Sleep EEG and Dementia

 September 28, 2020

Association of Sleep Electroencephalography-Based Brain Age Index With Dementia

Elissa Ye, MSc¹; Haoqi Sun, PhD¹; Michael J. Leone, MSc¹; et alLuis Paixao, MD¹; Robert J. Thomas, MD²; Alice D. Lam, MD, PhD¹; M. Brandon Westover, MD, PhD¹

Author Affiliations Article Information

JAMA Netw Open. 2020;3(9):e2017357. doi:10.1001/jamanetworkopen.2020.17357

Key Points

Question  Can an electroencephalography-based brain age index, calculated as the difference between chronological and estimated brain age through sleep electroencephalography, serve as a potential biomarker associated with dementia?

Findings  This cross-sectional study of 9834 polysomnograms using machine learning found that brain age index increased monotonically from nondementia to dementia subpopulations.

Meaning  These findings suggest that brain age index may be a useful biomarker associated with dementia and could have utility as a screening tool for the presence of underlying neurodegenerative disease and monitoring of disease progression.

Abstract

Importance  Dementia is an increasing cause of disability and loss of independence in the elderly population yet remains largely underdiagnosed. A biomarker for dementia that can identify individuals with or at risk for developing dementia may help close this diagnostic gap.

Objective  To investigate the association between a sleep electroencephalography-based brain age index (BAI), the difference between chronological age and brain age estimated using the sleep electroencephalogram, and dementia.

Metformin

 

Endocrinology>Type 2 Diabetes

More Evidence for Cognitive Benefits With Metformin in T2D

— Prospective study followed more than 1,000 older patients for 6 years

by Jeff Minerd, Contributing Writer, MedPage Today September 23, 2020

share to facebook

share to twitter

share to linkedin

email article

In older patients with diabetes, use of metformin was linked with slower cognitive decline and reduced risk of dementia, according to a prospective observational /.../study.

Alzheimer’s Dementia Recognition

Alzheimer’s Dementia Recognition Through Spontaneous Speech: The ADReSS Challenge

A new competition at an international speech A.I. conference hopes to push forward the ability to automatically detect Alzheimer’s dementia after analyzing a clip of a person talking. Startups like Winterlight Labs are also trying to build out this capability.

Frontotemporal Dementia

International view on genetic frontotemporal dementia

Published: Tuesday, December 3, 2019

Frontotemporal dementia is a subtype of neurodegenerative dementia, characterised by progressive changes in behaviour and personality or language difficulties. Frontotemporal dementia has a strong genetic component,1 and microtubule-associated protein tau (MAPT), progranulin (GRN), and chromosome 9 open reading frame 72 (C9orf72) are the most common mutated genes. Patients with this condition show heterogeneity in clinical presentation and a wide variability in age at symptom onset, age at death, and disease duration.

Read more »

Dementia

What Science Tells Us About Preventing Dementia Anne Tergesen, The Wall Street Journal There are no instant, miracle cures. But recent studies suggest we have more control over our cognitive health than we might think. It just takes some effort. Read this story now »

Predicting Alzheimer's-like memory loss before it strikes

https://www.nsf.gov/news/mmg/media/images/alzheimers_f.jpgAlzheimer's disease findings could open new treatment possibilities
More at https://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=299642&WT.mc_id=USNSF_1

This is a Research News item.

Alzheimer Disease and Dementia

CME ELERT/11.01.19

	Webcast | Credits: 1.00 | Expires 8/31/2021 Addressing Challenges in Alzheimer’s Disease Atri et al In a series of brief video segments, experts in neurology, psychiatry, and primary care discuss the diagnosis and treatment of Alzheimer’s disease. Supported by educational grants from ACADIA Pharmaceuticals Inc.; Allergan; Avanir Pharmaceuticals, Inc.; and Biogen MA, Inc.

	Brief Report | Credits: 1.00 | Expires 2/28/2021 Disclosure of Dementia Diagnosis Goldfarb et al Disclosing a diagnosis of dementia can be one of the most challenging aspects of care for clinicians. But doing so in a timely fashion benefits patients and their care partners. In this CME activity, learn about using patient-centered communication and following a structured process to disclose the diagnosis. Supported by educational grants from ACADIA Pharmaceuticals Inc.; Allergan; Avanir Pharmaceuticals, Inc.; and Biogen MA, Inc.

Brief Report | Credits: 1.50 | Expires 6/30/2021 Cognitive Assessment for Alzheimer’s Disease Shaughnessy et al Meaningful benefits can be derived from the evaluation of cognition in older adults when there is possible cognitive impairment and dementia. In this CME activity, experts explain how brief cognitive assessment tools and neuropsychological evaluations can aid diagnosis and inform a management plan. Supported by educational grants from ACADIA Pharmaceuticals Inc.; Allergan; Avanir Pharmaceuticals, Inc.; and Biogen MA, Inc.

