PCTs have a growing foothold in research because they can produce quickly usable results, typically by relying on electronic health record data. Because PCTs are embedded in delivery systems, even ...null trial results are directly relevant to practice. According to Porter, value consists of optimizing health outcomes relative to cost and placing patients and other stakeholders at the center of a health care system's activities.3 The question we should ask is: What is the worth of PCTs in enhancing health care value that is achieved through improved quality of care? ...research-related tasks may strain the capacity of clinical teams already caring for patients.9 Relying on multiple stakeholder partnerships and embedding in health systems are strengths of PCTs, but unforeseen events such as leadership or staffing changes, electronic health record barriers, or conditions such as the COVID-19 pandemic can affect studies.10 Health care system leaders may be reluctant to participate in PCTs that ask important questions but may not lead to short-term quality or safety gains.9 Embedding PCTs in integrated delivery systems can facilitate successful trials but undermine the claim that findings are generalizable to other settings.
Objectives
To investigate associations between acute care and critical illness hospitalizations and performance on physical functional measures and activities of daily living (ADLs).
Design
...Prospective cohort study.
Setting
Large health maintenance organization.
Participants
Two thousand nine hundred twenty‐six participants in Adult Changes in Thought, a study of aging enrolling dementia‐free individuals aged 65 and older not living in a nursing home from 1994 to September 30, 2008 (N = 2,926).
Measurements
The exposure of interest was hospitalization during study participation, subdivided by presence of critical illness. Outcomes included gait speed, grip strength, chair stand speed, and difficulty and dependence in performing ADLs measured at biennial visits.
Results
Median time between hospital discharge and the next study visit was 311 days (interquartile range (IQR) 151–501 days) after acute care hospitalization and 359 days (IQR 181–420 days) after critical illness hospitalization. Gait speed was slower after acute care (−0.05 m/s, 95% confidence interval (CI) = 0.01–0.04 m/s slower, P < .001) and critical illness (−0.16 m/s, 95% CI = −0.22 to −0.10, P < .001). Grip was weaker after acute care hospitalization (−0.8 kg, 95% CI = −1.0 to −0.6, P < .001) but not significantly different after critical illness hospitalization. Chair‐stand speed was slower after acute care hospitalization (−0.04 stands/s, 95% CVI = −0.05 to −0.04, P < .001) and critical illness hospitalization (−0.09, 95% CI = −0.15 to −0.03, P = .003). The odds of difficulty with (odds ratio (OR) = 1.4, 95% CI = 1.2–1.6, P < .001) or dependence in (OR = 2.0, 95% CI = 1.2–3.2, P = .006) one or more ADLs was higher after acute care hospitalization, as were the odds of difficulty with (OR = 1.9, 95% CI = 1.1–3.6, P = .03) or dependence in (OR = 7.9, 95% CI = 2.5–25.7, P = .001) one or more ADLs after critical illness.
Conclusion
In older adults, hospitalization, especially for critical illness, was associated with clinically relevant decline in gait and chair stand speed and strongly associated with difficulty with and dependence in ADLs.
Identifying ophthalmic diseases associated with increased risk of Alzheimer's disease (AD) may enable better screening and understanding of those at risk of AD.
Diagnoses of glaucoma, age-related ...macular degeneration (AMD), and diabetic retinopathy (DR) were based on International Classification of Diseases, 9th revision, codes for 3877 participants from the Adult Changes in Thought study. The adjusted hazard ratio for developing probable or possible AD for recent (within 5 years) and established (>5 years) diagnoses were assessed.
Over 31,142 person-years of follow-up, 792 AD cases occurred. The recent and established hazard ratio were 1.46 (P = .01) and 0.87 (P = .19) for glaucoma, 1.20 (P = .12) and 1.50 (P < .001) for AMD, and 1.50 (P = .045) and 1.50 (P = .03) for DR.
Increased AD risk was found for recent glaucoma diagnoses, established AMD diagnoses, and both recent and established DR. People with certain ophthalmic conditions may have increased AD risk.
•Glaucoma, AMD, and DR are associated with increased AD risk.•Cataract is not associated with increased risk of AD.•The onset of ophthalmic diagnoses may result in different risks of AD.•Ophthalmic diseases may share pathological pathways with AD, which may be the same or distinct across different ophthalmic conditions.•Screening for certain ophthalmic diseases may be important for understanding AD risk.
To systematically review and synthesize the evidence on differential associations between antihypertensive medication (AHM) classes and the risk of incident dementia.
Systematic review and random ...effects frequentist network meta-analysis. Embase, MEDLINE, and the Cochrane library were searched from origin to December 2019.
