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02/2020 journal articles

Editorials

ALZHEIMER’S DISEASE DRUG DEVELOPMENT PIPELINE 2020

M.N. Sabbagh

J Prev Alz Dis 2020;7(2):66-67

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CITATION:
M.N. Sabbagh (2020): Alzheimer’s Disease Drug Development Pipeline 2020. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2020.12

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LINKING GEROSCIENCE AND INTEGRATED CARE TO REINFORCE PREVENTION

J.R. Beard

J Prev Alz Dis 2020;7(2):68-69

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CITATION:
J.R. Beard (2020): Linking Geroscience and Integrated Care to Reinforce Prevention. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2020.13

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Review Articles

INTEGRATED CARE FOR OLDER PEOPLE AND THE IMPLEMENTATION IN THE INSPIRE CARE COHORT

C. Takeda, S. Guyonnet, Y. Sumi, B. Vellas, I. Araujo de Carvalho

J Prev Alz Dis 2020;7(2):70-74

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Backgrounds: The World Health Organization has published the Integrated Care for Older People, ICOPE handbook Guidance on person-centred assessment and pathways in primary care. This is an integrated individual care tool focused on the individual and healthy ageing. The ICOPE tool proposes step by step, a screening, a fine assessment, the development of a personalized care plan, its implementation and follow up and finally the consideration of the caregivers and community. The new Geroscience field is focusing on preventing age-related diseases, and should now investigate with the ICOPE tool the optimal maintenance of intrinsic capacity (IC) through mobility, cognition, psychology, vitality, hearing and vision. This article aims to present this new tool and to presents its innovative implementation at the Toulouse University Hospital through the INSPIRE study. We believe that the ICOPE integrated care program will also be a pragmatic way to maintain cognitive functions and detect early Alzheimer. Objectives: The main objective of the INSPIRE study is to build a Bio-resource Research Platform for Healthy Ageing gathering biological, clinical and digital resources in order to identify markers of ageing, age-related diseases and IC evolution. The study will be also testing the implementation and follow up of the ICOPE tool. Methods: The Inspire Platform will gather clinical data and bio-specimens from 1000 subjects in the Occitania Region, of different ages (from 30 years and over) over 10 years. Data will be collected annually. Using the ICOPE tool IC domains will be monitored every 4 months. Once IC decline is identified, participants will have a thorough clinical assessment and blood sampling to investigate the response of markers of ageing at the time of decline. The French ethic committee approved the study. Results: The Inspire platform aims to develop an integrative approach to promote novel new technologies for the assessment and monitoring of functional capacities.

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Original Research

EXPLORING FACTORS THAT CONTRIBUTE TO JOINING AND REGULARLY PRACTICING IN COGNITIVE TRAINING AMONG HEALTHY OLDER ADULTS: A ONE-YEAR FOLLOW-UP QUALITATIVE STUDY

P. Srisuwan, D. Nakawiro, S. Chansirikarnjana, O. Kuha, S. Kengpanich, K. Gesakomol

J Prev Alz Dis 2020;7(2):75-81

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BACKGROUND: Cognitive interventions have the potential to enhance cognition among healthy older adults. However, little is known of the factors associated with the joining and participating of older people in group-based multicomponent cognitive training (CT). OBJECTIVES: To explore factors that contribute to joining and regularly practicing CT over 1 year among healthy older adults. DESIGN: A qualitative study. SETTING: Geriatric clinic in Bangkok, Thailand. PARTICIPANTS: 40 nondemented community-dwelling older adults INTERVENTION: The CT of executive functions, attention, memory and visuospatial functions (TEAM-V) program was conducted over 5 sessions, with a 2-week interval between each session. MEASUREMENTS: An inductive qualitative approach, based on semi-structure interviews with 40 healthy older adults, was employed. The interviews explored factors of joining CT at baseline, factors of regularly participating in class at 6 months and at home at 1 year. Data were coded and analyzed using and the thematic analysis approach. RESULTS: After analyzing factors concerning joining CT, 3 core themes emerged: (1) individual characteristics with 3 subthemes of “health status”, “time arrangement”, and “financial status”; (2) individual perceptions with 2 subthemes of “perceived susceptibility to dementia” and “perceived severity of dementia” and (3) encouragement from families and friends. After analyzing factors of practicing CT in class, 3 core themes emerged: (1) program with 3 subthemes of “session”, “group facilitators” and “notification before class”; (2) accessibility with 2 subthemes of “distance” and “transportation” and (3) encouragement from families and friends. After analyzing factors of practicing CT at home, 2 core themes emerged: (1) contents of the training program and (2) encouragement from families and friends. CONCLUSIONS: Increased awareness of holistic factors including older adults’ characteristic and perceptions, support from families and friends and accessibility should be emphasized in planning CT. Designing the content of CT that could be applied or adapted in daily living and effective program components such as a notification system could increase practicing.