Dementia

October 22/29, 2019

Diagnosis and Management of Dementia: Review  Download PDF

Zoe Arvanitakis, MD, MS^1,2; Raj C. Shah, MD^1,3; David A. Bennett, MD^1,2

Author Affiliations Article Information

JAMA. 2019;322(16):1589-1599. doi:10.1001/jama.2019.4782

Abstract

Importance  Worldwide, 47 million people live with dementia and, by 2050, the number is expected to increase to 131 million.

Observations  Dementia is an acquired loss of cognition in multiple cognitive domains sufficiently severe to affect social or occupational function. In the United States, Alzheimer disease, one cause of dementia, affects 5.8 million people. Dementia is commonly associated with more than 1 neuropathology, usually Alzheimer disease with cerebrovascular pathology. Diagnosing dementia requires a history evaluating for cognitive decline and impairment in daily activities, with corroboration from a close friend or family member, in addition to a thorough mental status examination by a clinician to delineate impairments in memory, language, attention, visuospatial cognition such as spatial orientation, executive function, and mood. Brief cognitive impairment screening questionnaires can assist in initiating and organizing the cognitive assessment. However, if the assessment is inconclusive (eg, symptoms present, but normal examination findings), neuropsychological testing can help determine whether dementia is present. Physical examination may help identify the etiology of dementia. For example, focal neurologic abnormalities suggest stroke. Brain neuroimaging may demonstrate structural changes including, but not limited to, focal atrophy, infarcts, and tumor, that may not be identified on physical examination. Additional evaluation with cerebrospinal fluid assays or genetic testing may be considered in atypical dementia cases, such as age of onset younger than 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory. For treatment, patients may benefit from nonpharmacologic approaches, including cognitively engaging activities such as reading, physical exercise such as walking, and socialization such as family gatherings. Pharmacologic approaches can provide modest symptomatic relief. For Alzheimer disease, this includes an acetylcholinesterase inhibitor such as donepezil for mild to severe dementia, and memantine (used alone or as an add-on therapy) for moderate to severe dementia. Rivastigmine can be used to treat symptomatic Parkinson disease dementia.

Conclusions and Relevance  Alzheimer disease currently affects 5.8 million persons in the United States and is a common cause of dementia, which is usually accompanied by other neuropathology, often cerebrovascular disease such as brain infarcts. Causes of dementia can be diagnosed by medical history, cognitive and physical examination, laboratory testing, and brain imaging. Management should include both nonpharmacologic and pharmacologic approaches, although efficacy of available treatments remains limited.

Dementia

Diagnosis and Management of Dementia: Review

Zoe Arvanitakis, MD, MS^1,2; Raj C. Shah, MD^1,3; David A. Bennett, MD^1,2

Author Affiliations Article Information

JAMA. 2019;322(16):1589-1599. doi:10.1001/jama.2019.4782

Abstract

Importance  Worldwide, 47 million people live with dementia and, by 2050, the number is expected to increase to 131 million.

Observations  Dementia is an acquired loss of cognition in multiple cognitive domains sufficiently severe to affect social or occupational function. In the United States, Alzheimer disease, one cause of dementia, affects 5.8 million people. Dementia is commonly associated with more than 1 neuropathology, usually Alzheimer disease with cerebrovascular pathology. Diagnosing dementia requires a history evaluating for cognitive decline and impairment in daily activities, with corroboration from a close friend or family member, in addition to a thorough mental status examination by a clinician to delineate impairments in memory, language, attention, visuospatial cognition such as spatial orientation, executive function, and mood. Brief cognitive impairment screening questionnaires can assist in initiating and organizing the cognitive assessment. However, if the assessment is inconclusive (eg, symptoms present, but normal examination findings), neuropsychological testing can help determine whether dementia is present. Physical examination may help identify the etiology of dementia. For example, focal neurologic abnormalities suggest stroke. Brain neuroimaging may demonstrate structural changes including, but not limited to, focal atrophy, infarcts, and tumor, that may not be identified on physical examination. Additional evaluation with cerebrospinal fluid assays or genetic testing may be considered in atypical dementia cases, such as age of onset younger than 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory. For treatment, patients may benefit from nonpharmacologic approaches, including cognitively engaging activities such as reading, physical exercise such as walking, and socialization such as family gatherings. Pharmacologic approaches can provide modest symptomatic relief. For Alzheimer disease, this includes an acetylcholinesterase inhibitor such as donepezil for mild to severe dementia, and memantine (used alone or as an add-on therapy) for moderate to severe dementia. Rivastigmine can be used to treat symptomatic Parkinson disease dementia.

Conclusions and Relevance  Alzheimer disease currently affects 5.8 million persons in the United States and is a common cause of dementia, which is usually accompanied by other neuropathology, often cerebrovascular disease such as brain infarcts. Causes of dementia can be diagnosed by medical history, cognitive and physical examination, laboratory testing, and brain imaging. Management should include both nonpharmacologic and pharmacologic approaches, although efficacy of available treatments remains limited.

