A systematic review and meta-analysis on the prevalence of dementia in europe. estimates from the highest-quality studies adopting the dsm iv diagnostic criteria

BACKGROUND: Dementia, including Alzheimer's disease (AD), is one of the most burdensome medical conditions. Usually, the reviews that aim at calculating the prevalence of dementia include estimates from studies without assessing their methodological quality. Alzheimer's Disease International (ADI) proposed a score to assess the methodological quality of population-based studies aimed at estimating the prevalence of dementia. During the last three years, the European Commission has funded three projects (Eurodem, EuroCoDe, and ALCOVE) in order to estimate the prevalence of dementia in Europe. OBJECTIVE: The aim of this study was to perform a systematic review and meta-analysis of data on the prevalence of dementia in Europe derived from studies that included only subjects with a diagnosis of dementia according to the DSM IV criteria, and that had a high quality score according to ADI criteria. METHODS: We considered the studies selected by the two projects EuroCoDe (1993-2007) and Alcove (2008-2011), and we performed a new bibliographic search. For the systematic review, we only selected the subset of articles that included subjects with a diagnosis of dementia according to the DSM IV criteria. The studies were qualitatively assessed using the ADI tool. RESULTS: The meta-analysis considered 9 studies that were carried out in Europe between 1993 and 2018 including a total of 18,263 participants, of which 2,137 were diagnosed with dementia. The prevalence rate standardized for age and sex resulted 7.1%. DISCUSSION: This is the first systematic review on the prevalence of dementia in Europe considering only high-quality studies adopting the same diagnostic criteria (i.e., DSM IV)

An estimate of attributable cases of alzheimer disease and vascular dementia due to modifiable risk factors. the impact of primary prevention in europe and in italy

Background: Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD), while 15.8% are considered to be due to vascular dementia (VaD). In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. Aims: To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. Methods: Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR) was estimated for AD and VaD. Results: In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. Conclusion: A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention

The use of new mobile and gaming technologies for the assessment and rehabilitation of people with ataxia: a systematic review and meta-analysis

There are no currently available disease-modifying pharmacological treatments for most of the chronic hereditary ataxias; thus, effective rehabilitative strategies are crucial to help improve symptoms and therefore the quality of life. We propose to gather all available evidence on the use of video games, exergames, and apps for tablet and smartphone for the rehabilitation, diagnosis, and assessment of people with ataxias. Relevant literature published up to June 8, 2020, was retrieved searching the databases PubMed, ISI Web of Science, and the Cochrane Database. Data were extracted using a standardized form, and their methodological quality was assessed using RoB and QUADAS-2. Six studies of 434 retrieved articles met the predefined inclusion/exclusion criteria. Two of them were diagnostic, while 4 were experimental studies. Studies included participants ranging from 9 to 28 in trials and 70 to 248 in diagnostic studies. Although we found a small number of trials and of low methodological quality, all of them reported an improvement of motor outcomes and quality of life as measured by specific scales, including the SARA, BBS, DHI, and SF-36 scores. The main reason for such low quality in trials was that most of them were small and uncontrolled, thus non-randomized and unblinded. As video games, exergames, serious games, and apps were proven to be safe, feasible, and at least as effective as traditional rehabilitation, further and more high-quality studies should be carried out on the use of these promising technologies in people with different types of ataxia

Methodological Issues in the Clinical Validation of Biomarkers for Alzheimer's Disease : The Paradigmatic Example of CSF

The use of biomarkers is profoundly transforming medical research and practice. Their adoption has triggered major advancements in the field of Alzheimer's disease (AD) over the past years. For instance, the analysis of the cerebrospinal fluid (CSF) and neuroimaging changes indicative of neuronal loss and amyloid deposition has led to the understanding that AD is characterized by a long preclinical phase. It is also supporting the transition towards a biology-grounded framework and definition of the disease. Nevertheless, though sufficient evidence exists about the analytical validity (i.e., accuracy, reliability, and reproducibility) of the candidate AD biomarkers, their clinical validity (i.e., how well the test measures the clinical features, and the disease or treatment outcomes) and clinical utility (i.e., if and how the test improves the patient's outcomes, confirms/changes the diagnosis, identifies at-risk individuals, influences therapeutic choices) have not been fully proven. In the present review, some of the methodological issues and challenges that should be addressed in order to better appreciate the potential benefits and limitations of AD biomarkers are discussed. The ultimate goal is to stimulate a constructive discussion aimed at filling the existing gaps and more precisely defining the directions of future research. Specifically, four main aspects of the clinical validation process are addressed and applied to the most relevant CSF biomarkers: (1) the definition of reference values; (2) the identification of reference standards for the disease of interest (i.e., AD); (3) the inclusion within the diagnostic process; and (4) the statistical process supporting the whole framework

Multiple Scattering X-ray Photoelectron Diffraction Study Of The Srtio 3 (100) Surface

