Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission

The Lancet, Journal Year: 2024, Volume and Issue: 404(10452), P. 572 - 628

Published: July 31, 2024

Language: Английский

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Dementia Prevention and Treatment

JAMA Internal Medicine, Journal Year: 2024, Volume and Issue: 184(5), P. 563 - 563

Published: March 4, 2024

Importance Dementia affects 10% of those 65 years or older and 35% 90 older, often with profound cognitive, behavioral, functional consequences. As the baby boomers subsequent generations age, effective preventive treatment strategies will assume increasing importance. Observations Preventive measures are aimed at modifiable risk factors, many which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions any kind can prevent dementia. Nevertheless, addressing factors may other health benefits should be considered. Alzheimer disease treated cholinesterase inhibitors, memantine, antiamyloid immunomodulators, last modestly slowing cognitive decline in people mild impairment dementia due to disease. Cholinesterase inhibitors memantine benefit persons types dementia, including Lewy bodies, Parkinson vascular traumatic brain injury. Behavioral psychological symptoms best nonpharmacologic management, identifying mitigating underlying causes individually tailored behavioral approaches. Psychotropic medications minimal evidence efficacy for treating these associated increased mortality clinically meaningful risks falls decline. Several emerging prevention hold promise improve care future. Conclusions Relevance Although current approaches less than optimally successful, substantial investments research undoubtedly provide new answers reducing burden worldwide.

Language: Английский

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Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial

Alzheimer s Research & Therapy, Journal Year: 2024, Volume and Issue: 16(1)

Published: June 7, 2024

Abstract Background Evidence links lifestyle factors with Alzheimer’s disease (AD). We report the first randomized, controlled clinical trial to determine if intensive changes may beneficially affect progression of mild cognitive impairment (MCI) or early dementia due AD. Methods A 1:1 multicenter randomized phase 2 trial, ages 45-90 MCI AD and a Montreal Cognitive Assessment (MoCA) score 18 higher. The primary outcome measures were in cognition function tests: Clinical Global Impression Change (CGIC), Disease Scale (ADAS-Cog), Dementia Rating–Sum Boxes (CDR-SB), Rating (CDR-G) after 20 weeks an multidomain intervention compared wait-list usual care control group. ADAS-Cog, CDR-SB, CDR-Global scales using Mann-Whitney-Wilcoxon rank-sum test, CGIC was Fisher’s exact test. Secondary outcomes included plasma Aβ42/40 ratio, other biomarkers, correlating degree change these measures. Results Fifty-one patients enrolled, mean age 73.5. No significant differences any at baseline. Only two withdrew. All had ratios <0.0672 baseline, strongly supporting diagnosis. After weeks, between-group ( p = 0.001), CDR-SB 0.032), CDR 0.037) tests borderline significance ADAS-Cog test 0.053). CGIC, Global, showed improvement significantly less progression, group which worsened all four ratio increased decreased 0.003). There correlation between both ratio. microbiome improved only <0.0001). Conclusions Comprehensive improve many Trial registration Approved by Western Institutional Review Board on 12/31/2017 (#20172897) Boards sites. This study registered retrospectively clinicaltrials.gov October 8, 2020 (NCT04606420, ID: 20172897).

Language: Английский

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Japan‐Multimodal Intervention Trial for the Prevention of Dementia: A randomized controlled trial

Alzheimer s & Dementia, Journal Year: 2024, Volume and Issue: 20(6), P. 3918 - 3930

Published: April 22, 2024

We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild impairment (MCI).

Language: Английский

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An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial

Nature Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 28, 2025

Language: Английский

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Vascular cognitive impairment and dementia: Mechanisms, treatment, and future directions

International Journal of Stroke, Journal Year: 2024, Volume and Issue: 19(8), P. 838 - 856

Published: Sept. 16, 2024

Worldwide, around 50 million people live with dementia, and this number is projected to triple by 2050. It has been estimated that 20% of all dementia cases have a predominant cerebrovascular pathology, while perhaps another vascular diseases contribute mixed picture. Therefore, the contribution affects 20 currently will increase markedly in next few decades, particularly lower- middle-income countries. In review, we discuss mechanisms cognitive impairment (VCI) review management. VCI refers spectrum pathologies any degree impairment, ranging from subjective decline, mild dementia. While acute decline occurring soon after stroke most recognized form VCI, chronic disease, particular cerebral small-vessel can cause insidious absence stroke. Moreover, disease not only commonly co-occurs Alzheimer’s (AD) increases probability AD pathology result clinical but may also etiologically development pathologies. Despite its enormous health economic impact, neglected research area, adequately powered trials therapies, resulting proven treatments. Current management emphasizes prevention treatment risk factors, evidence for intensive hypertension control. Reperfusion therapies attenuate VCI. Associated behavioral symptoms such as apathy poststroke emotionalism are common. We highlight novel strategies hopefully lead new course-modifying therapies. Finally, importance including endpoints large cardiovascular need an increased focus funding important area.