Randomized controlled trials (RCTs) and prospective cohort studies that compared associations of different AHM classes with incident all-cause dementia and/or Alzheimer's disease over at least 1 year of follow-up.
All cause dementia and/or Alzheimer's disease.
Fifteen observational studies and 7 RCTs were included. Data on AHM classes were available for 649,790 participants and dementia occurred in 19,600 (3.02%). Network meta-analysis showed that in observational studies, treatment with either calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs) was associated with lower dementia risks than treatment with other antihypertensives: CCBs vs angiotensin converting enzyme inhibitors (ACE inhibitors) (HR=0.84, 95% CI 0.74-0.95), beta blockers (HR=0.83, 95% CI 0.73-0.95) and diuretics (HR=0.89, 95% CI 0.78-1.01) and ARBs vs ACE inhibitors (HR=0.88, 95% CI 0.81-0.97), beta blockers (HR=0.87, 95% CI 0.77-0.99), and diuretics (HR=0.93, 95% CI 0.83-1.05). There were insufficient RCTs to create a robust network based on randomized data alone.
Recommending CCBs or ARBs as preferred first-line antihypertensive treatment may significantly reduce the risk of dementia. If corroborated in a randomized setting, these findings reflect a low-cost and scalable opportunity to reduce dementia incidence worldwide.
Alzheimer disease and other dementing disorders are major sources of morbidity and mortality in aging societies. Proven strategies to delay onset or reduce risk for dementing disorders would be ...greatly beneficial.
To determine whether regular exercise is associated with a reduced risk for dementia and Alzheimer disease.
Prospective cohort study.
Group Health Cooperative, Seattle, Washington.
1740 persons older than age 65 years without cognitive impairment who scored above the 25th percentile on the Cognitive Ability Screening Instrument (CASI) in the Adult Changes in Thought study and who were followed biennially to identify incident dementia.
Baseline measurements, including exercise frequency, cognitive function, physical function, depression, health conditions, lifestyle characteristics, and other potential risk factors for dementia (for example, apolipoprotein E epsilon4); biennial assessment for dementia.
During a mean follow-up of 6.2 years (SD, 2.0), 158 participants developed dementia (107 developed Alzheimer disease). The incidence rate of dementia was 13.0 per 1000 person-years for participants who exercised 3 or more times per week compared with 19.7 per 1000 person-years for those who exercised fewer than 3 times per week. The age- and sex-adjusted hazard ratio of dementia was 0.62 (95% CI, 0.44 to 0.86; P = 0.004). The interaction between exercise and performance-based physical function was statistically significant (P = 0.013). The risk reduction associated with exercise was greater in those with lower performance levels. Similar results were observed in analyses restricted to participants with incident Alzheimer disease.
Exercise was measured by self-reported frequency. The study population had a relatively high proportion of regular exercisers at baseline.
These results suggest that regular exercise is associated with a delay in onset of dementia and Alzheimer disease, further supporting its value for elderly persons.
Growing evidence suggests that oxidative damage caused by the β-amyloid peptide in the pathogenesis of Alzheimer’s disease may be hydrogen peroxide mediated. Many polyphenols, the most abundant ...dietary antioxidants, possess stronger neuroprotection against hydrogen peroxide than antioxidant vitamins.
We tested whether consumption of fruit and vegetable juices, containing a high concentration of polyphenols, decreases the risk of incident probable Alzheimer’s disease in the
Kame Project cohort, a population-based prospective study of 1836 Japanese Americans in King County, Washington, who were dementia-free at baseline (1992-1994) and were followed through 2001.
After adjustment for potential confounders, the hazard ratio for probable Alzheimer’s disease was 0.24 (95% confidence interval CI, 0.09-0.61) comparing subjects who drank juices at least 3 times per week with those who drank less often than once per week with a hazard ratio of 0.84 (95% CI, 0.31-2.29) for those drinking juices 1 to 2 times per week (
P for trend < .01). This inverse association tended to be more pronounced among those with an apolipoprotein E
ε-4 allele and those who were not physically active. Conversely, no association was observed for dietary intake of vitamins E, C, or β-carotene or tea consumption.
Fruit and vegetable juices may play an important role in delaying the onset of Alzheimer’s disease, particularly among those who are at high risk for the disease. These results may lead to a new avenue of inquiry in the prevention of Alzheimer’s disease.
OBJECTIVETo assess whether angiotensin-II stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin-1 receptor blockers) convey a lower risk of incident ...dementia compared to angiotensin-II inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, beta blockers, and non-dihydropyridine calcium channel blockers), in accordance with the “angiotensin hypothesis.”
METHODSCox regression analyses of incident dementia (and/or mortality as competing risk) during 6–8 years of follow-up, in a population sample of 1909 non-demented community-dwelling individuals (54% women), aged 70–78 (mean74.5 ± 2.5) years.
