Journal of Alzheimer's Disease - Volume 91, issue 1

Authors: Carlew, Anne R. | Kaser, Alyssa | Schaffert, Jeff | Goette, William | Lacritz, Laura | Rossetti, Heidi

Article Type: Systematic Review

Abstract: Background: The concept of mild cognitive impairment (MCI) has evolved since its original conception. So, too, have MCI diagnostic methods, all of which have varying degrees of success in identifying individuals at risk of conversion to dementia. The neuropsychological actuarial method is a straightforward diagnostic approach that has shown promise in large datasets in identifying individuals with MCI who are likely to have progressive courses. This method has been increasingly applied in various iterations and samples, raising questions of how best to apply this method and when caution should be used. Objective: Our objective was to review the …literature investigating use of the neuropsychological actuarial method to diagnose MCI to identify strengths and weaknesses of this approach, as well as highlight areas for further research. Methods: Databases PubMed and PsychInfo were systematically searched for studies that compared the neuropsychological actuarial method to some other diagnostic method. Results: We identified 13 articles and extracted relevant study characteristics and findings. Existing literature was reviewed and integrated, with focus on the neuropsychological actuarial method’s performance relative to existing diagnostic methods/criteria as well as associations with longitudinal outcomes and biomarkers. Tables with pertinent methodological information and general findings are also provided. Conclusion: The neuropsychological actuarial method to diagnose MCI has shown utility some in large-scale homogenous databases compared to research criteria. However, its standing relative to consensus diagnostic methods is unclear, and emerging evidence suggests the neuropsychological actuarial method may be more prone to diagnostic errors in more demographically diverse populations. Show more

Keywords: Alzheimer’s disease, clinical decision-making, cognition disorders, neuropsychology, review

DOI: 10.3233/JAD-220805

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 169-182, 2023

Authors: Johnson, Adrienne L. | Seep, Elaina | Norton, Derek L. | Mundt, Marlon P. | Wyman, Mary F. | James, Taryn T. | Zuelsdorff, Megan | Lambrou, Nickolas H. | McLester-Davis, Lauren W.Y. | Umucu, Emre | Gleason, Carey E.

Article Type: Short Communication

Abstract: Individuals with Alzheimer’s disease and related dementias (ADRD) accrue higher healthcare utilization costs than peers without ADRD, but incremental costs of ADRD among American Indians/Alaska Natives (AI/AN) is unknown. State-wide paid electronic health record data were retrospectively analyzed using percentile-based bootstrapped 95% confidence intervals of the weighted mean difference of total 5-year billed costs to compare total accrued for non-Tribal and Indian Health Service utilization costs among Medicaid and state program eligible AI/AN, ≥40 years, based on the presence/absence of ADRD (matching by demographic and medical factors). AI/AN individuals with ADRD accrued double the costs compared to those without ADRD, …costing an additional $880.45 million to $1.91 billion/year. Show more

Keywords: Alaska Native, Alzheimer’s disease, American Indian, cost, dementia, healthcare utilization, incremental cost, Medicaid, Native American

DOI: 10.3233/JAD-220393

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 183-189, 2023

Authors: Chen, Liang | Xue, Jun | Zhao, Qianhua | Liang, Xiaoniu | Zheng, Li | Fan, Zhen | Souare, Ibrahima Sory Jnr | Suo, Yuanzhen | Wei, Xunbin | Ding, Ding | Mao, Ying

