Search Results for: È confermato il legame tra la malattia di Alzheimer e microbiota intestinale

Introduction
An important goal of advance care planning (ACP) is ensuring that patients receive care concordant with their preferences. High-quality evidence is needed about the effect of ACP on this and other outcomes.

Methods and analysis
Planning Ahead is a randomised controlled trial to test the effectiveness of facilitated ACP in community-dwelling older adults including those with normal cognition and those with Alzheimer’s Disease and Related Dementias (ADRD) who are at high risk of death. The primary aim is to determine the effect of the intervention on discordance between preferences for medical treatments and the treatments received in the year after the intervention. Secondary outcomes include decision-making quality, care at the end of life and cost. Eligible patients have a primary care provider at one of two Midwest health systems, have an approximate 33% mortality risk and do not have a POLST form at baseline. Patients with capacity can invite the person they would choose to be their healthcare decision maker to participate as a study partner. A surrogate decision maker enrols and receives the intervention for patients who lack capacity due to ADRD. The intervention uses the Respecting Choices Advanced Steps (RCAS) model of ACP delivered by a registered nurse and includes identification of the patient’s values and goals, education about ACP and the POLST form and the opportunity to complete a POLST form.

Ethics and dissemination
The study is approved by the Indiana University Institutional Review Board. Primary and secondary analyses will be published in peer-reviewed journals. We also plan dissemination through the media. We will construct a deidentified data set that could be available to other researchers. Survey data will be preserved and shared via the NIH-supported National Archive of Computerised Data on Ageing’s (NACDA) Open Ageing Repository (OAR).

Trial registration number
NCT04070183.

Objectives
The aim of the present study was to examine the reliability and validity (structural and convergent) of the Resilience and Strain Questionnaire in Caregivers of People with Dementia (ResQ-Care-Dem).

Design
Cross-sectional survey study.

Setting
Online survey in Germany.

Participants
The ResQ-Care-Dem was completed by 243 informal caregivers of people with dementia (Mage=59.7 years, SD=10.9, 84.8% female).

Methods
The ResQ-Care-Dem consists of four scales: two resilience scales (psychological aspects and social aspects of resilience) and two burden scales (interpersonal burden and general burden). The reliability of the two resilience and two burden scales was assessed using Cronbach’s alpha as a measure of internal consistency. Structural validity was examined using a principal axis factor analysis. Convergent validity was assessed by Pearson’s correlations with the Zarit Burden Interview (ZBI-7), the Caregiver Self-Efficacy Scale (CES-8) and the Gain in Alzheimer Care Instrument (GAIN).

Results
The ResQ-Care-Dem scales’ internal consistencies ranged between 0.65 and 0.81. The factorial structure could partly be confirmed, with the items of the four scales primarily loading on four factors. The burden scales demonstrated high and positive correlations with the score for caregiver burden (ZBI-7, r=0.51 – 0.55) and small to high, negative correlations with the scores for caregiver self-efficacy (CES-8, r=–0.52 –0.56) and gains from caregiving (GAIN, r=–0.21 –0.22), supporting construct validity of the scales. The resilience scales showed small to high positive correlations with the scores for caregiver self-efficacy (CES-8, r=0.50 – 0.57) and gains from caregiving (GAIN, r=0.27 – 0.50), as well as moderate negative correlations with the caregiver burden score (ZBI-7, r=–0.45 –0.50), providing evidence for the scales’ construct validity.

Conclusions
The reliability and structural validity of the ResQ-Care-Dem were partially confirmed. Evidence supporting its convergent validity suggests that the questionnaire has potential as a tool for assessing caregiver burden and resilience factors among informal caregivers of people with dementia. While these findings indicate potential practical applicability, future studies should investigate its performance in real-world settings and assess changes over time (eg, responsiveness) in longitudinal studies.

Riduce il dolore, l’affaticamento e l’impatto globale della malattia

Objective
A growing body of evidence points to a role for herpesviruses in the development of Alzheimer’s disease (AD) and a reduced risk of AD among patients receiving antiherpetic medications. We investigated the association between herpes simplex virus type 1 (HSV-1) and AD using real-world data (RWD) from USA.

Design
In a matched case–control study, patients with AD aged ≥50 years diagnosed between 2006 and 2021 were identified from the IQVIA PharMetrics Plus claims database. Controls were matched in a 1:1 ratio with subjects with AD on age, sex, region, database entry year and healthcare visit numbers.

Results
The study included 344 628 AD case–control pairs. History of HSV-1 diagnosis was present in 1507 (0.44%) patients with AD compared with 823 (0.24%) controls. HSV-1 diagnosis was found to be associated with AD (adjusted OR 1.80; 95% CI 1.65 to 1.96). Patients with HSV-1 who used antiherpetics were less likely to develop AD compared with those who did not use antiherpetics (adjusted HR 0.83, 95% CI 0.74 to 0.92).

Conclusions
Findings from this large RWD study implicate HSV-1 in the development of AD and highlight antiherpetic therapies as potentially protective for AD and related dementia.

Neglet e l’afasia tra principali problemi lungo termine malattia

Coinvolto anche un esperto dell’ospedale Gaslini di Genova

Decisiva per ridurre la diffusione della malattia

Visite e informazioni per sfatare fake news su malattia e diete

In gran parte dei casi sono familiari con malati Alzheimer

Background
Chronic restraint stress (CRS) is a tumour-promoting factor. However, the underlying mechanism is unknown.

