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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Delirium, neurofilament light chain, and progressive cognitive impairment: analysis of a prospective Norwegian population-based cohort

The Lancet Healthy Longevity, Journal Year: 2023, Volume and Issue: 4(8), P. e399 - e408

Published: July 14, 2023

BackgroundPrevious population-based, longitudinal studies have shown that delirium is associated with an increased risk of dementia and cognitive decline. However, the underlying biological mechanisms are largely unknown. We aimed to assess effects on both trajectories any neuronal injury, measured via neurofilament light chain (NfL).MethodsIn this analysis a prospective, 2-year follow-up, cohort study participants aged 65 years or older living in Sandefjord municipality, Norway, we included who were receiving domiciliary care services at least once per week between May 12, 2015, July 8, 2016. Individuals life expectancy less than 1 week, Lewy body dementia, psychiatric illness (except dementia), for whom substance misuse was principal indication excluded. Participants had comprehensive assessment 6-month intervals 2 years, which Montreal Cognitive Assessment (MoCA) blood sample NfL measure injury. All information clinical diagnoses medications cross-referenced medical records. During acute change mental status hospitalisation (ie, admission hospital), assessed day Diagnostic Statistical Manual Mental Disorders, fifth edition criteria. also from samples taken acutely hospitalised.FindingsBetween 2016, 210 eligible inclusion baseline (138 [66%] female 72 [34%] male), 203 completed assessment, 141 followed up years. 160 (76%) moderate severe frailty 112 (53%) dementia. 89 (42%) diagnosed one more episodes delirium. Incident independently decrease MoCA score next even after adjustment age, sex, education, previous score, (adjusted mean difference –1·5, 95% CI –2·9 –0·1). found interaction (β –0.254, –0·441 –0·066, p=0·010.), largest decline being observed people better cognition. good function high peak concentration during follow-up. Mediation analyses showed independent pathways follow-up contributions incident (–1·7, –2·8 –0·6) concentrations (–1·8, –2·5 –1·1). Delirium directly linked predicted value 1·2 pg/mL (95% 1·02 1·40, p=0·029) increase NfL.InterpretationIn older, episode score. Greater injury delirium, by NfL, greater For clinicians, our finding signs important regarding long-term deterioration acknowledge harmful brain.FundingSouth-Eastern Norway Health Authorities, Old Age Psychiatry Research Network, Telemark Hospital Trust, Vestfold Norwegian National Centre Ageing Health.TranslationFor translation abstract see Supplementary Materials section.

Language: Английский

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Persistent delirium is associated with cerebrospinal fluid markers of neuronal injury

Brain Communications, Journal Year: 2024, Volume and Issue: 6(5)

Published: Jan. 1, 2024

Abstract Delirium is associated with the risk of future long-term cognitive impairment, but degree to which markers neuronal injury may be distinct or shared dementia has yet comprehensively described. We investigated CSF biomarkers dementia, astrocytosis and damage in a clinical cohort persistent delirium, comparing them an outpatient memory clinic sample. Our aim was determine if different patterns biomarker changes could implicate specific mechanisms for delirium-related over above that attributable comorbid dementia. recruited 35 participants from Prince Wales Hospital, Sydney, Australia. included inpatients delirium persisting at least 5 days (n = 15, 10 underlying dementia) clinics 20, 17 dementia). assays were as follows: amyloid-β42, amyloid-β40, phosphorylated tau181, neurofilament light chain glial fibrillary acidic protein. used propensity score matching estimate effect sizes each standardized separately (irrespective superimposed delirium). Compared individuals without elevated protein (normalized coefficient per transformed standard deviation, β 0.85; 95% confidence interval: 0.03–1.68) (β 1.1; 0.5–1.6), not tau181. protein, tau181 all increased expected levels cases, former two comparable those seen [glial 1.54; 1.05–2.0) 0.65; 0.24–1.1)]. Persistent linked necessarily These findings support potential direct independent pathophysiology. Whether this involves astrocyte dysfunction axonal are both possibilities. Future work examining acute brain needed.

Language: Английский

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Impact of dementia and mild cognitive impairment on bone health in older people

Aging Clinical and Experimental Research, Journal Year: 2024, Volume and Issue: 37(1)

Published: Dec. 27, 2024

Mild cognitive impairment, dementia and osteoporosis are common diseases of ageing and, with the increasingly global population, increasing in prevalence. These conditions closely associated, shared risk factors, underlying biological mechanisms potential direct causal pathways. In this review, epidemiological mechanistic links between mild skeletal health explored. Discussion will focus on how changes brain bone signalling can underly associations these conditions, consider molecular cellular drivers context inflammation gut microbiome. There is a complex interplay nutritional changes, which may precede or follow onset impairment (MCI) dementia, health. Polypharmacy patients MCI there difficult prescribing decisions to be made due elevated falls associated many drugs used for problems, consequently increase fracture risk. Some medications prescribed directly impact addition, have difficulty remembering medication without assistance, meaning that but not taken. Cognitive improved delayed by physical activity exercise, evidence additional benefits fractures. Research gaps priorities aim reducing burden fractures people also discussed.