CITATION:
P. Srisuwan ; D. Nakawiro ; S. Chansirikarnjana ; O. Kuha ; S. Kengpanich ; K. Gesakomol (2020): Exploring Factors that Contribute to Joining and Regularly Practicing in Cognitive Training among Healthy Older Adults: A One-Year Follow-Up Qualitative Study. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2020.14

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KNOWLEDGE, ATTITUDE AND PREVENTIVE PRACTICE ON DEMENTIA CARE AMONG PRIMARY HEALTH PROFESSIONALS IN MACAO

I.L. Lo, W. Zeng, C.I. Lei, C. Lam, H.L. Lou

J Prev Alz Dis 2020;7(2):83-86

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The Macao Dementia Policy was recognized by Alzheimer Disease International as the 27th globally and one of the highest stage 5 to develop dementia friendly community and primary health professionals are in a pivotal position to enhance community-based dementia prevention and care quality. This study aimed to investigate the knowledge, attitude and preventive practice on dementia care among primary health professionals in Macao. A specially designed 30-item questionnaire was developed and validated for the study. The Content Validity Index (CVI) and Cronbach’s α of the questionnaire were 0.973 and 0.808. The questionnaires were distributed to all 375 primary health professionals from 8 Health Centers throughout Macao and 234 valid questionnaires (62.4%) were returned. The score for dementia care knowledge was 87.02+14.01; attitude was 69.52+5.83; preventive practice was 77.88+13.18, of which doctors (79.89+13.77) was significantly higher (t=2.29, p=0.023) than nurses (75.91+12.33). There were positive relationships between preventive practice and attitude (r=0.163, p=0.014), and age (r=0.212, p=0.002), and a negative relationship between knowledge and age (r=-0.139, p=0.040). These findings have significant implications that most primary health professionals in Macao had sufficient knowledge, a positive attitude and appropriate preventive practice on dementia care. However, enhanced dementia education to improve knowledge and preventive practice was a strong agenda for the training for senior staff and nurses.

CITATION:
I.L. Lo ; W. Zeng ; C.I. Lei ; C. Lam ; H.L. Lou (2020): Knowledge, Attitude and Preventive Practice on Dementia Care among Primary Health Professionals in Macao. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2020.10

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A MACHINE LEARNING FRAMEWORK FOR ASSESSMENT OF COGNITIVE AND FUNCTIONAL IMPAIRMENTS IN ALZHEIMER’S DISEASE: DATA PREPROCESSING AND ANALYSIS

N. Vinutha, S. Pattar, S. Sharma, P. D. Shenoy, K.R. Venugopal

J Prev Alz Dis 2020;7(2):87-94

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The neuropsychological scores and Functional Activities Questionnaire (FAQ) are significant to measure the cognitive and functional domain of the patients affected by the Alzheimer’s Disease. Further, there are standardized dataset available today that are curated from several centers across the globe that aid in development of Computer Aided Diagnosis tools. However, there are numerous clinical tests to measure these scores that lead to a challenging task for their assessment in diagnosis. Also, the datasets suffer from common missing and imbalanced data issues. In this paper, we propose a machine learning based framework to overcome these issues. Empirical results demonstrate that improved performance of Genetic Algorithm is obtained for the neuropsychological scores after Miss Forest Imputation and for FAQ scores is obtained after subjecting it to the Synthetic Minority Oversampling Technique.