Objective
We aimed to investigate whether CRS promotes head and neck squamous cell carcinoma (HNSCC) by altering the oral microbiota and related metabolites and whether kynurenine (Kyn) promotes HNSCC by modulating CD8+ T cells.

Design
4-nitroquinoline-1-oxide (4NQO)-treated mice were exposed to CRS. Germ-free mice treated with 4NQO received oral microbiota transplants from either CRS or control mouse donors. 16S rRNA gene sequencing and liquid chromatography-mass spectrometry were performed on mouse saliva, faecal and plasma samples to investigate alterations in their microbiota and metabolites. The effects of Kyn on HNSCC were studied using the 4NQO-induced HNSCC mouse model.

Results
Mice subjected to CRS demonstrated a higher incidence of HNSCC and oral microbial dysbiosis than CRS-free control mice. Pseudomonas and Veillonella species were enriched while certain oral bacteria, including Corynebacterium and Staphylococcus species, were depleted with CRS exposure. Furthermore, CRS-altered oral microbiota promoted HNSCC formation, caused oral and gut barrier dysfunction, and induced a host metabolome shift with increased plasma Kyn in germ-free mice exposed to 4NQO treatment. Under stress conditions, we also found that Kyn activated aryl hydrocarbon receptor (AhR) nuclear translocation and deubiquitination in tumour-reactive CD8+ T cells, thereby promoting HNSCC tumourigenesis.

Conclusion
CRS-induced oral microbiota dysbiosis plays a protumourigenic role in HNSCC and can influence host metabolism. Mechanistically, under stress conditions, Kyn promotes CD8+ T cell exhaustion and HNSCC tumourigenesis through stabilising AhR by its deubiquitination.

Idrocefalo normoteso, malattia curabile ma poco nota. Possibili fino a 35 miliardi di euro di risparmio in un anno per il Servizio sanitario nazionale

Objective
This study aims to shed light on the transformative potential of artificial intelligence (AI) in the early detection and risk assessment of non-communicable diseases (NCDs).

Study design
Bibliometric analysis.

Setting
Articles related to AI in early identification and risk evaluation of NCDs from 2000 to 2024 were retrieved from the Scopus database.

Methods
This comprehensive bibliometric study focuses on a single database, Scopus and employs narrative synthesis for concise yet informative summaries. Microsoft Excel V.365 and VOSviewer software (V.1.6.20) were used to summarise bibliometric features.

Results
The study retrieved 1745 relevant articles, with a notable surge in research activity in recent years. Core journals included Scientific Reports and IEEE Access, and core institutions included the Harvard Medical School and the Ministry of Education of the People’s Republic of China, while core countries comprised China, the USA, India, the UK and Saudi Arabia. Citation trends indicated substantial growth and recognition of AI’s impact on NCDs management. Frequent author keywords identified key research hotspots, including specific NCDs like Alzheimer’s disease and diabetes. Risk assessment studies demonstrated improved predictions for heart failure, cardiovascular risk, breast cancer, diabetes and inflammatory bowel disease.

Conclusion
Our findings highlight the increasing role of AI in early detection and risk prediction of NCDs, emphasising its widening research impact and future clinical potential.

Introduction
The prevalence of dementia is increasing, both worldwide and in China. This disease is associated with numerous restrictions for those affected but also for caregivers and society. Due to the limited effectiveness of pharmacological interventions, more research on non-pharmacological interventions is needed. For the non-pharmacological multimodal MAKS (M: motor training, A: activities of daily living training, K: cognitive training, S: social-communicative setting) intervention, positive effects on cognition, activities of daily living, and the occurrence of behavioural and psychological symptoms of dementia were identified in two randomised controlled trials in different settings in Germany. Thus, the German MAKS intervention was culturally adapted for China and will now be tested for its efficacy in Chinese nursing homes in a randomised controlled trial.

Methods and analysis
Participants will be residents of Chinese nursing homes in Shenyang, Nanjing and Dalian, fulfilling the ICD-10 criteria for Alzheimer’s dementia, the psychometric criteria for mild to moderate dementia (MMSE 10–23) and none of the exclusion criteria. With n=200, effects with an effect size of Cohen’s d=0.45 and a power of 1-β = 0.80 can be detected. Screening and data collection at baseline, t6 and t12 will be conducted via face-to-face contact by proxy raters in the nursing homes (i.e., trained nursing staff not involved in the intervention) and master students as external testers for the performance tests on cognition and activities of daily living. Participants will be randomly allocated to the intervention or control group. SinoMAKS (i.e., the Chinese version of the MAKS intervention) will be conducted at least three times a week for six months by trained MAKS therapists. The control group will receive care as usual for 12 months after baseline. Thus, the treatment phase is six months with follow-ups after six and 12 months after baseline. In the open phase, from t6 to t12, the nursing homes are free to offer SinoMAKS to the intervention group residents. In line with international guidelines, the primary population for analysis is the intention-to-treat sample. Global cognition (measured with the Addenbrooke’s Cognitive Examination-III) is the primary outcome. The hypotheses will be analysed using multiple linear regression with the outcome variables as dependent variables.

Ethics and dissemination
All procedures were approved by the Ethics Committee of the Medical Faculty of the Friedrich-Alexander-Universität Erlangen-Nürnberg (Ref. 24–162-B) and the Ethics Committee of the China Medical University (Ref. [2024]181). Written informed consent will be obtained from all participants or—if applicable—their legal representatives. Results will be published in peer-reviewed scientific journals and conference presentations.

Trial registration number
ISRCTN10262531.

Il controllo della malattia a 12 mesi si è triplicato