Dementia and Anticholinergics

Anticholinergic Drug Exposure and the Risk of DementiaA Nested Case-Control Study

Carol A. C. Coupland, PhD¹; Trevor Hill, MSc¹; Tom Dening, MD²; et alRichard Morriss, MD²; Michael Moore, MSc³; Julia Hippisley-Cox, MD^1,4

Author Affiliations Article Information

JAMA Intern Med. 2019;179(8):1084-1093. doi:10.1001/jamainternmed.2019.0677

editorial comment icon 

Editorial

Comment

Conclusions and Relevance  Exposure to several types of strong anticholinergic drugs is associated with an increased risk of dementia. These findings highlight the importance of reducing exposure to anticholinergic drugs in middle-aged and older people.

Introduction

An estimated 47 million people worldwide were living with dementia in 2015,¹ while in the United States around 5.7 million people have Alzheimer dementia.² Modifiable risk factors, including hypertension, hearing loss, depression, diabetes, and smoking, account for around 35% of dementia cases.¹ Anticholinergic drugs are another potentially modifiable risk factor. This broad group of drugs acts by blocking the neurotransmitter acetylcholine in the central and peripheral nervous system and includes some antihistamines, antidepressants, and medications for gastrointestinal and bladder disorders. These medicines can have short-term adverse effects, including confusion and memory loss in older people,^3-6 but it is less certain whether long-term use increases the risk of dementia.

Cognitive Screening

AAN Recommends Annual Cognitive Screening for Adults 65+

— New metrics recommend physicians measure how frequently they complete yearly cognitive screenings

by Judy George, Senior Staff Writer, MedPage TodaySeptember 18, 2019

Anticholinergic and Dementia

June 24, 2019

Anticholinergic Drug Exposure and the Risk of DementiaA Nested Case-Control Study

Carol A. C. Coupland, PhD¹; Trevor Hill, MSc¹; Tom Dening, MD²; et alRichard Morriss, MD²; Michael Moore, MSc³; Julia Hippisley-Cox, MD^1,4

Author Affiliations Article Information

JAMA Intern Med. 2019;179(8):1084-1093. doi:10.1001/jamainternmed.2019.0677

editorial comment icon 

Editorial

Comment

Key Points

Question  Is the risk of dementia among persons 55 years or older associated with the use of different types of anticholinergic medication?

Findings  In this nested case-control study of 58 769 patients with a diagnosis of dementia and 225 574 matched controls, there were statistically significant associations of dementia risk with exposure to anticholinergic antidepressants, antiparkinson drugs, antipsychotic drugs, bladder antimuscarinics, and antiepileptic drugs after adjusting for confounding variables.

Hearing loss

July 31, 2019

Association of Hearing Loss With Dementia

Chin-Mei Liu, PhD^1,2; Charles Tzu-Chi Lee, PhD¹

Author Affiliations Article Information

JAMA Netw Open. 2019;2(7):e198112. doi:10.1001/jamanetworkopen.2019.8112

Key Points Español  中文 (Chinese)

Question  What is the association of hearing loss with future incident dementia in the general population of Taiwan?

Findings  In this population-based matched cohort study of 16 270 participants, hearing loss was positively associated with incident dementia, especially in patients aged 45 to 64 years.

Meaning  Hearing loss is associated with a higher risk of dementia, and findings suggest that hearing protection, screening, and treatment may be used as strategies to mitigate this potential risk factor.

Abstract

Importance  Hearing loss (HL) may be a modifiable risk factor for dementia, and longitudinal studies are needed to examine the association of HL and dementia.

Objective  To investigate the association of HL with incident dementia in Taiwanese adults in the general population.

Design, Setting, and Participants  This population-based cohort study collected data from the National Health Insurance Research Database of Taiwan. Patients newly diagnosed with HL from January 1, 2000, through December 31, 2011 (n = 8135), constituted the exposed (HL) group. The HL group patients were matched by sex, age, residence, and insurance premium to individuals without HL (non-HL group) (n = 8135). Data were analyzed from January 1, 2000, to December 31, 2013.

Exposure  Hearing loss defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Main Outcomes and Measures  Dementia classified according to ICD-9-CM codes.

Results  Of a total of 16 270 participants (9286 [57.1%] men; mean [SD] age, 65.2 [11.1] years), 1868 developed dementia. The dementia incidence rate in the HL group was higher than that in the non-HL group (19.38 [95% CI, 18.25-20.57] per 1000 person-years vs 13.98 [95% CI, 13.01-15.00] per 1000 person-years) during the follow-up period. In the fully adjusted multivariate Cox proportional hazards regression model applied for risk analysis, patients with HL had a significant risk of dementia (hazard ratio [HR], 1.17; 95% CI, 1.07-1.29; false discovery rate [FDR] P = .003). Subgroup analysis revealed that, among 3 age groups (45-64, 65-74, and ≥75 years), the group aged 45 to 64 years was associated with a risk of dementia (HR, 2.21 [95% CI, 1.57-3.12]; FDR P < .001). In sensitivity analysis, the presence of HL among those aged 45 to 64 years (HR, 1.40; 95% CI, 1.12-1.75; FDR P = .01) was associated with a risk of dementia.

Conclusions and Relevance  In this study, hearing loss was positively associated with a risk of dementia, especially in patients aged 45 to 64 years. Hearing protection, screening, and treatment may be used as strategies for mitigating this potential risk factor.