Risk factors for dementia diagnosis

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The July International Psychogeriatrics Article of the Month is entitled “Risk factors for dementia diagnosis in German primary care practices” by Anke Booker, Louis EC Jacob, Michael Rapp, Jens Bohlken and Karel Kostev. This blog piece was written for us by one of the paper’s authors, Karel Kostev.

A number of factors are associated with the risk of developing dementia, for example, it is well known that the risk of developing this disease is higher in the elderly. Several previous works were controversial and partly focused on a low number of patients. We analyzed the association of different potential risk factors with the risk of developing dementia in German primary care practices.

Based on the large database with electronic medical records we selected 11,956 patients with an initial diagnosis of dementia between January 2010 and December 2014. To have a comparison group, 11,956 controls without dementia were also included and were matched with cases on the basis of age, sex, type of health insurance and physician.
For each patient we selected several disorders potentially associated with dementia based on primary care diagnoses. We used a multivariate regression model and could see that the risk of dementia increased significantly in connection with the following variables: diabetes, lipid metabolism, stroke, Parkinson’s disease, intracranial injury, coronary heart disease, mild cognitive impairment, and mental and behavioral disorders due to alcohol use. Conversely, the risk of dementia decreased with the use of statins, proton-pump inhibitors and antihypertensive drugs.

What are the main strengths of the study? We analyzed the ‘real life’ data from the clinical practice including all possible high risk patients who would be excluded from clinical trials. Further strengths are the high number of patients and the number of primary diagnoses included in the statistical analysis.

Many of these factors are already known so why is this research important? We analyzed patients who visited primary care physicians. The study results clearly highlighted the importance of personalized follow-up by the physicians on patients not only with high risk diagnoses for dementia like mild cognitive impairment but also diabetes or cardiovascular diseases to try to prevent or delay dementia.

The full paper “Risk factors for dementia diagnosis in German primary care practices” is available free of charge for a limited time here.

The commentary paper “Clarifying dementia risk factors: treading in murky waters” by Halima Amjad and Esther S. Oh is also available free of charge for a limited time here.

Variability in estimating the self-awareness of memory deficits

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The March International Psychogeriatrics Article of the Month is entitled ‘Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease’ by Johann Lehrner, Sandra Kogler, Claus Lamm, Doris Moser, Stefanie Klug, Gisela Pusswald, Peter Dal-Bianco, Walter Pirker and Eduard Auff

As the world population ages, we face sharp rises in prevalence rates for neurodegenerative diseases. In order to minimize entailing individual and societal burdens, early diagnosis is becoming increasingly important. Efforts to enable early recognition of impending cognitive decline led to the development of the concept of Mild Cognitive Impairment (MCI), which describes a transitional stage between normal age-related memory decline and dementia. Yet, not all individuals diagnosed with MCI can be considered as being in a prodromal phase of dementia. Accordingly, ongoing research is now focusing on the identification of (a) those individuals with MCI who are most likely to convert to dementia and (b) asymptomatic individuals in a pre-MCI stage. Yet, which early markers are available for their identification?

With some evidence pointing towards a connection between low memory awareness – an inability to (fully) recognize memory deficits – and subsequent memory decline, awareness measures bear potential as an important marker of underlying dementia pathologies. However, as research in this field is defined by inconsistencies, this hypothesis needs further investigation.

We therefore used data concerning our patients’ subjective memory appraisals and objective memory performance to create an awareness index, which allowed us to compare levels of awareness (and frequencies of memory overestimation) across healthy elderly people and patients with varying degrees of memory impairment. Our question was whether our approach would reveal characteristic awareness differences similar to prior research.

As expected, our findings suggest that self-awareness of memory deficits decreases as cognitive deficits – especially memory deficits – increase. Accordingly, the highest rate of overestimation of memory function was found among patients suffering from Alzheimer’s disease (63%), followed by amnestic MCI patients without and with Parkinson’s disease (46%, 38%), while patients with cognitive deficits other than memory (non-amnestic MCI) showed a tendency towards underestimation of memory function. Our analyses further revealed considerable between-group overlaps in awareness scores and strong influences of non-cognitive factors such as depression.

The main implication of our study is that memory awareness reflects objective deterioration to some extent, but that there is considerable inter-individual variability in awareness. It is this variability which gives rise to the question whether differences in awareness are predictive of future conversion to dementia.

We hold the view that research in this field is important insofar as awareness measures are of high practical relevance: As opposed to biomarkers and neuroimaging technologies, which are of restricted availability in primary care settings, both measures of subjective memory complaint and objective memory performance provide easily, time- and cost efficiently accessible sources of information. Moreover, they count among the standard repertoire of diagnosis in MCI and other dementia-related diseases. Researchers could use these data to further explore the diagnostic and predictive validity of awareness measures. We hope that our work inspires further research concerning memory awareness and strongly welcome any comments and remarks.

The full paper “Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease” is available free of charge for a limited time here.

The commentary on the paper, “Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease” is also available free of charge here.

Remembrance of Things Past: Revisiting Ethics in New Fetal Tissue Transplant Studies

Blog post by Jonathan Kimmelman, Assistant Professor, Biomedical Ethics Unit/Social Studies of Medicine, McGill University, Quebec, Canada

In a recent article in Science magazine, Constance Holden reports that European researchers are contemplating a revival of fetal tissue transplantation for the treatment of Parkinson’s disease. As the article recounts, fetal transplants were subjected to sham controlled studies in the late 1990s; none performed better than sham, and several caused disabling dyskinesias. So should fetal tissue transplantation be revived, and if so, how?
The challenges seem all the more formidable today. We now understand that Parkinson’s disease is not restricted to the dopaminergic neurons in the basal ganglia, but instead involves diffuse pathology. And yet, studies will not involve implantation of tissues throughout the brain. As Holden’s article points out, previous fetal transplant studies revealed that brain pathology spreads to implanted tissues, suggesting that permanent responses may be difficult to achieve.

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A Meeting of Minds – Cambridge Clinical Neuroscience and Mental Health Symposium

Blog Post by Jenny Ridge, Academic & Professional Marketing, Medicine

neuroscience logoThe Cambridge Clinical Neuroscience and Mental Health Symposium starts today, with Press authors ready to speak on the most up-to-date research.

Organised by Cambridge Neuroscience, whose mission is to increase our fundamental understanding of brain function and enhance quality of life, the Symposium is a highly significant event for all neuroscientists. The Symposium connects the varied and vast areas of neuroscience research and teaching that takes place across the University of Cambridge and affiliated institutions and is vital to furthering the aims of Cambridge Neuroscience.

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