bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can german discharge management by law support people with cognitive impairments across sectors
Authors: Schumacher‐Schönert Fanny , Boekholt Melanie , Nikelski Angela , Kracht Friederike , Vollmar Horst Christian , Hoffmann Wolfgang , Kreisel Stefan , Thyrian Jochen René 
Published: December 2023

AbstractAround 1.8 million people in Germany live with dementia. Ascending trend. Discharging people with cognitive impairment from the hospital and transitioning them to outpatient care brings special challenges and presents the health care system with a new and increasingly important task. In Germany there are legal efforts (§39 paragraph 1a, SGB V) to close gaps, wich are supposed to develop the discharge and transfer process. A relevant Cochrane review provided further impressions of the effectiveness of individualized discharge planning.The analysis is part of the intersec‐CM study; a multi‐centered, randomized controlled study to analyze the effectiveness of an intersectoral intervention and care management system. Discharge documents of all documents available at the time of discharge could be recorded by n = 382 subjects. This corresponds to a sample size of 95.02% of the total study population.Aim of the presentation is to provide an overview of the documentation process for discharge and transfer management in everyday clinical practice after the discharge management law came into force in accordance with §39 paragraph 1a, SGB V. It answers the research question „What form does documentation take within the framework of statutory discharge management for people with cognitive impairments?“ It highlights further characteristics of the discharge documents for vulnerable patient groups and shows which contents in the discharge documentation play a role in order to be able to provide cross‐sectoral support for people with cognitive impairment.There can be shown three findings; formal, content‐related and translational results. Even formal results show, that there is no standardization for discharge documents. Further content‐related results confirm, that the documentation process according to §39 paragraph 1a, SGB V has large documentation gaps. The documentation appears to be heterogeneous and communication for follow‐up treatment needs improvement. The greatest learning objective is to create awareness for standardization in the discharge documentation for people with cognitive impairment.
Machine‐learning derived white matter signatures and the risk of dementia, stroke and mortality: the Rotterdam Study
Authors: Rosbergen Mathijs T. , Wolters Frank J. , Vinke Elisabeth J. , Ikram M. Arfan , Vernooij Meike W 
Published: December 2023

AbstractBackgroundWhite matter hyperintensities (WMH), loss of white matter (WM) volume and WM microstructural integrity are important risk indicators of stroke and dementia, albeit of heterogeneous nature. Use of machine learning techniques may unravel different patterns of white matter injury, with distinct underlying pathologies and disease risk.MethodWe measured WMH volume, WM volume, global fractional anisotropy (FA) and global mean diffusivity (MD) in 5205 participants (mean age 64.9 years, 56.0% women) of the population‐based Rotterdam study with brain MRI between 2005 and 2016. We performed hierarchical clustering on age‐standardized imaging parameters to identify separate clusters of white matter injury, and compare determinants across clusters. We then determined the association between clusters and risk of dementia, stroke and mortality, using Cox proportional hazard models adjusted for sex, education, APOE‐ε4 and cardiovascular risk factors.ResultWe identified four distinct white matter signatures: (i) cluster with above‐average microstructural integrity and little WM atrophy and WMH, (ii) cluster with above‐average microstructural integrity and little WMH, yet substantial WM atrophy, (iii) cluster with poor microstructural integrity and substantial WMH, yet little WM atrophy, and (iv) cluster with poor microstructural integrity, substantial WM atrophy, and average WMH load. There were no clear differences between clusters in APOE genotype and cardiometabolic risk factors, except for higher prevalence of hypertension in cluster (iv). Cluster (iii) contained more women, and participants in clusters (iii) and (iv) had more microbleeds and lacunes. During a median 10.7 years of follow‐up, 272, 210, and 844 cases of dementia, stroke, death occurred, respectively. In fully adjusted models, dementia risk was increased for clusters (ii) (HR 1.57 [95%CI:1.04‐2.37]), (iii) (HR 2.43 [95%CI:1.68‐3.52]) and (iv) (HR 1.78 [95%CI:1.22‐2.62], compared to cluster (i). Moderate associations of clusters (iii) and (iv) with incidence stroke attenuated and were no longer statistically significant after adjustment for cardiovascular risk factors, while only cluster (iii) was associated with a small increase in mortality (HR 1.30 [95%CI:1.07‐1.58]).ConclusionMachine‐learning derived white matter signatures are differentially associated with dementia, stroke and mortality. Further research is needed to pinpoint differences in underlying pathology, and assess potential benefit of clusters for risk stratification.
Delineating amyloid peptide signatures among heterogenous plaque population in Alzheimer’s Disease
Authors: Koutarapu Srinivas 
Published: December 2023