Article Type: Research Article

Abstract: Background: Laboratory investigations have demonstrated that near-infrared (NIR) light treatment can reduce amyloid-β burden in models of Alzheimer’s disease (AD). However, previous clinical studies are rather insufficient. Objective: Before starting a large-scale clinical trial, we performed a pilot study to characterize the efficacy of NIR light for AD patients. Methods: Twenty participants with mild to moderate AD were assigned randomly to the intervention (1060-1080 nm and 800-820 nm NIR light treatment for 12 weeks) or control group (without sham treatment). Safety and efficacy were evaluated at baseline, week 4, 8, and 12, and 4 weeks after treatment. …Results: In the intervention and control groups at week 12, mean changes from baseline on the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) were -3.1 and -1.3 (p  = 0.5689). Mean changes from baseline on the Activities of Daily Living (ADL) were -3.6 versus 3.1 (p  = 0.0437). Mean changes from baseline on the Mini-Mental State Examination (MMSE) were 4.4 versus 1.0 (p  = 0.0253). The percentage of participants who exhibited a change larger than 4 points from baseline to week 12 was determined for the intervention and control groups on the ADAS-Cog (57% versus 29%), ADL (29% versus 0%), and MMSE (57% versus 14%). Treatment with NIR light did not increase the incidence of adverse events in participants. Conclusion: NIR light treatment appears to be safe and potentially beneficial for AD patients. It improved cognitive function and activities of daily living. The preliminary data encouraged us to launch a large-sample, multicenter, double-blind clinical trial. Show more

Keywords: Alzheimer’s disease, clinical study, cognition, pilot project, physical therapy

DOI: 10.3233/JAD-220866

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 191-201, 2023

Authors: Cowley, Alison | Booth, Vicky | Di Lorito, Claudio | Chandria, Pooja | Chadwick, Olivia | Stanislas, Catherine | Dunlop, Marianne | Howe, Louise | Harwood, Rowan H. | Logan, Pip A.

Article Type: Research Article

Abstract: Background: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a programme of physical activity and exercise designed to maintain participation in activities of daily living, mobility, and quality of life for people living with dementia. During the COVID-19 pandemic first national lockdown in England, the PrAISED physiotherapists, occupational therapists, and rehabilitation support workers adapted to delivering the intervention remotely via telephone or video conferencing. Objective: The aim of this study was to explore therapists’ experience of delivering the PrAISED intervention during the COVID-19 pandemic and derive implications for clinical practice. Methods: Qualitative …semi-structured interviews were conducted with 16 therapists using purposive sampling. Thematic analysis was used to analyze the transcripts. Results: Therapists reported a change in the relationship between themselves, the person with dementia and the caregiver, with an increased reliance on the caregiver and a loss of autonomy for the person living with dementia. There was concern that this would increase the burden on the caregiver. The therapists reported using creativity to adapt to different modes of delivery. They felt their sessions were mostly focused on providing social and emotional support, and that assessing, progressing, and tailoring the intervention was difficult. Conclusion: It is possible to deliver some elements of a physical intervention using remote delivery, but a dual modal approach including remote and face-to-face delivery would optimize treatment efficacy. Educational support would be required to enable people living with dementia and their caregivers to overcome barriers relating to digital literacy. Show more

Keywords: COVID-19, dementia, exercise, physical activity, rehabilitation, telerehabilitation

DOI: 10.3233/JAD-220424

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 203-214, 2023

Authors: Rajczyk, Jenna I. | Ferketich, Amy | Wing, Jeffrey J.

Article Type: Research Article

Abstract: Background: Smoking status may influence subjective cognitive decline (SCD); however, few studies have evaluated this association. Objective: To assess whether smoking status is associated with SCD among middle age and older adults, and to determine if this association is modified by sex at birth. Methods: A cross-sectional analysis was conducted using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey to analyze the relationship between SCD and smoking status (current, recent former, and remote former). Eligible respondents included participants 45 years of age or older who responded to the SCD and tobacco questions of …interest. Survey-weighted Poisson regression models were employed to estimate the crude and adjusted prevalence ratios (cPR/aPR) and corresponding 95% confidence intervals (CI) of the association between smoking status and SCD. A Wald test was computed to determine the significance of the interaction term between smoking status and sex (α = 0.05). Results: There were 136,018 eligible respondents, of which approximately 10% had SCD. There was a graded association between smoking and SCD, with the greatest prevalence of SCD among current smokers (aPR = 1.87; CI: 1.54, 2.28), followed by recent former smokers (aPR = 1.47; 95% CI: 1.02, 2.12), and remote former smokers (aPR = 1.11; 95% CI: 0.93, 1.33) each compared to never smokers. There was no evidence of effect modification by sex (p interaction = 0.73). Conclusion: The consistency of smoking as a risk factor for objective and subjective cognitive decline supports the need for future studies to further the evidence on whether changes to smoking status impacts cognition in middle age. Show more

