scholarly journals Brain Health Services: organization, structure, and challenges for implementation. A user manual for Brain Health Services—part 1 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Daniele Altomare ◽  
José Luis Molinuevo ◽  
Craig Ritchie ◽  
Federica Ribaldi ◽  
Emmanuel Carrera ◽  
...  
Keyword(s):  
Health Services ◽  
Cognitive Performance ◽  
Target Population ◽  
World Health ◽  
Brain Health ◽  
Societal Benefit ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Increased Risk ◽  
Memory Clinics

AbstractDementia has a devastating impact on the quality of life of patients and families and comes with a huge cost to society. Dementia prevention is considered a public health priority by the World Health Organization. Delaying the onset of dementia by treating associated risk factors will bring huge individual and societal benefit. Empirical evidence suggests that, in higher-income countries, dementia incidence is decreasing as a result of healthier lifestyles. This observation supports the notion that preventing dementia is possible and that a certain degree of prevention is already in action. Further reduction of dementia incidence through deliberate prevention plans is needed to counteract its growing prevalence due to increasing life expectancy.An increasing number of individuals with normal cognitive performance seek help in the current memory clinics asking an evaluation of their dementia risk, preventive interventions, or interventions to ameliorate their cognitive performance. Consistent evidence suggests that some of these individuals are indeed at increased risk of dementia. This new health demand asks for a shift of target population, from patients with cognitive impairment to worried but cognitively unimpaired individuals. However, current memory clinics do not have the programs and protocols in place to deal with this new population.We envision the development of new services, henceforth called Brain Health Services, devoted to respond to demands from cognitively unimpaired individuals concerned about their risk of dementia. The missions of Brain Health Services will be (i) dementia risk profiling, (ii) dementia risk communication, (iii) dementia risk reduction, and (iv) cognitive enhancement. In this paper, we present the organizational and structural challenges associated with the set-up of Brain Health Services.

scholarly journals Dementia risk communication. A user manual for Brain Health Services—part 3 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Leonie N. C. Visser ◽  
Carolina Minguillon ◽  
Gonzalo Sánchez-Benavides ◽  
Marc Abramowicz ◽  
Daniele Altomare ◽  
...  
Keyword(s):  
Health Services ◽  
Risk Communication ◽  
Disease Status ◽  
Prevention Programs ◽  
Brain Health ◽  
Individual Level ◽  
Risk Profiling ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
The Impact

AbstractGrowing evidence suggests dementia incidence can be reduced through prevention programs targeting risk factors. To accelerate the implementation of such prevention programs, a new generation of brain health services (BHS) is envisioned, involving risk profiling, risk communication, risk reduction, and cognitive enhancement. The purpose of risk communication is to enable individuals at risk to make informed decisions and take action to protect themselves and is thus a crucial step in tailored prevention strategies of the dementia incidence. However, communicating about dementia risk is complex and challenging.In this paper, we provide an overview of (i) perspectives on communicating dementia risk from an ethical, clinical, and societal viewpoint; (ii) insights gained from memory clinical practice; (iii) available evidence on the impact of disclosing APOE and Alzheimer’s disease biomarker test results gathered from clinical trials and observational studies; (iv) the value of established registries in light of BHS; and (v) practical recommendations regarding effective strategies for communicating about dementia risk.In addition, we identify challenges, i.e., the current lack of evidence on what to tell on an individual level—the actual risk—and on how to optimally communicate about dementia risk, especially concerning worried yet cognitively unimpaired individuals. Ideally, dementia risk communication strategies should maximize the desired impact of risk information on individuals’ understanding of their health/disease status and risk perception and minimize potential harms. More research is thus warranted on the impact of dementia risk communication, to (1) evaluate the merits of different approaches to risk communication on outcomes in the cognitive, affective and behavioral domains, (2) develop an evidence-based, harmonized dementia risk communication protocol, and (3) develop e-tools to support and promote adherence to this protocol in BHSs.Based on the research reviewed, we recommend that dementia risk communication should be precise; include the use of absolute risks, visual displays, and time frames; based on a process of shared decision-making; and address the inherent uncertainty that comes with any probability.