Language: Английский

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Limited generalizability and high risk of bias in multivariable models predicting conversion risk from mild cognitive impairment to dementia: A systematic review

Alzheimer s & Dementia, Journal Year: 2025, Volume and Issue: 21(4)

Published: April 1, 2025

Abstract Prediction models have been developed to identify mild cognitive impairment (MCI) cases likely convert dementia. This systematic review summarizes multi‐source prediction for MCI dementia conversion. PubMed and Embase were searched model development validation studies from inception up January 18 2024. Models assessed included predictors, predictive performance, risk of bias, generalizability. 62 included: 41 machine learning models, 11 regression 5 disease state indexes. The number predictors in the ranged 2 60; magnetic resonance imaging (MRI) scores most common sources. Performance measures indicate reasonable capabilities (area under curve [AUC] range: 0.58–0.98, accuracy 66.1–96.3%); however, are at high bias 47 lack external validation. Currently, no highly valid is available conversion due limited generalizability studies. Highlights Numerous predict likelihood individuals with MCI. seem a reasonably good performance predicting dementia, often lacking. There low that has externally validated accurately For more emphasis should be directed towards validation, generalizability, clinical applicability.

Language: Английский

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Factors Affecting Resilience and Prevention of Alzheimer's Disease and Related Dementias

Annals of Neurology, Journal Year: 2024, Volume and Issue: 96(4), P. 633 - 649

Published: Aug. 17, 2024

Alzheimer's disease (AD) is a devastating, age‐associated neurodegenerative disorder and the most common cause of dementia. The clinical continuum AD spans from preclinical to subjective cognitive decline, mild impairment, dementia stages (mild, moderate, severe). Neuropathologically, defined by accumulation amyloid β (Aβ) into extracellular plaques in brain parenchyma cerebral vasculature, abnormally phosphorylated tau that accumulates intraneuronally forming neurofibrillary tangles (NFTs). Development treatment approaches prevent or even reduce decline because has been slow compared other major causes death. Recently, United States Food Drug Administration gave full approval 2 different Aβ‐targeting monoclonal antibodies. However, this breakthrough modifying approach only applies limited subset patients there are stringent eligibility criteria. Furthermore, these do not progression disease, AD‐related pathologies, such as NFTs, directly targeted. A non‐mutually exclusive alternative address lifestyle interventions can help risk dementias (ADRD). It estimated addressing modifiable factors could potentially delay up 40% AD/ADRD cases. In review, we discuss some many may be associated with prevention and/or increasing resilience, well interact influence progression. [Color figure viewed at www.annalsofneurology.org ] ANN NEUROL 2024;96:633–649

Language: Английский

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Effect of long-term physical exercise and multidomain interventions on cognitive function and the risk of mild cognitive impairment and dementia in older adults: a systematic review with meta-analysis

Ageing Research Reviews, Journal Year: 2024, Volume and Issue: 100, P. 102463 - 102463

Published: Aug. 23, 2024

Language: Английский

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Age-associated dementia among older people aging with HIV in the United States: a modeling study

AIDS, Journal Year: 2024, Volume and Issue: 38(8), P. 1186 - 1197

Published: Feb. 7, 2024

Objective: Almost 400 000 people with HIV (PWH) in the United States are over age 55 years and at risk for age-associated dementias (AAD), including Alzheimer's disease vascular contributions to cognitive impairment dementia (VCID). We projected cumulative incidence mortality associated AAD among PWH least 60 compared general population. Design/methods: Integrating CEPAC AgeD-Pol models, we simulated two cohorts of 60-year-old male female individuals: PWH, US estimated AAD-associated rates. Projected outcomes included incidence, life expectancy, quality-adjusted life-years (QALYs). performed sensitivity scenario analyses on AAD-specific (e.g. incidence) HIV-specific disengagement from care) parameters, as well premature aging PWH. Results: that 22.1%/16.3% individuals/female individuals would develop by 80 15.9%/13.3% Accounting dementia-associated quality life, have a lower expectancy (QALYs): 17.4 (14.1 QALYs) 16.8 (13.4 individuals, respectively, population [male 21.7 (18.4 QALYs); 24.7 (20.2 QALYs)]. was most sensitive non-HIV-related mortality, engagement care, Conclusion: estimates morbidity, can inform decision-makers health systems planning ages. Improved prevention, treatment, supportive care critical HIV.

Language: Английский

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