Keywords: Alzheimer’s disease, cigarette smoking, cognition, cognitive aging, dementia

DOI: 10.3233/JAD-220501

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 215-223, 2023

Authors: Soppela, Helmi | Krüger, Johanna | Hartikainen, Päivi | Koivisto, Anne | Haapasalo, Annakaisa | Borroni, Barbara | Remes, Anne M. | Katisko, Kasper | Solje, Eino

Article Type: Research Article

Abstract: Background: Currently, there are few studies considering possible modifiable risk factors of frontotemporal dementia (FTD). Objective: In this retrospective case-control study, we evaluated whether a history of traumatic brain injury (TBI) associates with a diagnosis of FTD or modulates the clinical phenotype or onset age in FTD patients. Methods: We compared the prevalence of prior TBI between individuals with FTD (N = 218) and age and sex-matched AD patients (N = 214) or healthy controls (HC; N = 100). Based on the patient records, an individual was categorized to the TBI+ group if they were reported to have suffered from TBI during …lifetime. The possible associations of TBI with age of onset and disease duration were also evaluated in the whole FTD patient group or separately in the sporadic and genetic FTD groups. Results: The prevalence of previous TBI was the highest in the FTD group (19.3%) when compared to the AD group (13.1%, p  = 0.050) or HC group (12%, p  = 0.108, not significant). Preceding TBI was more often associated with the sporadic FTD cases than the C9orf72 repeat expansion-carrying FTD cases (p  = 0.003). Furthermore, comparison of the TBI+ and TBI- FTD groups indicated that previous TBI was associated with an earlier onset age in the FTD patients (B = 3.066, p  = 0.010). Conclusion: A preceding TBI associates especially with sporadic FTD and with earlier onset of symptoms. The results of this study suggest that TBI may be a triggering factor for the neurodegenerative processes in FTD. However, understanding the precise underlying mechanisms still needs further studies. Show more

Keywords: Comorbidity, dementia, frontotemporal dementia, head trauma, risk factors, traumatic brain injury

DOI: 10.3233/JAD-220545

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 225-232, 2023

Authors: Katabathula, Sreevani | Davis, Pamela B. | Xu, Rong

Article Type: Research Article

Abstract: Background: Mild cognitive impairment (MCI), a prodromal phase of Alzheimer’s disease (AD), is heterogeneous with different rates and risks of progression to AD. There are significant gender disparities in the susceptibility, prognosis, and outcomes in patients with MCI, with female being disproportionately negatively impacted. Objective: The aim of this study was to identify sex-specific heterogeneity of MCI using multi-modality data and examine the differences in the respective MCI subtypes with different prognostic outcomes or different risks for MCI to AD conversion. Methods: A total of 325 MCI subjects (146 women, 179 men) and 30 relevant features …were considered. Mixed-data clustering was applied to women and men separately to discover gender-specific MCI subtypes. Gender differences were compared in the respective subtypes of MCI by examining their MCI to AD disease prognosis, descriptive statistics, and conversion rates. Results: We identified three MCI subtypes: poor-, good-, and best-prognosis for women and for men, separately. The subtype-wise comparison (for example, poor-prognosis subtype in women versus poor-prognosis subtype in men) showed significantly different means for brain volumetric, cognitive test-related, also for the proportion of comorbidities. Also, there were substantial gender differences in the proportions of participants who reverted to normal function, remained stable, or converted to AD. Conclusion: Analyzing sex-specific heterogeneity of MCI offers the opportunity to advance the understanding of the pathophysiology of both MCI and AD, allows stratification of risk in clinical trials of interventions, and suggests gender-based early intervention with targeted treatment for patients at risk of developing AD. Show more

Keywords: Alzheimer’s disease, comorbidity, gender differences, heterogeneity, mild cognitive impairment, subtypes

