Search Results for: Un esame del sangue predice il rischio di ammmalarsi di Alzheimer

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Stroke, Ahead of Print. BACKGROUND:The pathological basis underlying motor impairment in older adults is partially accounted for by Alzheimer disease and related dementias pathologies. We tested the hypothesis that arteriolosclerosis, a pathological correlate of small vessel disease, outside the cerebrum is related to motor impairment in older adults above and beyond Alzheimer disease and related dementias pathologies.METHODS:The data were from decedents of a community-based clinical-autopsy study. Arteriolosclerosis was assessed in the cerebrum (as 1 of 10 Alzheimer disease and related dementias pathologies), midbrain, cerebellum, pons, and 4 levels of the spinal cord. Parkinsonism was assessed using the Unified Parkinson Disease Rating Scale. Other motor performances included timed-peg placement and finger tapping, grip and pinch strength, walking 8 ft and turning 360° twice, and sensor-derived metrics assessing tandem walk. Multivariate linear regression models were used to examine the association of arteriolosclerosis across varied motor performances.RESULTS:The participants (n=403) were on average 91.4 (6.1) years old at death, and 73.2% (n=295) were women. The frequency of moderate/severe arteriolosclerosis varied outside the cerebrum, ranging from 15.5% (40/258) in the pons to 49.6% (200/403) in the spinal cord. The correlation of the severity of arteriolosclerosis between these regions ranged from unrelated to modestly related. Spinal arteriolosclerosis was associated with impaired motor function (P=0.006), in particular more severe parkinsonism (estimate, 0.170; SE, 0.071;P=0.018) and less hand dexterity (estimate, −0.022; SE, 0.009;P=0.014). Arteriolosclerosis of the cerebellum was associated with impaired tandem walk (P=0.012), in particular more variability in the acceleration signal in the mediolateral direction (estimate, 0.023; SE, 0.011;P=0.040). Arteriolosclerosis in the pons or midbrain was not associated with motor performances.CONCLUSIONS:Arteriolosclerosis severity varies in the central nervous system tissues outside of the cerebrum and is differentially associated with varied motor performances, suggesting that the adverse motor consequences of small vessel disease in older adults may be underestimated by studies focusing only on the brain.

Libro del neurologo Gennaro Barbato. ‘Decisivo è il territorio’

Introduction
Herpes simplex virus 1 (HSV-1) infects approximately two-thirds of the global population under the age of 50 years. Although widely prevalent, the possible implications of HSV-1 in neurodegenerative diseases, especially dementia and Alzheimer’s disease, remain poorly understood. This review seeks to elucidate this association and explore the potential benefits of preventing or treating herpesvirus infections on dementia risk. The goal is to enhance our understanding of HSV-1’s potential role in dementia, which could inform the development of future therapeutic interventions for these conditions.

Methods and analysis
PubMed, Embase (Elsevier/Ovid), Web of Science, Scopus, Global Health, PsycInfo, Cochrane Library and Clinicaltrials.gov will be searched from the inception of each respective database. Studies that have HSV-1 as an exposure and dementia, or its subtypes, as a primary outcome will be included. Two researchers will independently screen titles, abstracts and full texts, with discrepancies resolved by a third researcher. Systematic data extraction from eligible studies will be performed using a standardised template. Risk of bias of individual studies will be assessed with the Cochrane Collaboration approach. We will assess the overall quality of cumulative evidence using the Grading of Recommendations, Assessment, Development and Evaluations criteria. Statistical analysis will employ a random effects model, and heterogeneity will be determined with Cochrane’s Q test and assessed using I2. Studies will be grouped by population subgroups and dementia subtypes when possible to explore nuances in results. We will consider performing meta-regression if heterogeneity remains after subgroup analyses. All statistical analyses will be conducted using Stata V.18 software (College Station, Texas, USA).

Ethics and dissemination
No ethical approval is required since data will be collected from existing studies. The review will be disseminated through peer-reviewed publication and at national and international conferences.

PROSPERO registration number
CRD42024516789.

Objectives
To assess the cost-effectiveness of aducanumab at its updated price for treating patients with mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD).

Design
Cost-effectiveness analysis.

Settings
A five-state Markov model was constructed using 10 000 virtual patients to assess the cost-effectiveness of aducanumab from the perspective of the US healthcare system. The model employed a one-year cycle time and a lifetime time horizon. Transition probabilities and mortality rates were derived from a literature review. To address uncertainty and generalise the base case results, both one-way and probabilistic sensitivity analyses were conducted.

Participants
10 000 virtual patients with MCI and mild AD.

Interventions
The study group consisted of patients using aducanumab, while the control group consisted of those using a placebo.

Primary and secondary outcome measures
Primary outcomes included costs and quality-adjusted life years (QALYs). In line with the healthcare system perspective, only direct medical costs were included. Drug costs were obtained from official records, while other medical costs were derived from literature reviews. Utilities used to calculate QALYs were also obtained from the literature. Incremental analysis was conducted to assess cost-effectiveness in the base case analysis by comparing the incremental cost-effectiveness ratio (ICER) against the willingness-to-pay (WTP) threshold. A discount rate of 3% was applied to both costs and effectiveness.

Results
From the perspective of the US healthcare system, compared with the control group, the study group had an incremental cost of US$143 821.1 and an incremental QALY of 0.10. The ICER of patients using aducanumab compared with those using placebo was US$1 012 219.0 per QALY gained, which was much greater than the WTP threshold of US$50 000 to US$150 000, indicating that using aducanumab was not cost-effective. One-way sensitivity analysis showed the five most sensitive parameters were relative risk of progressing from MCI to mild AD, the utility of MCI, initial age, discount rate and the price of aducanumab. In the probabilistic sensitivity analysis, when the WTP was the WTP threshold of US$150 000, the probability of aducanumab being cost-effective was 0%. In addition, when the probability of aducanumab being cost-effective was 50%, the WTP was US$1 180 000, and when the probability of aducanumab being cost-effective was 95%, the WTP was US$1 906 000.

Conclusions
Even with the updated price being half of the original, aducanumab is still not cost-effective, underscoring the need for affordable, evidence-based AD treatments.

Introduction
The use of teleneuropsychology or neuropsychological remote assessment increased during and after the COVID-19 pandemic in 2020. Teleneuropsychology facilitates remote assessment for populations that do not have access to neuropsychological services as well as individuals who are vulnerable or have physical restrictions that would otherwise make it difficult for individuals to receive appropriate care. However, there are many instruments that are not validated or lack normative data for the overall population. Therefore, this study aims to develop normative data for a neuropsychological battery administered on telehealth with commonly used tools to identify cognitive performance in older adults.

Methods and analysis
The following study will use a previously informatics-generated list of participants who have a lower risk of developing Alzheimer’s disease and other related dementias. Participants will complete screening surveys related to cognitive and health status. They will also complete questionnaires related to sociodemographic information, depression, functionality and social determinants of health. Participants will undergo a teleneuropsychological battery examination via remote assessment. We estimate recruiting 500 participants to establish normative data.

Ethics and dissemination
The current protocol is approved by the University of Florida’s Institutional Review Board. Results will be analysed and disseminated in a research paper once sample number goals are completed.

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