AbstractBackgroundAlzheimer’s disease (AD) is the most common neurodegenerative disorder affecting nearly 12% of individuals older than 65 years. The disease poses an immense societal challenge and personal suffering, particularly as there were still no curative treatments as the pathogenic mechanisms of AD remain elusive. One of the main challenge would be to understand the chemical basis of heterogeneity involved in the formation of variety of plaque polymorphs. These plaques are known to be extracellular deposits of amyloid beta (AB) peptide. In this study we aim to investigate the chemical nature of structuraly diverse plaque polymorphs in patient samples with sporadic AD, familial AD and Cognitively unimpaired pathological ageing.MethodWe employed a novel chemical imaging strategy combining microscopy with matrix assisted laser desorption/ioninsation ‐ mass spectrometry imaging (MALDI‐MSI) to delineate AB signatures of heterogenous plaque polymorphs. These plaques are then grouped into sAD‐diffused plaques (DP), sAD‐cored plaques (CP), sAD coarse grain plaques (sAD‐CG), CU‐AP diffused plaques(DP of CU‐AP), fAD cored plaques (fAD‐CP) and fAD coarse grain plaques (fAD‐CG) along with amyloid vasculature from sAD and fAD based on the high resolution hyperspectral microscopy images combined with multivariate image analysis performed on MALDI‐MSI data. These plaques are then investigated for differences in the AB signatures.ResultAβ1‐40 is more abundant in more compact plaques like CG and CP in comparison to DP and DP of CU‐AP. Aβ3pE‐40 in less aggregated diffused plaques of CU‐AP than cored plaques of sAD.ConclusionThis study provides neurochemical information of the amyloid plaque polymorphs crucial for the development of a biomarker . Our data suggests Aβ1‐40 and 3pE depositions are critical in plaque maturation . fAD plaques are more compact than in sAD, larger extend of Aβ1‐40/1‐42. We also present the chemical characterization of coarse grain plaques for the first time. Similarities of CG to CAA point towards vascular involvement in the formation of coarse grain plaques
Does rTMS improve cognitive function in age‐related neurodegenerative diseases? A systematic review and meta‐analysis
Authors: Miller Amy , Allen Richard J. , Juma Alisha A. , Chowdhury Rumana , Burke Melanie Rose 
Published: December 2023

AbstractBackgroundHigh‐frequency, repetitive transcranial magnetic stimulation (rTMS) targeted over the dorsolateral prefrontal cortex (DLPFC) is widely used in research to promote neuroplasticity and cognitive enhancement. RTMS is a promising intervention to tackle cognitive decline in people living with age‐related neurodegenerative diseases. However, there is currently no systematic evidence examining the effects of DLPFC‐targeted, high‐frequency rTMS on cognitive function in this population. The aim of this systematic review was to evaluate the efficacy and moderators of this treatment intervention.MethodA comprehensive literature search of five electronic databases was performed to identify articles published before October, 2022. Following PRISMA guidelines, the identified articles were screened, data was extracted, and the methodological quality was assessed using the Cochrane tool, Risk of Bias 2 (ROB2). Meta‐analyses were performed using R Studio (v4.1.2).ResultSixteen studies involving 474 participants met the inclusion criteria, of which 8 studies measured global cognitive function. The results from the random‐effects meta‐analysis showed rTMS significantly improved global cognitive function relative to control groups shown by a large, significant effect size (g = 1.39, 95% CI, 0.34‐2.43; p = .017). No significant effects were found between subgroups or for individual cognitive domains.ConclusionHigh‐frequency rTMS, targeted over the DLPFC, appears to improve global cognitive function in people living with age‐related neurodegenerative diseases. However, these results should be interpreted with caution due to the small number of studies included, and high between‐study heterogeneity.
Effects of mindfulness training and exercise on cognitive function in healthy older adults without dementia: the MEDEX clinical trial
Authors: Lenze Eric J. 
Published: December 2023