CITATION:
N. Vinutha ; S. Pattar ; S. Sharma ; P. D. Shenoy ; K.R. Venugopal (2020): A Machine Learning Framework for Assessment of Cognitive and Functional Impairments in Alzheimer’s Disease: Data Preprocessing and Analysis. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2020.7

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EFFECTS OF RICE WINE LEES ON COGNITIVE FUNCTION IN COMMUNITY-DWELLING PHYSICALLY ACTIVE OLDER ADULTS: A PILOT RANDOMIZED CONTROLLED TRIAL

N. Nagai, N. Shindo, A. Wada, H. Izu, T. Fujii, K. Matsubara, Y. Wada, N. Sakane

J Prev Alz Dis 2020;7(2):95-103

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Background: Rice wine lees (RWL), a Japanese traditional fermented product, is a rich source of one-carbon metabolism-related nutrients, which may have beneficial effects on cognitive function. Objectives: We aimed to examine the effect of the RWL on cognitive function in community-dwelling physically active older adults. Design: Double-blind, randomized, placebo-controlled study (clinical trial number: UMIN 000027158). Setting: Community-based intervention including assessments conducted at the University of Hyogo and a public liberal arts school in Himeji City, Japan. Participants: A total of 35 community-dwelling older adults (68–80 years) who performed mild exercise before and during the trial were assigned to either the RWL (n=17) or the placebo group (n=18). Intervention: Daily consumption of 50 g RWL powder, which contained one-carbon metabolism-related nutrients, or the placebo powder (made from soy protein and dextrin) for 12 weeks. Both supplements included equivalent amounts of energy and protein. Measurements: Montreal Cognitive Assessment, computerized cognitive function test, and measurements of serum predictive biomarkers (transthyretin, apolipoprotein A1, and complement C3) were conducted at baseline and follow-up. Results: Visual selective attention and serum transthyretin significantly improved in the RWL group, whereas there was no significant change in the placebo group. No significant group difference was observed in the remaining cognitive performance tests. Conclusions: RWL supplements seem to have a few effects on cognitive function in community-dwelling physically active older adults. However, the impact was limited; therefore, further studies with sufficient sample size are warranted to elucidate this issue.

CITATION:
N. Nagai ; N. Shindo ; A. Wada ; H. Izu ; T. Fujii ; K. Matsubara ; Y. Wada ; N. Sakane (2019): Effects of Rice Wine Lees on Cognitive Function in Community-Dwelling Physically Active Older Adults: A Pilot Randomized Controlled Trial. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2019.45

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FEASIBILITY OF USING A WEARABLE BIOSENSOR DEVICE IN PATIENTS AT RISK FOR ALZHEIMER’S DISEASE DEMENTIA

N. Saif, P. Yan, K. Niotis, O. Scheyer, A. Rahman, M. Berkowitz, R. Krikorian, H. Hristov, G. Sadek, S. Bellara, R.S. Isaacson

J Prev Alz Dis 2020;7(2):104-111

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Background: Alzheimer’s disease (AD) is the most common and most costly chronic neurodegenerative disease globally. AD develops over an extended period prior to cognitive symptoms, leaving a “window of opportunity” for targeted risk-reduction interventions. Further, this pre-dementia phase includes early physiological changes in sleep and autonomic regulation, for which wearable biosensor devices may offer a convenient and cost-effective method to assess AD-risk. Methods: Patients with a family history of AD and no or minimal cognitive complaints were recruited from the Alzheimer’s Prevention Clinic at Weill Cornell Medicine & New York-Presbyterian. Of the 40 consecutive patients screened, 34 (85%) agreed to wear a wearable biosensor device (WHOOP). One subject (2.5%) lost the device prior to data collection. Of the remaining subjects, 24 were classified as normal cognition and were asymptomatic, 6 were classified as subjective cognitive decline, and 3 were amyloid-positive (one with pre-clinical AD, one with pre-clinical Lewy-Body Dementia, and one with mild cognitive impairment due to AD). Sleep-cycle, autonomic (heart rate variability [HRV]) and activity measures were collected via WHOOP. Blood biomarkers and neuropsychological testing sensitive to cognitive changes in pre-clinical AD were obtained. Participants completed surveys assessing their sleep-patterns, exercise habits, and attitudes towards WHOOP. The goal of this prospective observational study was to determine the feasibility of using a wrist-worn biosensor device in patients at-risk for AD dementia. Unsupervised machine learning was performed to first separate participants into distinct phenotypic groups using the multivariate biometric data. Additional statistical analyses were conducted to examine correlations between individual biometric measures and cognitive performance. Results: 27 (81.8%) participants completed the follow-up surveys. Twenty-four participants (88.9%) were satisfied with WHOOP after six months, and twenty-three (85.2%) wanted to continue wearing WHOOP. K-means clustering separated participants into two groups. Group 1 was older, had lower HRV, and spent more time in slow-wave sleep (SWS) than Group 2. Group 1 performed better on two cognitive tests assessing executive function: Flanker Inhibitory Attention/Control (FIAC) (p=.031), and Dimensional Change Card Sort (DCCS) (p=.061). In Group 1, DCCS was correlated with SWS (ρ=.68, p=0.024) and HRV (ρ=.6, p=0.019). In Group 2, DCCS was correlated with HRV (ρ=.55, p=0.018). There were no significant differences in blood biomarkers between the two groups. Conclusions: Wearable biosensor devices may be a feasible tool to assess AD-related physiological changes. Longitudinal collection of sleep and HRV data may potentially be a non-invasive method for monitoring cognitive changes related to pre-clinical AD. Further study is warranted in larger populations.