scholarly journals Female sex, early-onset hypertension, and risk of dementia

Neurology ◽  
2017 ◽  
Vol 89 (18) ◽  
pp. 1886-1893 ◽  
Author(s):  
Paola Gilsanz ◽  
Elizabeth Rose Mayeda ◽  
M. Maria Glymour ◽  
Charles P. Quesenberry ◽  
Dan M. Mungas ◽  
...  
Keyword(s):  
Care Delivery ◽  
Early Adulthood ◽  
Health Care Delivery System ◽  
Proportional Hazard ◽  
Brain Health ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Cox Proportional Hazard Models

Objective:To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women.Methods:We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age 32.7 years; early adulthood) and 1978–1985 (mean age 44.3 years; mid-adulthood) and were members as of January 1, 1996 (mean age 59.8 years). Hypertension categories based on measurements of blood pressure (BP) and change in hypertension categories between the 2 examinations (e.g., onset hypertension) were used to predict dementia incidence from January 1, 1996, to September 30, 2015. Cox proportional hazard models were adjusted for demographics, vascular comorbidities, and hypertension treatment; inverse probability weighting accounted for differential attrition between first BP measurement and start of follow-up.Results:A total of 532 individuals (9.4%) were diagnosed with dementia. Early adulthood hypertension was not associated with dementia, though effect estimates were elevated among women. Mid-adulthood hypertension was associated with 65% (95% confidence interval [CI] 1.25–2.18) increased dementia risk among women but not men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women (95% CI 1.24–2.40) compared to stable normotensive. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.Conclusions:Though midlife hypertension was more common in men, it was only associated with dementia risk in women. Sex differences in the timing of dementia risk factors have important implications for brain health and hypertension management.

scholarly journals Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities

2019 ◽  
Vol 75 (9) ◽  
pp. 1983-1995
Author(s):  
Debra Umberson ◽  
Rachel Donnelly ◽  
Minle Xu ◽  
Matthew Farina ◽  
Michael A Garcia
Keyword(s):  
Racial Disparities ◽  
Black Parents ◽  
Black And White ◽  
Death Of A Child ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Increased Risk ◽  
White Parents ◽  
Increase Risk ◽  
Hispanic White

Abstract Objectives This study considers whether experiencing the death of a child prior to midlife (by parental age 40) is associated with subsequent dementia risk, and how such losses, which are more common for black than for white parents, may add to racial disparities in dementia risk. Methods We use discrete-time event history models to predict dementia incidence among 9,276 non-Hispanic white and 2,182 non-Hispanic black respondents from the Health and Retirement Study, 2000–2014. Results Losing a child prior to midlife is associated with increased risk for later dementia, and adds to disparities in dementia risk associated with race. The death of a child is associated with a number of biosocial variables that contribute to subsequent dementia risk, helping to explain how the death of child may increase risk over time. Discussion The death of a child prior to midlife is a traumatic life course stressor with consequences that appear to increase dementia risk for both black and white parents, and this increased risk is explained by biosocial processes likely activated by bereavement. However, black parents are further disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk.

scholarly journals Sibling Death in the Family and Dementia Risk

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 862-863
Author(s):  
Hyungmin Cha ◽  
Patricia Thomas ◽  
Debra Umberson
Keyword(s):  
Life Course ◽  
Hispanic Americans ◽  
Stressful Life Event ◽  
Ethnic Disparities ◽  
Stressful Event ◽  
Sibling Loss ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Increased Risk ◽  
The Life Course

Abstract Growing evidence points to the role of stress in contributing to dementia risk, and experiencing the death of a family member is a particularly stressful life event. Sibling relationships are typically life-long relationships and the death of a sibling is likely to be a stressful event in the life course; however, there is little research illuminating the possible consequences of sibling loss for dementia risk. This study considers whether experiencing the death of a sibling before midlife is associated with subsequent dementia risk and how such losses, which are more common for Black and Hispanic than for White populations, may add to racial/ethnic disparities in dementia risk. We use discrete-time event history models to predict dementia incidence among 9,590 non-Hispanic white, 1,669 non-Hispanic black, and 1,109 Hispanic respondents from the Health and Retirement Study, 2000-2014. Losing a sibling during the observation period is associated with increased risk for later dementia. The death of a sibling is robust to the inclusion of a variety of biosocial factors that contribute to subsequent dementia risk. The death of a sibling is a life course event with consequences that appear to increase dementia risk for Black and Hispanic older adults, and this increased risk is explained by biosocial processes likely activated by bereavement. However, Black and Hispanic Americans are further disadvantaged in that they are more likely than White Americans to experience the death of a sibling, and such losses add to the already substantial racial disadvantage in dementia risk.