DOI: 10.3233/JAD-220600

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 233-243, 2023

Authors: Dover, Mary | Moseley, Taylor | Biskaduros, Adrienne | Paulchakrabarti, Mousumi | Hwang, Sung Hee | Hammock, Bruce | Choudhury, Biswa | Kaczor-Urbanowicz, Karolina Elżbieta | Urbanowicz, Andrzej | Morselli, Marco | Dang, Johnny | Pellegrini, Matteo | Paul, Ketema | Bentolila, Laurent A. | Fiala, Milan

Article Type: Research Article

Abstract: Background: Macrophages of healthy subjects have a pro-resolution phenotype, upload amyloid-β (Aβ) into endosomes, and degrade Aβ, whereas macrophages of patients with Alzheimer’s disease (AD) generally have a pro-inflammatory phenotype and lack energy for brain clearance of Aβ. Objective: To clarify the pathogenesis of sporadic AD and therapeutic effects of polyunsaturated fatty acids (PUFA) with vitamins B and D and antioxidants on monocyte/macrophage (MM) migration in the AD brain, MM transcripts in energy and Aβ degradation, MM glycome, and macrophage clearance of Aβ. Methods: We followed for 31.3 months (mean) ten PUFA-supplemented neurodegenerative patients: 3 with …subjective cognitive impairment (SCI), 2 with mild cognitive impairment (MCI), 3 MCI/vascular cognitive impairment, 2 with dementia with Lewy bodies, and 7 non-supplemented caregivers. We examined: monocyte migration in the brain and a blood-brain barrier model by immunochemistry and electron microscopy; macrophage transcriptome by RNAseq; macrophage glycome by N-glycan profiling and LTQ-Orbitrap mass spectrometry; and macrophage phenotype and phagocytosis by immunofluorescence. Results: MM invade Aβ plaques, upload but do not degrade Aβ, and release Aβ into vessels, which develop cerebrovascular amyloid angiopathy (CAA); PUFA upregulate energy and Aβ degradation enzyme transcripts in macrophages; PUFA enhance sialylated N-glycans in macrophages; PUFA reduce oxidative stress and increase pro-resolution MM phenotype, mitochondrial membrane potential, and Aβ phagocytosis (p  < 0.001). Conclusion: Macrophages of SCI, MCI, and AD patients have interrelated defects in the transcriptome, glycome, Aβ phagocytosis, and Aβ degradation. PUFA mend macrophage transcriptome, enrich glycome, enhance Aβ clearance, and benefit the cognition of early-stage AD patients. Show more

Keywords: Alzheimer’s disease, amyloid-β, cerebrovascular amyloid angiopathy, coenzyme Q2, glycome, macrophage, mitochondrial membrane potential, phagocytosis, polyunsaturated fatty acids, transcriptome

DOI: 10.3233/JAD-220764

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 245-261, 2023

Authors: Kong, Yu | Chen, Zhongyun | Shi, Qi | Zuo, Ya | Zhang, Jing

Article Type: Research Article

Abstract: Background: The 14-3-3 protein in cerebrospinal fluid (CSF) is a suitable biomarker for the diagnosis of Creutzfeldt-Jakob disease (CJD). However, it has also been detected in various non-prion-related rapidly progressive dementia (RPD), which affected its diagnostic performance and clinical utilization. Objective: To investigate the general disease distribution with positive 14-3-3 result and to evaluate the association between CSF 14-3-3 protein and the clinical features in patients with non-prion RPD. Methods: A total of 150 patients with non-prion RPD were enrolled. The clinical data were collected and CSF 14-3-3 test was performed for all patients. The distribution …of various diseases with a positive 14-3-3 result was analyzed and the association of CSF 14-3-3 with clinical features was tested. Results: The CSF 14-3-3 protein was detected in 23.3% of non-prion RPD patients, and the most frequent diagnoses were autoimmune encephalitis (22.9%) and neurodegenerative disease (22.9%). CSF 14-3-3 protein was more common in older patients (p  = 0.028) and those presenting myoclonus (p  = 0.008). In subgroup analysis, the positive 14-3-3 test was more common in neurodegenerative disease with a long time from the symptom onset to CSF 14-3-3 test (p  = 0.014). Conclusion: CSF 14-3-3 protein could be detected in a broad spectrum of non-prion RPD. In particular, patients with autoimmune encephalitis and rapidly progressive neurodegenerative diseases and those with myoclonus have a greater likelihood of a positive 14-3-3 result. These results could help clinicians interpret the results of CSF 14-3-3 protein more reasonably. Show more

