IMPORTANCE: American football is the largest participation sport in US high schools and is a leading cause of concussion among adolescents. Little is known about the long-term cognitive and mental ...health consequences of exposure to football-related head trauma at the high school level. OBJECTIVE: To estimate the association of playing high school football with cognitive impairment and depression at 65 years of age. DESIGN, SETTING, AND PARTICIPANTS: A representative sample of male high school students who graduated from high school in Wisconsin in 1957 was studied. In this cohort study using data from the Wisconsin Longitudinal Study, football players were matched between March 1 and July 1, 2017, with controls along several baseline covariates such as adolescent IQ, family background, and educational level. For robustness, 3 versions of the control condition were considered: all controls, those who played a noncollision sport, and those who did not play any sport. EXPOSURES: Athletic participation in high school football. MAIN OUTCOMES AND MEASURES: A composite cognition measure of verbal fluency and memory and attention constructed from results of cognitive assessments administered at 65 years of age. A modified Center for Epidemiological Studies’ Depression Scale score was used to measure depression. Secondary outcomes include results of individual cognitive tests, anger, anxiety, hostility, and heavy use of alcohol. RESULTS: Among the 3904 men (mean SD age, 64.4 0.8 years at time of primary outcome measurement) in the study, after matching and model-based covariate adjustment, compared with each control condition, there was no statistically significant harmful association of playing football with a reduced composite cognition score (–0.04 reduction in cognition vs all controls; 97.5% CI, –0.14 to 0.05) or an increased modified Center for Epidemiological Studies’ Depression Scale depression score (–1.75 reduction vs all controls; 97.5% CI, –3.24 to –0.26). After adjustment for multiple testing, playing football did not have a significant adverse association with any of the secondary outcomes, such as the likelihood of heavy alcohol use at 65 years of age (odds ratio, 0.68; 95% CI, 0.32-1.43). CONCLUSIONS AND RELEVANCE: Cognitive and depression outcomes later in life were found to be similar for high school football players and their nonplaying counterparts from mid-1950s in Wisconsin. The risks of playing football today might be different than in the 1950s, but for current athletes, this study provides information on the risk of playing sports today that have a similar risk of head trauma as high school football played in the 1950s.
Choice, understanding, appreciation and reasoning compose the standard model of decision-making capacity. Difficulties in determining capacity can arise when patients exhibit partial impairment. We ...suggest that a pragmatic approach, focusing on how capacity status affects the ultimate decision to override the patient's wishes, can help evaluators resolve difficult cases.
Quality improvement initiatives have become a major force in shaping
health care. These initiatives are diverse but share a common goal of generating
knowledge that will guide improvements in health ...care. Although quality improvement
occupies an uncertain territory between clinical care and research, this difference
is extremely important. If a quality improvement initiative is research, federal
regulations require a variety of procedures that must be followed to protect
the human subjects involved. Conversely, if the same initiative is not research,
the regulations outlining these procedures are not applicable.This article proposes 2 criteria to determine whether a quality improvement
initiative should be reviewed as research. Such an initiative should be reviewed
and regulated as research if (1) the majority of patients involved are not
expected to benefit directly from the knowledge to be gained or (2) if additional
risks or burdens are imposed to make the results generalizable. Implementation
of these criteria offers the possibility that the rights and interests of
those who participate in quality improvement initiatives will be protected.
Abstract Amyloid PET imaging is a novel diagnostic test that can detect in living humans one of the two defining pathologic lesions of Alzheimer disease, amyloid-β deposition in the brain. The ...Amyloid Imaging Task Force of the Alzheimer's Association and Society for Nuclear Medicine and Molecular Imaging previously published appropriate use criteria for amyloid PET as an important tool for increasing the certainty of a diagnosis of Alzheimer disease in specific patient populations. Here, the task force further clarifies and expands 3 topics discussed in the original paper: first, defining dementia experts and their use of proper documentation to demonstrate the medical necessity of an amyloid PET scan; second, identifying a specific subset of individuals with mild cognitive impairment for whom an amyloid PET scan is appropriate; and finally, developing educational programs to increase awareness of the amyloid PET appropriate use criteria and providing instructions on how this test should be used in the clinical decision-making process.
In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments ...that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.
The US Food and Drug Administration (FDA) approved aducanumab, the first treatment targeting ß-amyloid, a protein associated with Alzheimer's disease. Both the FDA and the US House of Representatives ...have launched efforts to reform the accelerated-approval process, mostly focused on empowering the FDA to rescind approval after a drug is authorized. To minimize that risk, the FDA should recast itself as the guardian of information by providing more transparency about its decision-making and ensuring drug companies produce information about clinical benefit.
Understanding the prevalence of beliefs, attitudes, and expectations about Alzheimer's disease dementia in the public could inform strategies to mitigate stigma.
Random sample of 317 adults from the ...U.S. public was analyzed to understand reactions toward a man with mild-stage Alzheimer's disease dementia.
In adjusted analyses, over half of respondents expected the person to be discriminated against by employers (55.3%; 95% confidence interval CI = 47.0–65.2) and be excluded from medical decision-making (55.3%; 95% CI = 46.9–65.4). Almost half expected his health insurance would be limited based on data in the medical record (46.6%; 95% CI = 38.0–57.2), a brain imaging result (45.6%, 95% CI = 37.0–56.3), or genetic test result (44.7%; 95% CI = 36.0–55.4).
Public education and policies are needed to address concerns about employment and insurance discrimination. Studies are needed to discover how advances in diagnosis and treatment may change Alzheimer's disease stigma.
Research suggests that Alzheimer disease (AD) pathophysiology begins prior to the clinical expression of the disease and that biomarker measures may provide direct evidence of this process. As a ...result, it may be possible to uncouple the diagnosis of AD from the clinical expression of the disease. The shifting boundaries between normal brain aging and disease present 3 challenges: 1) establishing guidelines for researchers and clinicians to safely and effectively communicate the diagnosis of preclinical AD, 2) setting up a process that effectively translates this diagnosis into practice and policy, and 3) adapting laws, regulations, and professional practices to the diagnosis of preclinical AD. The field of genetic testing for AD suggests how to balance a patient's desire to know his or her risk of developing dementia with a clinician's desire to mitigate the potential harms of that information. The development of diagnostic and treatment guidelines for other diseases of aging, such as cardiovascular disease, suggests the need for a National Alzheimer's Education Program to develop policies and procedures to translate preclinical AD into both clinical practice and policy. Revisions are needed to laws, regulations, and professional practices governing driving, financial management and planning, and privacy and confidentiality.
Abstract In the history of medicine, one means to progress is when we make the decision that our assumptions and definitions of disease are no longer consistent with the scientific evidence, and no ...longer serve our health care needs. The arc of scientific progress is now requiring a change in how we diagnose Alzheimer's disease. Both the National Institute on Aging—Alzheimer's Association (NIA-AA) 2011 workgroup and the International Work Group (IWG) have proposed guidelines that use detectable measures of biological changes in the brain, commonly known as biological markers, or biomarkers, as part of the diagnosis. This Special Report examines how the development and validation of Alzheimer's disease biomarkers—including those detectable in the blood or cerebral spinal fluid, or through neuroimaging—is a top research priority, and how this has the potential to markedly change how we diagnose Alzheimer's disease and, as a result, how we count the number of people with this disease. As research advances a biomarker-based method for diagnosis and treatment at the earliest stages of Alzheimer's disease, we envision a future in which Alzheimer's disease is placed in the same category as other chronic diseases, such as cardiovascular disease or diabetes, which can be readily identified with biomarkers and treated before irrevocable disability occurs.
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