AbstractBackgroundA 2×2 factorial multi‐site randomized clinical trial was conducted to determine whether Mindfulness Based Stress Reduction (MBSR), exercise, or their combination improve cognitive function in older adults..Method585 older adults (aged 65‐84; mean age 71.5, 72.5% women) with subjective cognitive concerns but no dementia were randomized to MBSR, exercise with aerobic, strength and functional components, combined MBSR and exercise, or a health education control group. Interventions lasted 18 months and consisted of group‐based classes and home practice.ResultNeither MBSR, exercise, nor their combination significantly improved either primary outcome of memory or cognitive control (composites of neuropsychological tests), or secondary outcomes of hippocampal volume, DLPFC thickness and surface area, functional cognitive capacity or self‐reported cognitive concerns.ConclusionAmong older adults with subjective cognitive concerns but without dementia, mindfulness training, exercise, or both did not significantly improve cognitive or brain structural outcomes.
Transitioning from dementia‐related stigma to a Community Level Dementia Screening Program in Rural Kenya (DEM‐SKY)
Authors: Musyimi Christine W. , Ndetei David , Farina Nicolas , Masila Joe , Muyela Levi A. , Mutunga Elizabeth Kasimu 
Published: December 2023

AbstractBackgroundPrimary health care providers face the challenge of making timely dementia diagnosis due to limited time available to interact with patients resulting in stigma, neglect and abuse. With training, these providers can collaborate with Community Health Workers (CHWs) to improve dementia detection and articulate the needs of communities whilst mobilizing resources that are salient in decision‐making, care coordination and service delivery processes. In this study, we outline the process that led to integration of a Community Level Dementia Screening Program in Rural Kenya (DEM‐SKY).MethodAs part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, ten CHWs were trained to deliver a dementia anti‐stigma intervention to 59 members of the general public in rural Kenya, through four bi‐weekly psycho‐education sessions. This led to increased number of people turning up for dementia screening at a county referral hospital. However, due to lack of knowledge and busy waiting lines at the hospital, discussions on how to integrate dementia screening within the hospital began.ResultFindings from the STRiDE project formed the basis of integrating a community‐level dementia screening programme in Makueni County Referral Hospital in Kenya, a program that has seen more than 600 adults aged 60 and above screened for dementia by CHWs in a period of one month. Through partnership and collaboration with the hospital, a recording and reporting system for people living with dementia was established to provide an indication of the number of dementia cases and individuals referred from the community. This was made possible through: (i) training formal and informal providers on importance of dementia screening, (ii) continued awareness in communities to change existing negative dementia perceptions and (iii) motivating CHWs through project visibility materials and recognizing them in community events.ConclusionPublic awareness and stigma reduction using CHWs can be a precursor to strengthening health care systems through routine dementia screening for older people in community settings. This integration process also requires using task‐sharing approaches in order to promote timely detection and improve care coordination at all levels of care, thus forming a basis for formulation, implementation of policy and service planning.
Using a newly validated algorithm to estimate prevalence and incidence of Alzheimer’s Disease and related dementias in Medicare claims
Authors: Afonso Ana Sofia , Schroeder Krista Marie , Wang Huabo , Grace Sarah , Phipps Adam , Sims John R. 
Published: December 2023

AbstractBackgroundFew published studies have estimated the prevalence and incidence of Alzheimer’s disease (AD) and AD related dementias (ADRD) in the US Medicare population using fit‐for‐purpose claims algorithms. This study utilized a newly validated administrative claims algorithm for identifying ADRD, the “1‐year Bynum‐Standard ADRD algorithm”, adjusted for positive predictive value (PPV) and sensitivity, to estimate the 2019 annual prevalence and annual incidence of ADRD in US Medicare patients 65+ years of age.MethodsThis study utilized Medicare Part A and B claims (Fee‐For‐Service and Medicare Advantage) limited to patients with at least one 2019 medical encounter. The study’s source population was limited to those 65+ years of age with Medicare Part D coverage and 1‐year pre‐encounter continuous enrollment. Utilizing the 1‐year Bynum‐Standard ADRD claims algorithm, patients with ADRD were compiled. As the Brynum‐Standard algorithm includes AD as well as related dementias, a second AD cohort was built adapting the algorithm’s code list to include only specific AD diagnoses. Prevalence was calculated as a percent of the source population after adjustment for PPV and sensitivity of the algorithm. Incidence calculations required a 1‐year pre‐diagnosis exclusion period.ResultsFrom 53.9 million Medicare patients with at least one 2019 medical encounter, 33.3 million patients qualified for the source population. Of these patients, 2.7 million (8.0%) qualified as having ADRD using the 1‐year Bynum‐Standard algorithm and 0.86 million of these patients (32.2%) were newly diagnosed (incident). After adjusting for 31.3% sensitivity and 70.3% PPV of the algorithm the estimated 2019 annual prevalence and incidence of ADRD in the Medicare population aged 65 or older was 18% and 5.8% respectively. When limited to patients with specific AD diagnoses only, 1.0 million prevalent and 0.37 million incident patients were identified resulting in an annual adjusted prevalence and incidence of 6.9% and 2.5% respectively. Prevalence and incidence calculations including adjustments are provided in figure 1.ConclusionUsing a fit‐for‐purpose validated algorithm, the 2019 annual prevalence and incidence of ADRD in the Medicare population aged 65+ with Part D enrollment was estimated to be 18% and 5.8% respectively.
Stimulation of Cerebral Angiogenesis and Neurogenesis with Transcatheter Intracerebral Laser Photobiomodulation Therapy in Alzheimer’s Disease and Vascular Parkinsonism Aggravated by Dementia
Authors: Maksimovich Ivan V 
Published: December 2023