Keywords: 14-3-3 protein, biomarker, cerebrospinal fluid, rapidly progressive dementia

DOI: 10.3233/JAD-220718

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 263-272, 2023

Authors: Wiseman, Alyssa L. | Briggs, Clark A. | Peritt, Ariel | Kapecki, Nicolas | Peterson, Daniel A. | Shim, Seong S. | Stutzmann, Grace E.

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) is a chronic neurodegenerative disorder with a progressive loss of cognitive function. Currently, no effective treatment regimen is available. Lithium, a mood stabilizer for bipolar disorder, exerts broad neuroprotective and neurotrophic actions and improves cognitive function. Objective: The study investigated if lithium stabilizes Ca2+ signaling abnormalities in hippocampal neurons and subsequently normalize downstream effects on AD neuropathology and synaptic plasticity in young AD mice. Methods: Four-month-old 3xTg-AD mice were treated with a LiCl diet chow for 30 days. At the end of the lithium treatment, a combination of two-photon Ca2+ …imaging, electrophysiology, and immunohistochemistry assays were used to assess the effects of the LiCl treatment on inositol trisphosphate receptor (IP3 R)-dependent endoplasmic reticulum (ER) Ca2+ and voltage-gated Ca2+ channel (VGCC)-mediated Ca2+ signaling in CA1 neurons, neuronal nitric oxide synthase (nNOS) and hyperphosphorylated tau (p-tau) levels and synaptic plasticity in the hippocampus and overlying cortex from 3xTg-ADmice. Results: Thirty-day LiCl treatment reduced aberrant IP3 R-dependent ER Ca2+ and VGCC-mediated Ca2+ signaling in CA1 pyramidal neurons from 3xTg-AD mice and restored neuronal nitric oxide synthase (nNOS) and hyperphosphorylated tau (p-tau) levels to control levels in the hippocampal subfields and overlying cortex. The LiCl treatment enhanced post-tetanic potentiation (PTP), a form of short-term plasticity in the hippocampus. Conclusion: The study found that lithium exerts therapeutic effects across several AD-associated early neuronal signaling abnormalities including aberrant Ca2+ signaling, nNOS, and p-tau formation and enhances short-term synaptic plasticity. Lithium could serve as an effective treatment or co-therapeutic for AD. Show more

Keywords: Alzheimer’s disease, Ca2+signaling, lithium, neuronal nitric oxide synthase, phosphorylated tau, synaptic plasticity

DOI: 10.3233/JAD-220758

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 273-290, 2023

Authors: Rådestig, Maya Arvidsson | Skoog, Johan | Zetterberg, Henrik | Skillbäck, Tobias | Zettergren, Anna | Sterner, Therese Rydberg | Fässberg, Madeleine Mellqvist | Sacuiu, Simona | Waern, Margda | Wetterberg, Hanna | Blennow, Kaj | Skoog, Ingmar | Kern, Silke

Article Type: Research Article

Abstract: Background: Most research on cerebrospinal fluid (CSF) neurofilament light protein (NfL) as a marker for neurodegeneration and neurogranin (Ng) for synaptic dysfunction has largely focused on clinical cohorts rather than population-based samples. Objective: We hypothesized that increased CSF levels of NfL and Ng are associated with subtle cognitive deficits in cognitively unimpaired (CU) older adults. Methods: The sample was derived from the Gothenburg H70 Birth Cohort Studies and comprised 258 CU 70-year-olds, with a Clinical Dementia Rating score of zero. All participants underwent extensive cognitive testing. CSF levels of NfL and Ng, as well as amyloid …β1 - 42 , total tau, and phosphorylated tau, were measured. Results: Participants with high CSF NfL performed worse in one memory-based test (Immediate recall, p  = 0.013) and a language test (FAS, p  = 0.016). Individuals with high CSF Ng performed worse on the memory-based test Supra Span (p  = 0.035). When stratified according to CSF tau and Aβ42 concentrations, participants with high NfL and increased tau performed worse on a memory test than participants normal tau concentrations (Delayed recall, p  = 0.003). In participants with high NfL, those with pathologic Aβ42 concentrations performed worse on the Delayed recall memory (p  = 0.044). In the high Ng group, participants with pathological Aβ42 concentrations had lower MMSE scores (p  = 0.027). However, in regression analysis we found no linear correlations between CSF NfL or CSF Ng in relation to cognitive tests when controlled for important co-variates. Conclusion: Markers of neurodegeneration and synaptic pathology might be associated with subtle signs of cognitive decline in a population-based sample of 70-year-olds. Show more

