50 countries with enduring brain or/and physical health conditions. We first used a multilevel modelling to identify risk factors associated with higher burden. Then, we defined profiles of discrepancy between loneliness and social isolation, based on the differences between standardized score on a scale of loneliness and of social connectedness and estimated the association between the discrepancy and higher burden. Result: In our sample, 74% of caregivers were female, 44% were caring for people with dementia, and 22% for people with multiple conditions, including dementia. The most prevalent age group was 60-69 years old. Factors significantly associated with higher care burden were being female, having poorer financial situation, worse mental health during the pandemic, caring for people with dementia or intellectual disabilities, caring in the same home, being diagnosed with COVID, and changes of care abilities. 40% of caregivers consistently reported high level of loneliness and social isolation, 38% reported consistent lower levels of both, and two groups reported discordance (low levels of loneliness and high social isolation in 13%; high levels of loneliness and mild social isolation in 12%). The latter group was at the highest risk of self-reported increased and intense care burden. Conclusion: This represents the largest, most widespread survey on the impact of the COVID-19 pandemic on caregivers of people with long-term conditions to date and reflects the importance of capturing the nuances in the relationship between loneliness and social isolation in caregivers. It will be an important resource for support agencies and to inform policy