scholarly journals Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Janice M. Ranson ◽  
Timothy Rittman ◽  
Shabina Hayat ◽  
Carol Brayne ◽  
Frank Jessen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Services ◽  
Risk Reduction ◽  
Initial Assessment ◽  
Modifiable Risk Factors ◽  
Brain Health ◽  
Local Resources ◽  
Risk Profiling ◽  
Dementia Risk ◽  
Personalized Risk

AbstractWe envisage the development of new Brain Health Services to achieve primary and secondary dementia prevention. These services will complement existing memory clinics by targeting cognitively unimpaired individuals, where the focus is on risk profiling and personalized risk reduction interventions rather than diagnosing and treating late-stage disease. In this article, we review key potentially modifiable risk factors and genetic risk factors and discuss assessment of risk factors as well as additional fluid and imaging biomarkers that may enhance risk profiling. We then outline multidomain measures and risk profiling and provide practical guidelines for Brain Health Services, with consideration of outstanding uncertainties and challenges. Users of Brain Health Services should undergo risk profiling tailored to their age, level of risk, and availability of local resources. Initial risk assessment should incorporate a multidomain risk profiling measure. For users aged 39–64, we recommend the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) Dementia Risk Score, whereas for users aged 65 and older, we recommend the Brief Dementia Screening Indicator (BDSI) and the Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI). The initial assessment should also include potentially modifiable risk factors including sociodemographic, lifestyle, and health factors. If resources allow, apolipoprotein E ɛ4 status testing and structural magnetic resonance imaging should be conducted. If this initial assessment indicates a low dementia risk, then low intensity interventions can be implemented. If the user has a high dementia risk, additional investigations should be considered if local resources allow. Common variant polygenic risk of late-onset AD can be tested in middle-aged or older adults. Rare variants should only be investigated in users with a family history of early-onset dementia in a first degree relative. Advanced imaging with 18-fluorodeoxyglucose positron emission tomography (FDG-PET) or amyloid PET may be informative in high risk users to clarify the nature and burden of their underlying pathologies. Cerebrospinal fluid biomarkers are not recommended for this setting, and blood-based biomarkers need further validation before clinical use. As new technologies become available, advances in artificial intelligence are likely to improve our ability to combine diverse data to further enhance risk profiling. Ultimately, Brain Health Services have the potential to reduce the future burden of dementia through risk profiling, risk communication, personalized risk reduction, and cognitive enhancement interventions.

scholarly journals P0774KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE AND THE RISK OF ALL CAUSE, VASCULAR AND ALZHEIMER'S DEMENTIA: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hong Xu ◽  
Marco Trevisan ◽  
Marie Evans ◽  
Bengt Lindholm ◽  
Juan Jesus Carrero
Keyword(s):  
Vascular Dementia ◽  
Kidney Function ◽  
Previous History ◽  
Sensitivity Analyses ◽  
Swedish Population ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Increased Risk ◽  
Lower Egfr ◽  
Kidney Function Decline

