Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

The Lancet, Journal Year: 2020, Volume and Issue: 396(10248), P. 413 - 446

Published: July 30, 2020

should consider dementia in older people without known who have frequent admissions or develop delirium.Delirium is common with and contributes to cognitive decline.In hospital, care including appropriate sensory stimulation, ensuring fluid intake, avoiding infections might reduce delirium incidence.Acting now on prevention, intervention, will vastly improve living dying for individuals their families, thus society.Research UK, would like thank them financial help.These organisations funded the fares, accommodation, food Commission meeting but had no role

Language: Английский

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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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Cognitive training for people with mild to moderate dementia

Cochrane library, Journal Year: 2019, Volume and Issue: unknown

Published: March 25, 2019

Language: Английский

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Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials

Ageing Research Reviews, Journal Year: 2020, Volume and Issue: 66, P. 101232 - 101232

Published: Nov. 26, 2020

Language: Английский

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European Stroke Organisation and European Academy of Neurology joint guidelines on post‐stroke cognitive impairment

European Journal of Neurology, Journal Year: 2021, Volume and Issue: 28(12), P. 3883 - 3920

Published: Sept. 3, 2021

The optimal management of post-stroke cognitive impairment (PSCI) remains controversial. These joint European Stroke Organisation (ESO) and Academy Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making regarding prevention, diagnosis, treatment prognosis.Guidelines were developed according the Grading Recommendations, Assessment, Development Evaluation (GRADE) methodology. working group identified relevant clinical questions, performed systematic reviews, assessed quality available evidence, made specific recommendations. Expert consensus statements provided where insufficient evidence was recommendations.There limited randomized controlled trial (RCT) single or multicomponent interventions prevent decline. Lifestyle treating vascular risk factors have many health benefits, but a effect is not proven. We found no routine screening following stroke, recognize importance targeted assessment. describe accuracy various tests, clearly superior approach testing. There make recommendation for use cholinesterase inhibitors, memantine nootropics rehabilitation. on prediction tools cognition. association between PSCI acute structural brain imaging features unclear, although presence substantial white matter hyperintensities presumed origin magnetic resonance may help predict outcomes.These highlight fundamental areas robust lacking. Further definitive RCTs are needed, we suggest priority future research.

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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A multimodal precision-prevention approach combining lifestyle intervention with metformin repurposing to prevent cognitive impairment and disability: the MET-FINGER randomised controlled trial protocol

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

Published: Jan. 31, 2024

Abstract Background Combining multimodal lifestyle interventions and disease-modifying drugs (novel or repurposed) could provide novel precision approaches to prevent cognitive impairment. Metformin is a promising candidate in view of the well-established link between type 2 diabetes (T2D) Alzheimer’s Disease emerging evidence its potential neuro-protective effects (e.g. vascular, metabolic, anti-senescence). MET-FINGER aims test FINGER 2.0 intervention, combining an updated multidomain intervention with metformin, where appropriate, APOE ε4-enriched population older adults (60–79 years) at increased risk dementia. Methods international randomised, controlled, parallel-group, phase-IIb proof-of-concept clinical trial, metformin included through trial-within-trial design. 600 participants will be recruited three sites (UK, Finland, Sweden). Participants dementia based on vascular factors screening, first randomised (lifestyle + if eligible; active arm) receive regular health advice (control arm). allocated group indicators T2D additionally (2000 mg/day 1000 mg/day) placebo. The study duration years. changes global cognition (primary outcome, using Neuropsychological Test Battery), memory, executive function, processing speed domains; functional status; lifestyle, other dementia-related (secondary outcomes), compared control arm. feasibility, interaction (between-groups differences healthy changes), lifestyle-metformin combination exploratory outcomes. adapted from original trial (diet, physical activity, training, monitoring cardiovascular/metabolic factors, social interaction) consistently delivered countries. administered as Glucophage®XR/SR 500, (500 mg oral tablets). metformin/placebo treatment double blinded. Conclusion putative repurposed drug for impairment prevention. Although preliminary, findings crucial information innovative prevention strategies form basis larger phase-III design future research this field. Trial registration ClinicalTrials.gov (NCT05109169).