Language: Английский

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Can admission Braden skin score predict delirium in older adults in the intensive care unit? Results from a multicenter study

Journal of Clinical Nursing, Journal Year: 2023, Volume and Issue: 33(6), P. 2209 - 2225

Published: Dec. 10, 2023

Abstract Aims and Objectives To investigate whether a low Braden Skin Score (BSS), reflecting an increased risk of pressure injury, could predict the delirium in older patients intensive care unit (ICU). Background Delirium, common acute encephalopathy syndrome ICU patients, is associated with prolonged hospital stay, long‐term cognitive impairment mortality. However, few studies have explored relationship between BSS delirium. Design Multicenter cohort study. Methods The study included 24,123 adults from Medical Information Mart for Intensive Care IV (MIMIC‐IV) database 1090 eICU Collaborative Research Database (eICU‐CRD), all whom had record on admission to ICU. We used structured query language extract relevant data electronic health records. primary outcome, was primarily diagnosed by Confusion Assessment Method or Delirium Screening Checklist. Logistic regression models were validate association outcome. A STROBE checklist reporting guide this Results median age within MIMIC‐IV eICU‐CRD databases approximately 77 75 years, respectively, 11,195 (46.4%) 524 (48.1%) being female. at enrollment both 15 (interquartile range: 13, 17). Multivariate logistic showed negative prevalence Similar patterns found database. Conclusions This significant patients. Relevance Clinical Practice BSS, which simple accessible, may reflect frailty It recommended that assessment be as essential component management strategies No Patient Public Contribution retrospective study, no public involved design conduct

Language: Английский

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Delirium

Springer eBooks, Journal Year: 2024, Volume and Issue: unknown, P. 377 - 385

Published: Jan. 1, 2024

Language: Английский

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Association of Hippocampus volume with normal serum Natrium levels and predictive analyses of cognitive adversities in non-demented middle-aged and older adults

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 4, 2024

Abstract Introduction Serum Natrium abnormalities are largely observed in older adults and associated with higher risks. Less is known about the association between serum variations medial temporal brain structures, mainly involved cognition memory. The study’s objective was to explore Hippocampus volume assess cognitive Methods Non-demented ADNI3 participants (healthy controls (HC) mild impairment (MCI)) complete Natrium, ADAS 13 score, at baseline were included. Linear non-linear associations evaluated. To odds of MCI, logistic regression adjusted performed. Holm method used adjust for Family-wise error rate main analysis reported as a q -value. Results A total 469 cases median age 70 years (IQR: 66, 76) level 141 139, 142). levels showed significant study population MCI subgroup (Adj. ß =-95 (−162, −28), p =0.006, =0.036). did not show neither ADAS13 score Total =-0.04(−0.28, 0.21), =0.8) nor being diagnosed (OR = 1.00(0.88, 1.13), 0.935). Conclusions Normal significantly volumes depending on underlying neurodegenerative pathology, thus, without predicting clinically relevant adversity. Further studies needed better understand mechanisms protective factors. Key findings within normal ranges volume. particularly impairment. There no score. predict concomitant risk

Language: Английский

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Accumulating the key proteomic signatures associated with delirium: Evidence from systematic review

PLoS ONE, Journal Year: 2024, Volume and Issue: 19(12), P. e0309827 - e0309827

Published: Dec. 19, 2024

Delirium is a severe neuropsychiatric illness that occurs frequently in intensive care and postoperative units which results prolonged hospital stays increases patient’s mortality morbidity rates. This review focused on accumulating the common key proteomic signatures significantly associated with delirium. We carried out systematic literature of studies delirium biomarkers published between 1 st January 2000 31 December 2023 from following electronic bibliographic databases including PubMed, Scopus, EBSCOhost (CINAHL, Medline). A total 1746 were identified reviewed, 78 included our review. The PRISMA guidelines, PEO framework, JBI quality assessment method followed this to maintain inclusion exclusion criteria risk bias assessment. Most cohort (68%) case-control (23%) design. have accumulated 313 proteins or gene encoded 189 unique. Among unique proteins, we top 13 most investigated (IL-6, CRP, IL-8, S100B, IL-10, TNF-a, IL-1b, Cortisol, MCP-1, GFAP, IGF-1, IL-1ra, NFL) are these cytokines inflammatory indicating strong interconnection There was remarkable inconsistency among reporting specific potential biomarker. No single biomarker can be solely used diagnose predict current provides rationale for further molecular investigation delirium-related biomarkers. Also, it’s recommended conduct in-depth research decipher drug target biomolecules prognostic, diagnostic, therapeutic development against

Language: Английский

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The U-shaped curve predicting cognitive vulnerability to delirium severity

Brain, Journal Year: 2023, Volume and Issue: 146(5), P. 1743 - 1744

Published: April 6, 2023

This scientific commentary refers to ‘Extremes of baseline cognitive function determine the severity delirium: a population study’ by Tsui et al. (https://doi.org/10.1093/brain/awad062).

Language: Английский

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