Abstract Background and Aims Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk are conflicting. In this large Swedish population-based cohort, we explore the links between kidney function, kidney function decline and dementia incidence. Method In the Stockholm CREAtinine Measurements (SCREAM) project, we studied the association of baseline eGFR with the risk of incident dementia among 329,822 residents of Stockholm who accessed healthcare, were ≥65 years and had no previous history of dementia. We estimated the rate of eGFR decline among the 205,622 residents with repeated eGFR measurements during the first year and investigated its association with dementia risk. The primary outcome was dementia incidence based on ICD-10 codes or use of anti-dementia drugs. Secondary outcomes were incidence of the dementia subtypes Alzheimer’s and vascular dementia. Results 18,983 cases of dementia (5.8% of participants) were detected throughout 1,185,304 person-years. Dementia incidence rates (IR) were progressively higher with lower eGFR: from 6.56/1000 person-years in persons with eGFR 90-104 ml/min to 30.28/1000 person-years in those with eGFR<30 ml/min). Compared with eGFR of 90-104 ml/min, lower eGFR was associated with a higher dementia risk [adjusted hazard ratio (HR), 1.69; 95% confidence interval (CI], 1.52-1.89 in eGFR 30-59 ml/min and HR 2.55, 1.86-3.50 in eGFR<30 ml/min). A steeper decline in eGFR within one year was linearly associated with higher dementia risk for declines greater than 2ml/min/1.73 m2/year. Risk magnitudes were stronger for vascular dementia than for Alzheimer. Sensitivity analyses across predefined strata or after excluding early events yielded similar results. As many as 11% (95% CI 7-14%) of dementia cases were attributed to chronic kidney disease (eGFR<60 mL/min/1.73m2), a proportion higher than that attributed to other dementia risk factors such as cardiovascular disease and diabetes. Conclusion In the general population, both low kidney function and faster kidney function decline are associated with increased risk of developing dementia, particularly vascular dementia.

scholarly journals Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Alina Solomon ◽  
Ruth Stephen ◽  
Daniele Altomare ◽  
Emmanuel Carrera ◽  
Giovanni B. Frisoni ◽  
...  
Keyword(s):  
Health Services ◽  
Risk Reduction ◽  
Risk Groups ◽  
Risk Scores ◽  
Current Evidence ◽  
Brain Health ◽  
Dementia Risk ◽  
Dementia Prevention ◽  
Multidomain Intervention ◽  
Prevention Trials

AbstractAlthough prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting several risk factors and disease mechanisms simultaneously, in individuals without dementia at baseline. Based on the findings, we formulate recommendations for implementing precision risk reduction strategies into new services called Brain Health Services. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: non-pharmacological multidomain interventions (i.e., combining two or more intervention domains), target population including individuals without dementia, and primary outcomes including cognitive/functional performance changes and/or incident cognitive impairment or dementia. Further literature searches covered the following topics: sub-group analyses assessing potential modifiers for the intervention effect on cognition in the multidomain prevention trials, dementia risk scores used as surrogate outcomes in multidomain prevention trials, dementia risk scores in relation to brain pathology markers, and cardiovascular risk scores in relation to dementia. Multidomain intervention studies conducted so far appear to have mixed results and substantial variability in target populations, format and intensity of interventions, choice of control conditions, and outcome measures. Most trials were conducted in high-income countries. The differences in design between the larger, longer-term trials that met vs. did not meet their primary outcomes suggest that multidomain intervention effectiveness may be dependent on a precision prevention approach, i.e., successfully identifying the at-risk groups who are most likely to benefit. One such successful trial has already developed an operational model for implementing the intervention into practice. Evidence on the efficacy of risk reduction interventions is promising, but not yet conclusive. More long-term multidomain randomized controlled trials are needed to fill the current evidence gaps, especially concerning low- and middle-income countries and integration of dementia prevention with existing cerebrovascular prevention programs. A precision risk reduction approach may be most effective for dementia prevention. Such an approach could be implemented in Brain Health Services.

The EPA Guidance Project: Guidance for Mental Healthcare in Europe

2015 ◽  
Vol 12 (01) ◽  
pp. 5-11
Author(s):  
I. Großimlinghaus ◽  
J. Zielasek ◽  
W. Gaebel
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Graduate Training ◽  
Action Plan ◽  
Stakeholder Involvement ◽  
Mental Healthcare ◽  
World Health ◽  
Post Graduate Training ◽  
Health Organization

Summary Background: The development of guidelines is an important and common method to assure and improve quality in mental healthcare in European countries. While guidelines have to fulfill predefined criteria such as methodological accuracy of evidence retrieval and assessment, and stakeholder involvement, the development of guidance was not standardized yet. Aim: In 2008, the European Psychiatric Association (EPA) initiated the EPA Guidance project in order to provide guidance in the field of European psychiatry and related fields for topics that are not dealt with by guideline developers – for instance due to lack of evidence or lack of funding. The first three series of EPA Guidance deal with diverse topics that are relevant to European mental healthcare, such as quality assurance for mental health services, post-graduate training in mental healthcare, trust in mental health services and mental health promotion. Results: EPA Guidance recommendations address current and future challenges for European psychiatry. They are developed in accordance with the World Health Organization (WHO) European Mental Health Action Plan.

