Acetyl Cholinesterase Inhibitors and Cell-Derived Peripheral Inflammatory Cytokines in Early Stages of Alzheimer's Disease

Clinical and preclinical studies firmly support the involvement of the inflammation in the pathogenesis of Alzheimer's disease (AD). Despite acetylcholinesterase inhibitors (AChEI) being widely used in AD patients, there is no conclusive evidence about their impact on the inflammatory response.Funding was received from a program co-financed by the European Social Fund and the Greek State (GSRT LS5-3808)info:eu-repo/semantics/publishedVersio

How telemedicine can improve the quality of care for patients with alzheimer’s disease and related dementias? A narrative review

Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer’s disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population

Individualised sensory intervention to improve quality of life in people with dementia and their companions (SENSE-Cog trial): study protocol for a randomised controlled trial

Background: Hearing and vision impairments are highly prevalent in people with dementia and may have a negative impact on quality of life and other dementia-related outcomes. Intervening to optimise sensory impairment and support sensory function may be a means of improving dementia-related outcomes. The SENSE-Cog trial will test whether a home-based multi-part sensory intervention is effective in improving quality of life and other key outcomes in people with dementia and hearing or vision problems (or both) and their companions. Methods: This is an European, multi-centre, observer-blind, pragmatic, randomised controlled trial. Three hundred fifty four people with dementia and hearing or vision impairment (or both) and their companions will be randomly assigned to receive either "care as usual" or a multi-component sensory intervention including assessment and correction of hearing or vision impairments (or both), home-based (maximum 10 visits over 18 weeks), therapist-delivered sensory support (that is, adherence to devices; improving the sensory environment (that is, lighting), communication training, and sign-posting to other support agencies). Change from baseline to intervention end (18 weeks) and post-intervention (36 weeks) will be compared between the two arms in the following outcomes: quality of life (primary endpoint), sensory and cognitive functional ability, relationships, mental well-being, health resource utilisation and cost-effectiveness. Discussion: This is one of two articles outlining the SENSE-Cog trial. Here, we describe the protocol for the effectiveness of the SENSE-Cog intervention. A parallel and complementary process evaluation will be described elsewhere. If the SENSE-Cog trial demonstrates that the sensory intervention improves outcomes in dementia, we will make a toolkit of training materials, resources and information available to health and social care providers to implement the intervention in routine practice. This will be a significant contribution to the therapeutic management of people with dementia and sensory impairment. Trial registration: ISRCTN (Trial ID: ISRCTN17056211) on 19 February 2018

Trials

Background Optimising hearing and vision function may be important in improving a range of outcomes for people living with dementia (PwD) and their companions. The SENSE-Cog cross-national randomised controlled trial (RCT) is evaluating the effectiveness of a sensory intervention (SI) to improve quality of life for PwD with concurrent hearing and/or vision impairment, in five European countries. To ascertain how or why the intervention will, or will not, achieve its outcomes, we have designed a process evaluation to explore potential discrepancies between expected and observed outcomes. This will also help us to understand how context may influence the outcomes. Here we describe the protocol for this process evaluation, which is embedded within the RCT. Methods/design We will use a mixed methods approach with a theoretical framework derived from the UK Medical Research Council’s’ guidance on process evaluations. It will include the following: (1) evaluating how key aspects of the intervention will be delivered, which will be important to scale the intervention in real world populations; (2) characterising the contextual issues, which may shape the delivery and the impact of the intervention in different countries; and (3) investigating possible causal mechanisms through analyses of potential moderators and mediators. To avoid bias, we will analyse the process data before the analysis of the main effectiveness outcomes. Discussion This evaluation will provide insight into how the complex SENSE-Cog SI will be tailored, enacted and received across the different European contexts, all of which have unique health and social care economies. The findings will provide insight into the causal mechanisms effecting change, and will determine whether we should implement the intervention, if effective, on a wider scale for PwD and concurrent sensory impairment

Recommendations for the Use of Serious Games in Neurodegenerative Disorders: 2016 Delphi Panel

The use of Serious Games (SG) in the health domain is expanding. In the field of neurodegenerative disorders (ND) such as Alzheimer’s disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients’ treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014). The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI) and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI). SG are more adapted for use with trained caregivers (both at home and in clinical settings), with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game), and should be personalized with the help of a clinician

Νοσολογικά προβλήματα και θνησιμότητα θηλυκών προβάτων κατά την περί τον τοκετό περίοδο: μέτρα συχνότητας και παράγοντες επικινδυνότητας