Keywords: Biomarkers, cerebrospinal fluid, dementia, neurofilament protein, neurogranin

DOI: 10.3233/JAD-220452

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 291-303, 2023

Authors: Lukkarinen, Heikki | Vanninen, Aleksi | Tesseur, Ina | Pemberton, Darrel | Van Der Ark, Peter | Kokkola, Tarja | Herukka, Sanna-Kaisa | Rauramaa, Tuomas | Hiltunen, Mikko | Blennow, Kaj | Zetterberg, Henrik | Leinonen, Ville

Article Type: Research Article

Abstract: Background: Alzheimer’s disease cerebrospinal fluid (CSF) biomarkers amyloid-β 1–42 (Aβ42 ), total tau (T-tau), and phosphorylated tau 181 (P-tau181 ) are widely used. However, concentration gradient of these biomarkers between intraventricular (V-CSF) and lumbar CSF (L-CSF) has been demonstrated in idiopathic normal pressure hydrocephalus (iNPH), potentially affecting clinical utility. Objective: Here we aim to provide conversion factors for clinical and research use between V-CSF and L-CSF. Methods: Altogether 138 iNPH patients participated. L-CSF samples were obtained prior to shunt surgery. Intraoperative V-CSF samples were obtained from 97 patients. Post-operative follow-up L- and V-CSF (shunt reservoir) samples …of 41 patients were obtained 1–73 months after surgery and then after 3, 6, and 18 months. CSF concentrations of Aβ42 , T-tau, and P-tau181 were analyzed using commercial ELISA assays. Results: Preoperative L-CSF Aβ42 , T-tau, and P-tau181 correlated to intraoperative V-CSF (ρ = 0.34–0.55, p  < 0.001). Strong correlations were seen between postoperative L- and V-CSF for all biomarkers in every follow-up sampling point (ρ s Aβ42 : 0.77–0.88, T-tau: 0.91–0.94, P-tau181 : 0.94–0.96, p  < 0.0001). Regression equations were determined for intraoperative V- and preoperative L-CSF (Aβ42 : V-CSF = 185+0.34*L-CSF, T-tau: Ln(V-CSF) = 3.11+0.49*Ln(L-CSF), P-tau181 : V-CSF = 8.2+0.51*L-CSF), and for postoperative V- and L-CSF (Aβ42 : V-CSF = 86.7+0.75*L-CSF, T-tau: V-CSF = 86.9+0.62*L-CSF, P-tau181 : V-CSF = 2.6+0.74*L-CSF). Conclusion: Aβ42 , T-tau, and P-tau181 correlate linearly in-between V- and L-CSF, even stronger after CSF shunt surgery. Equations presented here, provide a novel tool to use V-CSF for diagnostic and prognostic entities relying on the L-CSF concentrations and can be applicable to clinical use when L-CSF samples are not available or less invasively obtained shunt reservoir samples should be interpreted. Show more

Keywords: Aβ42, biomarkers, idiopathic normal pressure hydrocephalus, P-tau, T-tau

DOI: 10.3233/JAD-220652

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 305-319, 2023

Authors: Wagle, Jørgen | Selbæk, Geir | Benth, Jūratė Šaltytė | Gjøra, Linda | Rønqvist, Thale Kinne | Bekkhus-Wetterberg, Peter | Persson, Karin | Engedal, Knut