AbstractBackgroundThe research is focused on the stimulation of cerebral angiogenesis and neurogenesis using Transcatheter Intracerebral Laser Photobiomodulation Therapy (PBMT) in patients with dementia in Alzheimer’s disease (AD) and patients with vascular parkinsonism (VP).MethodThe examination of 155 patients included assessment of CDR, The Tomography Dementia Rating scale (TDR), MMSE, cerebral CT, MRI, SG, rheoencephalography (REG) and cerebral MUGA.85 patients were selected, of whom:• 48 (30.97%) people suffering from AD, aged 34‐80 (mean age 67.5), men ‐ 17 (35.42%), women ‐ 31 (54.58%). According to dementia severity, patients were subdivided: preclinical stage (TDR‐0) ‐ 4, mild stage (TDR‐1) ‐ 16, moderately severe stage (TDR‐2) ‐ 21, severe stage (TDR‐3) ‐ 7 patients.• 37 (23.87%) people suffering from VP, aged 58‐80 (mean age 77), men 28 (75.68%), women ‐ 9 (24.32%). 19 (51.35%) had a mild dementia stage (CDR‐1).In hospital conditions, in a specialized cath lab, all patients underwent Transcatheter Intracerebral Laser Photobiomodulation Therapy (PBMT) (wavelength 632.8 nanometers).ResultAll 48 (100%) patients with AD underwent angiogenesis stimulation resulting in cerebral collateral capillary revascularization and closure of atreriovenous shunts.Simultaneously, patients showed a 10‐20% increase in cerebral temporal lobes volume, which indicates cerebral neurogenesis development and tissue regeneration. The process was accompanied by dementia level decrease and cognitive functions restoration. Consequently, patients were transferred to a milder TDR group. Depending on the initial dementia severity, the resulting positive effect was observed from 2 to 15 years.All 37 (100%) patients with VP underwent angiogenesis stimulation resulting in cerebral microcirculation improvement and cerebral involutive changes decrease, which indicates the neurogenesis development and tissue regeneration. The process was accompanied by decreased dementia and cognitive functions restoration. The resulting positive effect was observed over 10 years.ConclusionDespite the differences in AD and VP etiology, Transcatheter Intracerebral Laser Photobiomodulation Therapy (PBMT) is an effective treatment for dementia in these diseases. The method stimulates angiogenesis and improves blood supply to the brain, it stimulates neurogenesis and the restoration of normal tissue structures, which leads to improved mental and cognitive functions. The resulting effect persists for a long time.
Individuals from Memory Clinic were Associated with Severer Amyloid Deposition in the Chinese Population in Urban Cities
Authors: he kun , Li Binyin , Huang Lin , Zhao Jun , Hua Fengchun , Wang Tao , Li Junpeng , Wang Jie , Wang Mengjie , Huang Qi , Xu Shasha , Chen Ke‐Liang , Ren Shuhua , Cai Huawei , Jiang Donglang , Hu Jingchao , Han xinmin , Guan Yihui , Guo Qihao , Xie Fang 
Published: December 2023