CITATION:
N. Saif1 ; P. Yan ; K. Niotis ; O. Scheyer ; A. Rahman ; M. Berkowitz ; R. Krikorian ; H. Hristov ; G. Sadek ; S. Bellara ; R.S. Isaacson (2019): Feasibility of Using a Wearable Biosensor Device in Patients at Risk for Alzheimer’s Disease Dementia. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2019.39

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EFFECTS OF A GROUP-BASED 8-WEEK MULTICOMPONENT COGNITIVE TRAINING ON COGNITION, MOOD AND ACTIVITIES OF DAILY LIVING AMONG HEALTHY OLDER ADULTS: A ONE-YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL

P. Srisuwan, D. Nakawiro, S. Chansirikarnjana, O. Kuha, P. Chaikongthong, T.Suwannagoot

J Prev Alz Dis 2020;7(2):112-121

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BACKGROUND: Cognitive interventions have the potential to enhance cognition among healthy older adults. However, little attention has been paid to the effect of cognitive training (CT) on mood and activities of daily living (ADL). OBJECTIVES: To assess the effectiveness of a multicomponent CT using a training program of executive functions, attention, memory and visuospatial functions (TEAM-V Program) on cognition, mood and instrumental ADL. DESIGN: A randomized, single-blinded, treatment-as-usual controlled trial. SETTING: Geriatric clinic in Bangkok, Thailand. PARTICIPANTS: 77 nondemented community-dwelling older adults (mean age 65.7±4.3 years). INTERVENTION: The CT (TEAM-V) program or the treatment-as-usual controlled group. The TEAM-V intervention was conducted over 5 sessions, with a 2-week interval between each session. Of 77 participants randomized (n=40 the TEAM-V program; n=37 the control group). MEASUREMENTS: The Thai version of Montreal Cognitive Assessment (MoCA), The Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Thai version of Hospital Anxiety and Depression Scale (HADS) and The Chula ADL were used to assess at baseline, 6 months and 1 year. RESULTS: Compared with the control arm, the TEAM-V Program was associated with reducing anxiety (P = 0.004). Compared with the baseline, participants receiving the TEAM-V Program were associated with significantly improved general cognition (MoCA, P < 0.001), immediate recall (word recall task, P = 0.01), retrieval and retention of memory process (word recognition task, P = 0.01), attention (number cancellation part A, P < 0.001) and executive function (maze test, P = 0.02) at 1 year. No training effects on depression (P = 0.097) and IADL (P = 0.27) were detected. CONCLUSIONS: The TEAM-V Program was effective in reducing anxiety. Even though, the program did not significantly improve cognition, depression and ADL compared with the control group, global cognition, memory, attention and executive function improved in the intervention group compared with baseline. Further studies incorporating a larger sample size, longitudinal follow-up and higher-intensity CT should be conducted.