COVID 19 and Special Care Dentistry: A Narrative Review

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1473-1476
Author(s):  
Ashwika Datey ◽  
Soumya Singhai ◽  
Gargi Nimbulkar ◽  
Kumar Gaurav Chhabra ◽  
Amit Reche
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Care Delivery ◽  
Special Care ◽  
World Health ◽  
Healthcare Sector ◽  
Health Care Needs ◽  
Oral Diseases ◽  
Care Needs

The COVID 19 outbreak has been declared a pandemic by the world health organisation. The healthcare sector was overburdened and overstretched with the number of patient increasing and requiring health services. The worst-hit population always are the people with special needs, whether it is children, pregnant females or the geriatric population. The need for the emergency kind of health services was so inflated that the other special population which required them equally as those patients with the COVID 19 suffered a lot. Dentistry was not an exception, and even that is also one of the important components of the health care delivery system and people requiring oral health care needs were also more. Those undergoing dental treatments would not have completed the treatment, and this would have resulted in various complications. In this situation, some dental emergency guidelines have been released by Centres for Disease Control (CDC) for the urgent dental care those requiring special care dentistry during the COVID 19 pandemic. Children with special care needs were considered more vulnerable to oral diseases; hence priority should have been given to them for dental treatments moreover in the future also more aggressive preventive measures should be taken in order to maintain oral hygiene and prevent many oral diseases. Guardians/caregivers should be made aware and motivated to maintain the oral health of children with special health care needs. This review mainly focuses on the prevention and management of oral diseases in children's with special care needs.

Antidiabetics: Structural Diversity of Molecules with a Common Aim

2018 ◽  
Vol 25 (18) ◽  
pp. 2140-2165 ◽  
Author(s):  
Jelena B. Popovic-Djordjevic ◽  
Ivana I. Jevtic ◽  
Tatjana P. Stanojkovic
Keyword(s):  
Structural Diversity ◽  
World Health ◽  
Common Disease ◽  
Peroxisome Proliferator ◽  
Epidemic Disease ◽  
Peroxisome Proliferator Activated Receptor ◽  
Increased Risk ◽  
Dipeptidyl Peptidase Iv Inhibitors ◽  
Glucagon Like Peptide 1 ◽  
Health Organization

Background: Diabetes mellitus type 2 (DMT2) is an endocrine disease of global proportions which is currently affecting 1 in 12 adults in the world, with still increasing prevalence. World Health Organization (WHO) declared this worldwide health problem, as an epidemic disease, to be the only non-infectious disease with such categorization. People with DMT2 are at increased risk of various complications and have shorter life expectancy. The main classes of oral antidiabetic drugs accessible today for DMT2 vary in their chemical composition, modes of action, safety profiles and tolerability. Methods: A systematic search of peer-reviewed scientific literature and public databases has been conducted. We included the most recent relevant research papers and data in respect to the focus of the present review. The quality of retrieved papers was assessed using standard tools. Results: The review highlights the chemical structural diversity of the molecules that have the common target-DMT2. So-called traditional antidiabetics as well as the newest and the least explored drugs include polypeptides and amino acid derivatives (insulin, glucagon-like peptide 1, dipeptidyl peptidase-IV inhibitors, amylin), sulfonylurea derivatives, benzylthiazolidine- 2,4-diones (peroxisome proliferator activated receptor-γ agonists/glitazones), condensed guanido core (metformin) and sugar-like molecules (α-glucosidase and sodium/ glucose co-transporter 2 inhibitors). Conclusion: As diabetes becomes a more common disease, interest in new pharmacological targets is on the rise.

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