The specific objectives of this thesis are as follows: (a) the investigation of the incidence risk of peri-parturient mortality in a field investigation in flocks in Greece, (b) the study of the time that such mortality occurs in relation to lambing, (c) the identification of the pathological conditions more frequently associated with the deaths and (d) the evaluation of factors potentially associated with death during the peri-parturient period. The thesis is divided in two chapters, followed by the general discussion.In the first chapter, the limited relevant literature regarding death of ewes during the peri-parturient period is reviewed.In the second chapter, a field study into the mortality of ewes during the peri-parturient period is described. The study involved 60 flocks for a period of two years.In total, there were 13,418 and 13,599 ewes at the start of each of the two study years, respectively, in the 60 flocks. At the individual animal level, the peri-parturient period was defined from 10 days before to 7 days after lambing (i.e., a total duration of 18 days). In all the ewes that died during that period, a detailed post-mortem examination was performed. The time of death in relation to lambing was established. Following the appropriate paraclinical tests on relevant samples (e.g., post-mortem examination, microbiological examination of tissue samples) and based on their results, a diagnosis was made of the pathological condition in the ewe. In total, 15 variables (flock-level factors) were evaluated for potential association with deaths during the peri-parturient period. In relation to the time of occurrence within each year of the study, death was classified as having occurred before, during or after lambing. The incidence rates of death during the peri-parturient period during the entire peri-parturient period, as well as in each of the three components of the period (before, at, after lambing) were established. Univariable and multivariable analyses were performed to detect risks factors associated with death during the peri-parturient period.A total of 345 deaths of adult ewes were recorded during the two years of the study; the average incidence risk during the two years was 1.3%. There were 147 deaths outside the peri-parturient period, whilst a total of 198 deaths (57.4% of all deaths) occurred during the peri-parturient period (P 1.50 lambs per ewe) emerged to be significant (P = 0.035). With regard to the occurrence of death before or after lambing, the season during which lambing took place and the number of animals in the flock, respectively, were found to be significant.The conclusions from the results of the present thesis are summarised herebelow.(a) Death during the peri-parturient period was found to occur sporadically and most cases occurred 10 days prior to lambing.(b) Pregnancy toxaemia was the pathological condition most frequently associated with peri-parturient mortality.(c) Factors found to have a significant association with occurrence of peri-parturient mortality included the average lambing rate at flock level (increased risk with average lambing rate > 1.5), the season of the year during which the lambing period took place (highest risk during the winter), and the number of animals in the flock (highest risk in the flock with ≤ 200 ewes).Οι ειδικότεροι στόχοι της παρούσας διατριβής ήταν οι εξής: (α) η διερεύνηση της θνησιμότητας σε θηλυκά πρόβατα κατά την περί τον τοκετό περίοδο, σε μία έρευνα πεδίου σε εκτροφές προβάτων, (β) η διαπίστωση της ειδικότερης χρονικής περιόδου σε σχέση με τον τοκετό, οπότε συνέβαιναν αυτά τα περιστατικά θανάτου, (γ) η ταυτοποίηση των παθολογικών καταστάσεων που σχετίζονταν με τα περιστατικά θανάτου και (δ) η εκτίμηση παραγόντων επικινδυνότητας για αυτά τα περιστατικά θανάτου. Η διατριβή χωρίζεται σε δύο κεφάλαια και ακολουθεί η γενική συζήτηση.