Language: Английский

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Toward a theory‐based specification of non‐pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

Alzheimer s & Dementia, Journal Year: 2020, Volume and Issue: 17(2), P. 255 - 270

Published: Nov. 20, 2020

Abstract Introduction Non‐pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues produce mixed results. Methods In current position paper, experts in NPT specified treatment targets, aims, ingredients using an umbrella framework, Rehabilitation Treatment Specification System. Results Experts provided a snapshot authoritative summary of evidence different NPTs based on best synthesis efforts, identified main gaps knowledge relevant barriers, directions future research. trial methodology provide practice principles recommendations those working this area, underscoring importance prespecified protocols. Discussion We conclude that strongly supports various relation their primary discuss opportunities challenges associated unifying theoretical framework guide efforts area.

Language: Английский

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European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

European Stroke Journal, Journal Year: 2021, Volume and Issue: 6(3), P. I - XXXVIII

Published: Sept. 1, 2021

The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and Academy Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment prognosis. were developed according ESO standard operating procedure the Grading Recommendations, Assessment, Development Evaluation (GRADE) methodology. working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses literature, assessed quality available evidence made specific recommendations. Expert consensus statements provided insufficient was based on GRADE approach. There limited randomised controlled trial regarding single or multicomponent interventions prevent decline. Interventions improve lifestyle treat vascular risk factors may have many health benefits but a beneficial effect cognition is not proven. We found no routine screening following stroke recognise importance targeted assessment. described accuracy various tests clearly superior approach testing. make recommendation for use cholinesterase inhibitors, memantine nootropics rehabilitation. prediction tools syndromes (cognitive impairment, dementia delirium). association between most acute structural brain imaging features unclear, although presence substantial white matter hyperintensities presumed origin MRI help predict outcomes. highlighted fundamental areas robust lacking. Further, definitive trials are needed, we suggest priority future research.

Language: Английский

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Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n1804 - n1804

Published: Aug. 18, 2021

Abstract Objectives To examine the association between cognitively stimulating work and subsequent risk of dementia to identify protein pathways for this association. Design Multicohort study with three sets analyses. Setting United Kingdom, Europe, States. Participants Three associations were examined: cognitive stimulation in 107 896 participants from seven population based prospective cohort studies IPD-Work consortium (individual participant data meta-analysis working populations); proteins a random sample 2261 one study; 13 656 two studies. Main outcome measures Cognitive was measured at baseline using standard questionnaire instruments on active versus passive jobs over time job exposure matrix indicator. 4953 plasma samples scanned. Follow-up incident varied 13.7 30.1 years depending cohort. People identified through linked electronic health records repeated clinical examinations. Results During 1.8 million person risk, 1143 people recorded. The found be lower high compared low (crude incidence per 10 000 4.8 group 7.3 group, age sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 0.92, heterogeneity specific estimates I 2 =0%, P=0.99). This robust additional adjustment education, factors adulthood (smoking, heavy alcohol consumption, physical inactivity, strain, obesity, hypertension, prevalent diabetes baseline), cardiometabolic diseases (diabetes, coronary heart disease, stroke) before diagnosis (fully 0.82, 0.68 0.98). also observed during first follow-up (hazard 0.60, 0.37 0.95) year onwards (0.79, 0.66 replicated indicator 1 deviation increase 0.69 0.86). In analysis controlling multiple testing, higher associated levels that inhibit central nervous system axonogenesis synaptogenesis: slit homologue (SLIT2, fully β −0.34, P<0.001), carbohydrate sulfotransferase 12 (CHSTC, −0.33, peptidyl-glycine α-amidating monooxygenase (AMD, −0.32, P<0.001). These increased SD being 1.16 (95% 1.05 1.28) SLIT2, 1.13 (1.00 1.27) CHSTC, 1.04 (0.97 1.13) AMD. Conclusions old than those non-stimulating jobs. findings is potentially synaptogenesis might provide clues underlying biological mechanisms.

Language: Английский

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