RESULTSAfter a median of 6.7 years of follow-up, dementia status was available for 1,870 (98%) and mortality for 1,904 (>99%) participants. Dementia incidence was 5.6% (27/480) in angiotensin-II stimulating, 8.2% (59/721) in angiotensin-II inhibiting, and 6.9% (46/669) in both antihypertensive type users. Adjusted for dementia risk factors including blood pressure and medical history, angiotensin-II stimulating antihypertensive users had a 45% lower incident dementia rate (HR = 0.55, 95% CI = 0.34–0.89) without excess mortality (HR = 0.86, 95% CI = 0.64–1.16), and individuals using both types had a non-significant 20% lower dementia rate (HR = 0.80, 95% CI = 0.53–1.20) without excess mortality (HR = 0.97, 95% CI = 0.76–1.24), compared to angiotensin-II inhibiting antihypertensive users. Results were consistent for subgroups based on diabetes and stroke history, but may be specific for individuals without a history of cardiovascular disease.
CONCLUSIONSUsers of angiotensin-II stimulating antihypertensives had lower dementia rates compared to angiotensin-II inhibiting antihypertensive users, supporting the “angiotensin hypothesis.” Confounding by indication must be examined further, although sub-analyses suggest this did not influence results. If replicated, dementia prevention could become a compelling indication for older individuals receiving antihypertensive treatment.
A framework for integrating population health management with personalized medicine is proposed. This could guide genome-wide sequencing, which has the potential to improve both practices.
Recent advancement in the technology of virtual reality (VR) has allowed improved applications for cognitive rehabilitation.
The aim of this review is to facilitate comparisons of therapeutic ...efficacy of different VR interventions.
A systematic approach for the review of VR cognitive rehabilitation outcome research addressed the nature of each sample, treatment apparatus, experimental treatment protocol, control treatment protocol, statistical analysis and results. Using this approach, studies that provide valid evidence of efficacy of VR applications are summarized. Applications that have not yet undergone controlled outcome study but which have promise are introduced.
Seventeen studies conducted over the past eight years are reviewed. The few randomized controlled trials that have been completed show that some applications are effective in treating cognitive deficits in people with neurological diagnoses although further study is needed.
Innovations requiring further study include the use of enriched virtual environments that provide haptic sensory input in addition to visual and auditory inputs and the use of commercially available gaming systems to provide tele-rehabilitation services. Recommendations are offered to improve efficacy of rehabilitation, to improve scientific rigor of rehabilitation research and to broaden access to the evidence-based treatments that this research has identified.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
70.
Frailty and incident dementia Gray, Shelly L; Anderson, Melissa L; Hubbard, Rebecca A ...
The journals of gerontology. Series A, Biological sciences and medical sciences,
09/2013, Letnik:
68, Številka:
9
Journal Article
Recenzirano
Odprti dostop
We sought to examine whether frailty is associated with dementia, Alzheimer's disease (AD), and non-AD dementia risk.
This is a prospective population-based cohort derived from an integrated health ...maintenance organization. The sample consisted of 2,619 participants aged 65 and older without dementia at baseline followed from 1994 to 2010. Frailty was defined as having at least 3 of the following criteria: weakness (grip strength), slowness (walking speed), weight loss, low physical activity, and self-reported exhaustion. Follow-up occurred every 2 years to identify incident dementia, possible or probable AD, and non-AD dementia using standard research criteria. Covariates came from self-report and study measures. We used adjusted Cox proportional hazards models to examine the association between frailty and each outcome.
Over a mean follow-up of 6.5 years, 521 participants developed dementia (of which 448 developed AD). In the model adjusted for age, sex, education, and race, the hazard ratio for frailty was 1.78 (95% confidence interval CI 1.32-2.40). In the fully adjusted models, the hazard ratio for frailty was 1.20 for all-cause dementia (95% CI 0.85-1.69), 1.08 for AD (95% CI 0.74-1.57), and 2.57 for non-AD dementia (95% CI 1.08-6.11). For all-cause dementia, we found an interaction between baseline cognitive score and frailty (p = .02); hazard ratio for frailty was 1.78 for those with higher global cognition (95% CI 1.14-2.78) and 0.79 for those with lower global cognition (95% CI 0.50-1.26).
Frailty was associated with dementia when adjusting only for demographic variables but not in the fully adjusted model. Frailty was associated with higher risk of developing non-AD dementia but not AD. Although frailty was not associated with all-cause dementia in the entire sample, an association did exist in participants with higher cognitive scores. Mechanisms underlying these associations remain to be elucidated.
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