AbstractBackgroundAmyloid deposition is considered the initial pathology in Alzheimer’s disease (AD), investigation of amyloid pathology and the risk factor for amyloid pathology and cognitive declines in the Chinese population is critical for personalized management. However, the prevalence of amyloid deposition and the risk factors for amyloid pathology are unknown in the Chinese population.MethodParticipants were recruited from urban communities and memory clinics in Shanghai and Zhengzhou, China. A total of 246 AD individuals, 274 Mild cognitive impairment (MCI) individuals, and 506 Normal cognition (NC) individuals were identified: 106 AD, 156 MCI and 506 NC from the Community‐based cohort (COMC) as well as 140 AD and 118 MCI from the Clinic‐based cohort (CLIC). Amyloid positivity and deposition were analyzed based on amyloid positron emission tomography (PET) scans. We also performed a partial least squares (PLS) analysis to evaluate the associations of cohort, age, sex, education level, and ApoE genotype with amyloid qualification, quantification results and global cognition in all 1026 participants.ResultAcross the two cohorts, the AD group displayed the significantly highest rate of amyloid positivity (211/246, 85.8%), followed by the MCI (122/274, 44.5%) and NC groups (136/506, 26.9%, all P < 0.001). Participants from the CLIC displayed a higher rate of amyloid positivity than those from the COMC in the MCI (68/118, 57.6% vs. 54/156, 34.6%, P < 0.001) and AD groups (128/140, 91.4% vs. 83/106, 78.3%, P = 0.006). MCI (SUVr: 1.37 ± 0.25 vs. 1.25 ± 0.18, P < 0.001), Aβ+ MCI (SUVr: 1.48 ± 0.27 vs. 1.37 ± 0.24, P = 0.03) and AD individuals (SUVr: 1.47 ± 0.23 vs. 1.39 ± 0.23, P = 0.01) in the CLIC displayed significantly greater amyloid deposition than those in the COMC. According to the PLS model, we found that the CLIC was significantly associated with positive amyloid deposition and severer amyloid deposition.ConclusionWe found that individuals from CLIC displayed a higher amyloid positive rate and severer amyloid deposition. Specifically, in a PLS model, The CLIC, was strongly associated with amyloid pathology.
Longitudinal declines in locus coeruleus integrity are related to worse episodic memory
Authors: Dahl Martin J , Bachman Shelby L , Dutt Shubir , Düzel Sandra , Bodammer Nils C. , Lindenberger Ulman , Kühn Simone , Werkle‐Bergner Markus , Mather Mara 
Published: December 2023

AbstractBackgroundAbnormally phosphorylated tau, an indicator of Alzheimer’s disease, starts accumulating in the locus coeruleus (LC), the brain’s major noradrenaline supply, during the first decades of life. Facilitated by technical advances, recent evidence shows that age‐related deficits in noradrenergic neuromodulation impinge on late‐life memory. However, investigations assessing longitudinal locus coeruleus changes and their association with senescent memory are scarce. Moreover, comparisons to other neuromodulatory systems that decline with age are lacking, questioning the specificity of noradrenergic effects.MethodWe collected high‐resolution magnetic resonance imaging (MRI) data of the dopaminergic substantia nigra–ventral tegmental area (SN–VTA) and the noradrenergic locus coeruleus (LC) of 320 younger and older participants of the Berlin Aging Study‐II at two time points (TP1, TP2; ∼1.9 years apart). The imaging protocol included three dedicated scans sensitive to the SN–VTA and LC. We aggregated the information shared across imaging modalities by estimating multimodal latent factors expressing dopaminergic and noradrenergic integrity.Participants also completed a comprehensive cognitive battery at three time points (TP1–TP3), including tests of fluid intelligence, episodic memory, and working memory. We used structural equation modeling to evaluate cross‐sectional associations of SN–VTA and LC integrity with late‐life cognition. In a second set of models, we probed longitudinal changes in SN–VTA and LC integrity (TP1–TP2) and used them to predict participants’ future cognitive performance (TP3).ResultCross‐sectionally, we found differential associations of dopaminergic and noradrenergic nuclei with late‐life cognition. While LC integrity was positively related to better episodic memory across several memory tasks, SN–VTA integrity was positively related to working memory performance. Moreover, consistent with a largely shared biosynthesis of the neuromodulators, dopaminergic and noradrenergic nuclei correlated positively. Longitudinally, we found that older age was associated with more negative change in SN–VTA and LC integrity (TP1–TP2). Importantly, more negative changes in LC integrity reliably predicted worse future episodic memory (at TP3).ConclusionThese findings support the feasibility of in‐vivo indices for catecholaminergic integrity with potential clinical utility, given the degeneration of both neuromodulatory systems in several age‐associated diseases. Moreover, they highlight differential roles of dopaminergic and noradrenergic neuromodulatory nuclei in late‐life cognitive decline.