Στο πρώτο κεφάλαιο, ανασκοπείται η σχετική, περιορισμένη βιβλιογραφία αναφορικά με περιστατικά θανάτου θηλυκών προβάτων κατά την περί τον τοκετό περίοδο. Στο δεύτερο κεφάλαιο, περιγράφεται μία μελέτη πεδίου σε περιστατικά θανάτου θηλυκών προβάτων κατά την περί τον τοκετό περίοδο. Η μελέτη πραγματοποιήθηκε σε 60 προβατοτροφικές εκμεταλλεύσεις για χρονικό διάστημα δύο ετών.Kατά την έναρξη καθενός από τα δύο έτη της μελέτης πεδίου υπήρχαν συνολικά 13.418 και 12.599 θηλυκά πρόβατα, αντίστοιχα, στις 60 εκτροφές. Σε κάθε ζώο ατομικά, η περί τον τοκετό περίοδος καθορίστηκε από 10 ημέρες πριν από τον τοκετό έως 7 μέρες μετά από αυτόν (δηλαδή, συνολική διάρκεια 18 ημέρες). Υπολογίστηκαν μέτρα συχνότητας εμφάνισης περιστατικών θανάτου κατά την περί τον τοκετό περίοδο, καθώς και κατά καθεμία από τις τρεις χρονικές υποπεριόδους αυτής (πριν, κατά, μετά τον τοκετό). Σε όλα τα περιστατικά, πραγματοποιήθηκαν οι κατάλληλες παρακλινικές εξετάσεις (π.χ., νεκροτομική εξέταση, μικροβιολογική εξέταση ιστοτεμαχίων) και καθορίστηκε ο χρόνος θανάτου κάθε ζώου σε σχέση με τον τοκετό (δηλαδή: πριν, κατά ή μετά από αυτόν). Με βάση τα ευρήματα των κατά περίπτωση περαιτέρω εξετάσεων, έγινε διάγνωση της παθολογικής κατάστασης που σχετιζόταν με το περιστατικό. Στη συνέχεια, συνολικά 15 παράγοντες (που αφορούσαν στην εκτροφή) αξιολογήθηκαν για δυνητική συσχέτιση με τα περιστατικά θανάτου κατά την περί τον τοκετό περίοδο. Πραγματοποιήθηκαν μονοπαραγοντικές και πολυπαραγοντικές αναλύσεις για την αξιολόγηση παραγόντων επικινδυνότητας που σχετίζονταν με τα περιστατικά θανάτου κατά την περί τον τοκετό περίοδο.Σε όλη τη διάρκεια της μελέτης (δύο έτη), στις 60 εκτροφές καταγράφηκαν συνολικά 345 περιστατικά θανάτου σε ενήλικα θηλυκά πρόβατα. Η μέση συχνότητα περιστατικών θανάτου στη διάρκεια αυτών των δύο ετών ήταν 1,3%. Από αυτά, 147 περιστατικά συνέβησαν εκτός της περί τον τοκετό περιόδου και 198 περιστατικά (57,4% του συνόλου των περιστατικών θανάτου) συνέβησαν στη διάρκεια της περί τον τοκετό περιόδου (P 1,50 αρνιά ανά προβατίνα) ήταν ο μόνος παράγοντας επικινδυνότητας για περιστατικά θανάτου θηλυκών προβάτων κατά την περί τον τοκετό περίοδο (Ρ = 0.035).Τα συμπεράσματα που προκύπτουν από τα ευρήματα αυτής της διατριβής, είναι τα παρακάτω.(α) Περιστατικά θανάτου κατά την περί τον τοκετό περίοδο συμβαίνουν σποραδικά σε εκτροφές προβάτων, τα περισσότερα δε από αυτά πριν από τον τοκετό.(β) Η τοξιναιμία εγκυμοσύνης είναι το κλινικό πρόβλημα που σχετίζεται συχνότερα με περιστατικά θανάτου κατά τη συγκεκριμένη περίοδο.(γ) Ο κύριος παράγοντας επικινδυνότητας για θνησιμότητα κατά την περί τον τοκετό περίοδο είναι ο αυξημένος δείκτης πολυδυμίας σε κάποια εκτροφή (> 1,50 αρνιά ανά προβατίνα)

Patient- and Caregiver-Related Factors Associated with Caregiver Assessed Global Deterioration Scale Scoring in Demented Patients

Background. Informant-based rating scales are widely used in dementia but patients’ and caregivers’ features influence the final scoring. We aimed to evaluate the role of patient- and caregiver-related factors in a caregiver rated Global Deterioration Scale (GDS) score in a sample of Greek patients with dementia. Methods. We included 194 patients with dementia and 194 caregivers/family relatives; Mini-Mental State Examination (MMSE); Neuropsychiatric Inventory (NPI); Katz Index of Activities of Daily Living (K-IADL) were administered to (a) patients and Center for Epidemiologic Studies-Depression (CES-D) Scale; Zarit Burden Interview (ZBI) to (b) caregivers. Participants’ demographics and patients’ and caregivers’ characteristics were entered into a 3-block regression analysis. Results. The final model explained 55% of the total variance of the caregiver assessed GDS score. The following variables significantly contributed to the final model: MMSE (β=-0.524); K-IADL (β=-0.264); ZBI (β=0.145). Conclusion. We herein confirm the contribution of patients’ cognitive and functional status and caregivers’ burden in caregiver rated GDS scoring irrespective of demographic-related characteristics