CITATION:
P. Srisuwan ; D. Nakawiro ; S. Chansirikarnjana ; O. Kuha ; P. Chaikongthong ; T.Suwannagoot (2019): Effects of a Group-Based 8-Week Multicomponent Cognitive Training on Cognition, Mood and Activities of Daily Living among Healthy Older Adults: A One-Year Follow-Up of a Randomized Controlled Trial . The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2019.42

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Brief Report

DATA-DRIVEN PARTICIPANT RECRUITMENT: FINDINGS FROM THE ALZHEIMER’S DISEASE NEUROIMAGING INITIATIVE 3

C. Barger, J. Fockler, W. Kwang, S. Moore, D. Flenniken, A. Ulbricht, P. Aisen, M.W. Weiner, on behalf of the Alzheimer’s Disease Neuroimaging Initiative

J Prev Alz Dis 2020;7(2):122-127

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Background: Effective and measurable participant recruitment methods are urgently needed for clinical studies in Alzheimer’s disease. Objectives: To develop methods for measuring recruitment tactics and evaluating effectiveness. Methods: Recruitment tactics for the Alzheimer’s Disease Neuroimaging Initiative (ADNI3) were measured using web and phone analytics, campaign metrics and survey responses. Results: A total of 462 new participants were enrolled into ADNI3 through recruitment efforts. We collected metrics on recruitment activities including 82,003 unique visitors to the recruitment website and 3,335 calls to study phone numbers. The recruitment sources that produced the most screening and enrollment included online advertisements, local radio and newspaper coverage and emails and referrals from registries. Conclusions: Analysis of recruitment activity obtained through tracking methods provided some insight for effective recruitment. ADNI3 can serve as an example of how a data-driven approach to centralized participant recruitment can be utilized to facilitate clinical research.

CITATION:
C. Barger ; J. Fockler ; W. Kwang ; S. Moore ; D. Flenniken ; A. Ulbricht ; P. Aisen ; M.W. Weiner ; on behalf of the Alzheimer’s Disease Neuroimaging Initiative (2020): Data-Driven Participant Recruitment: Findings from the Alzheimer’s Disease Neuroimaging Initiative 3. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2020.5

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CORTICAL Β-AMYLOID IN OLDER ADULTS IS ASSOCIATED WITH MULTIDOMAIN INTERVENTIONS WITH AND WITHOUT OMEGA 3 POLYUNSATURATED FATTY ACID SUPPLEMENTATION

C. Hooper, N. Coley, P. De Souto Barreto, P. Payoux, A.S. Salabert, S. Andrieu, M. Weiner, B. Vellas, for the MAPT/DSA study group

J Prev Alz Dis 2020;7(2):128-134

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Multidomain lifestyle interventions (including combinations of physical exercise, cognitive training and nutritional guidance) are attracting increasing research attention for reducing the risk of Alzheimer’s disease (AD). Here we examined for the first time the cross-sectional relationship between cortical β-amyloid (Aβ) and multidomain lifestyle interventions (nutritional and exercise counselling and cognitive training), omega 3 polyunsaturated fatty acid (n-3 PUFA) supplementation or their combination in 269 participants of the Multidomain Alzheimer Preventive Trial (MAPT). In adjusted multiple linear regression models, compared to the control group (receiving placebo alone), cortical Aβ, measured once during follow-up (mean 512.7 ± 249.6 days post-baseline), was significantly lower in the groups receiving multidomain lifestyle intervention + placebo (mean difference, -0.088, 95 % CI, -0.148,-0.029, p = 0.004) or multidomain lifestyle intervention + n-3 PUFA (-0.100, 95 % CI, -0.160,-0.041, p = 0.001), but there was no difference in the n-3 PUFA supplementation alone group (-0.011, 95 % CI, -0.072,0.051, p = 0.729). Secondary analysis provided mixed results. Our findings suggest that multidomain interventions both with and without n-3 PUFA supplementation might be associated with lower cerebral Aβ. Future trials should investigate if such multidomain lifestyle interventions are causally associated with a reduction or the prevention of the accumulation of cerebral Aβ.

CITATION:
C. Hooper ; N. Coley ; P. De Souto Barreto ; P. Payoux ; A.S. Salabert ; S. Andrieu ; M. Weiner ; B. Vellas ; for the MAPT/DSA study group (2020): Cortical β-Amyloid in Older Adults Is Associated with Multidomain Interventions with and without Omega 3 Polyunsaturated Fatty Acid Supplementation. The Journal of Prevention of Alzheimer’s Disease (JPAD). http://dx.doi.org/10.14283/jpad.2020.4

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