The atomic surface structure of SrTiO3 (100) after annealing at 630 °C in vacuum is investigated by x-ray photoelectron diffraction (XPD) using the Sr 3 d5/2 core level. The photoelectron diffraction peaks are successfully assigned by considering the forward scattering of photoelectrons by the atomic potential near the emitter atom in the lattice. The strongest diffraction peaks are aligned along the single crystal internuclear axes. We compare the results of photoelectron multiple scattering calculations (MSC) of SrO and TiO2 terminated SrTiO3 (100) surfaces, including surface relaxation and rumpling, with the experimental data. For TiO2 and SrO terminated SrTiO3 (100) surfaces, all top-layer cations relax inward, whereas second-layer atoms relax outward. The surface rumpling for SrO- and TiO2 -terminated surfaces agrees well with low-energy electron diffraction results. Using a genetic algorithm the best agreement of MSC to the experimental XPD data is obtained for a SrO terminated surface with a 30% coverage of 3 ML SrO(100) islands. © 2009 American Institute of Physics.1063Rijnders, G., Curras, S., Huijben, M., Blanck, D., Rogalla, H., Kotecki, D.E., Baniecki, J.D., Wise, R., (2004) Appl. Phys. Lett., 84, p. 1150. , 0003-6951, () 10.1063/1.1646463;, IBM J. Res. Dev. 0018-8646 43, 367 (1999)Kawasaki, M., Ohtomo, A., Arakane, T., Takahashi, K., Yoshimoto, M., Koinuma, H., Atomic control of SrTiO3 surface for perfect epitaxy of perovskite oxides (1996) Applied Surface Science, 107, pp. 102-106. , DOI 10.1016/S0169-4332(96)00512-0, PII S0169433296005120Erdman, N., Marks, L.D., (2003) Surf. Sci., 526, p. 107. , 0039-6028,. 10.1016/S0039-6028(02)02573-6Kubo, T., Nozoye, H., (2001) Phys. Rev. Lett., 86, p. 1801. , 0031-9007,. 10.1103/PhysRevLett.86.1801Szot, K., Speier, W., Breuer, U., Meyer, R., Szade, J., Waser, R., (2000) Surf. 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High prevalence of extrapyramidal signs and symptoms in a group of Italian dental technicians

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Multiple scattering x-ray photoelectron diffraction study of the SrTiO3(100) surface

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)The atomic surface structure of SrTiO3(100) after annealing at 630 degrees C in vacuum is investigated by x-ray photoelectron diffraction (XPD) using the Sr 3d(5/2) core level. The photoelectron diffraction peaks are successfully assigned by considering the forward scattering of photoelectrons by the atomic potential near the emitter atom in the lattice. The strongest diffraction peaks are aligned along the single crystal internuclear axes. We compare the results of photoelectron multiple scattering calculations (MSC) of SrO and TiO2 terminated SrTiO3(100) surfaces, including surface relaxation and rumpling, with the experimental data. For TiO2 and SrO terminated SrTiO3(100) surfaces, all top-layer cations relax inward, whereas second-layer atoms relax outward. The surface rumpling for SrO- and TiO2-terminated surfaces agrees well with low-energy electron diffraction results. Using a genetic algorithm the best agreement of MSC to the experimental XPD data is obtained for a SrO terminated surface with a 30% coverage of 3 ML SrO(100) islands.1063Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)European Commission [NMP3-CT-2005-013862]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [0554993-4]European Commission [NMP3-CT-2005-013862

Use of biomarkers in ongoing research protocols on alzheimer’s disease

The present study aimed to describe and discuss the state of the art of biomarker use in ongoing Alzheimer’s disease (AD) research. A review of 222 ongoing phase 1, 2, 3, and 4 protocols registered in the clinicaltrials.gov database was performed. All the trials (i) enrolling subjects with clinical disturbances and/or preclinical diagnoses falling within the AD continuum; and (ii) testing the efficacy and/or safety/tolerability of a therapeutic intervention, were analyzed. The use of biomarkers of amyloid deposition, tau pathology, and neurodegeneration among the eligibility criteria and/or study outcomes was assessed. Overall, 58.2% of ongoing interventional studies on AD adopt candidate biomarkers. They are mostly adopted by studies at the preliminary stages of the drug development process to explore the safety profile of novel therapies, and to provide evidence of target engagement and disease-modifying properties. The biologically supported selection of participants is mostly based on biomarkers of amyloid deposition, whereas the use of biomarkers as study outcomes mostly relies on markers of neurodegeneration. Biomarkers play an important role in the design and conduction of research protocols targeting AD. Nevertheless, their clinical validity, utility, and cost-effectiveness in the “real world” remain to be clarified

Vascular risk factors and white matter hyperintensities in patients with amnestic mild cognitive impairment

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Universal Prevention of Dementia in Italy: A Document Analysis of the 21 Italian Regional Prevention Plans

BackgroundUp to 40% of dementia cases are theoretically avoidable and population-level interventions (i.e., universal prevention) are a key component in facing the global public health challenge of dementia. However, information on the agenda for the universal prevention of dementia at the national and sub-national levels is still lacking.ObjectivesWe aim to provide a comprehensive description of the universal prevention strategies specific to dementia in Italian regions and autonomous provinces (APs).DesignWe conducted a document analysis of the 21 Italian Regional Prevention Plans (RPPs), with a focus on interventions that target potentially modifiable risk factors for dementia. We analysed the final version of the documents, which were previously downloaded from the dedicated section of the Italian Ministry of Health website in January 2023. We classified the interventions as direct, indirect, or absent. Additionally, we created a quality checklist to outline the essential programmatic elements and applied it to summarise the key findings of the RPPs.MeasurementsWe reported the number of populationlevel interventions specific for dementia with sub-national detail. We reported information on the risk factor targeted by the interventions, the age groups and populations they were designed for. We summarized the presence or absence of 63 programmatic items using a four-domain checklist.ResultsWe identified 248 interventions for dementia prevention among the assessed RPPs: 100% of the plans addressed physical inactivity; 30-35% addressed smoking, alcohol, obesity, and social isolation; 25% addressed hypertension, diabetes, and air pollution; only 5-10% addressed education, depression, and hearing loss. Most interventions targeted the general population. Quality checklist scores significantly varied among regions, with demographics and prevention strategies domains scoring higher than disease burden and intervention feasibility ones.ConclusionsThe population-level interventions in the Italian Regional Prevention Programs dedicated to dementia prevention primarily focus on vascular risk factors, with limited coverage of dementia-specific factors such as traumatic brain injury and hearing loss. This data should be considered when planning future interventions for dementia prevention