Article Type: Research Article

Abstract: Background: The CERAD Word List Memory Test (WLMT) is widely used in the assessment of older adults with suspected dementia. Although normative data of the WLMT exist in many different regions of the world, normative data based on large population-based cohorts from the Scandinavian countries are lacking. Objective: To develop normative data for the WLMT based on a large population-based Norwegian sample of healthy older adults aged 70 years and above, stratified by age, gender, and education. Methods: A total of 6,356 older adults from two population-based studies in Norway, HUNT4 70 + and HUNT4 Trondheim 70+, were …administered the WLMT. Only persons with normal cognitive function were included. We excluded persons with a diagnosis of mild cognitive impairment (MCI) and dementia, and persons with a history of stroke and/or depression. This resulted in 3,951 persons aged between 70 and 90 years, of whom 56.2% were females. Regression-based normative data were developed for this sample. Results: Age, gender, and education were significant predictors of performance on the WLMT list-learning subtests and the delayed recall subtest, i.e., participants of younger age, female sex, and higher education level attained higher scores compared to participants of older age, male sex, and lower level of education. Conclusion: Regression-based normative data from the WMLT, stratified by age, gender, and education from a large population-based Norwegian sample of cognitively healthy older adults aged 70 to 90 years are presented. An online norm calculator is available to facilitate scoring of the subtests (in percentiles and z-scores). Show more

Keywords: CERAD Word List Memory Test, cognition, memory, neuropsychological tests, normative data, older adults, population-based

DOI: 10.3233/JAD-220672

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 321-343, 2023

Authors: Kim, Jinhee | Jang, Hyemin | Park, Yu-hyun | Youn, Jinyoung | Seo, Sang Won | Kim, Hee Jin | Na, Duk L.

Article Type: Research Article

Abstract: Background: Age at onset was suggested as one possible risk factor for motor dysfunction in Alzheimer’s disease (AD). Objective: We investigated the association of motor symptoms with cognition or neurodegeneration in patients with AD, and whether this association differs by the age at onset. Methods: We included 113 amyloid positive AD patients and divided them into early-onset AD (EOAD) and late-onset AD (LOAD), who underwent the Unified Parkinson’s Disease Rating Scale (UPDRS)-Part III (=UPDRS) scoring, Mini-Mental State Examination (MMSE)/Clinical Deterioration Rating Sum-of-Boxes (CDR-SOB), and magnetic resonance image (MRI). Multiple linear regression was used to evaluate the …association of UPDRS and MMSE/CDR-SOB or MRI neurodegeneration measures, and whether the association differs according to the group. Results: The prevalence of motor symptoms and their severity did not differ between the groups. Lower MMSE (β= –1.1, p  < 0.001) and higher CDR-SOB (β= 2.0, p  < 0.001) were significantly associated with higher UPDRS. There was no interaction effect between MMSE/CDR-SOB and AD group on UPDRS. Global or all regional cortical thickness and putaminal volume were negatively associated with UPDRS score, but the interaction effect of neurodegeneration and AD group on UPDRS score was significant only in parietal lobe (p for interaction = 0.035), which showed EOAD to have a more pronounced association between parietal thinning and motor symptoms. Conclusion: Our study suggested that the severity of motor deterioration in AD is related to the severity of cognitive impairment itself rather than age at onset, and motor symptoms might occur through multiple mechanisms including cortical and subcortical atrophy. Show more

Keywords: Alzheimer’s disease, neuropsychological tests, parkinsonian disorders

DOI: 10.3233/JAD-220745

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 345-354, 2023

Authors: Swerdlow, Neal R. | Joshi, Yash B. | Sprock, Joyce | Talledo, Jo | Molina, Juan L. | Delano-Wood, Lisa | Iwanaga, Dylan | Kotz, Juliana E. | Huege, Steven | Léger, Gabriel C. | Light, Gregory A.

Article Type: Research Article

Abstract: Background: The uncompetitive NMDA antagonist, memantine (MEM), enhances prepulse inhibition of startle (PPI) across species. MEM is used to treat Alzheimer’s disease (AD); conceivably, its acute impact on PPI might be used to predict a patient’s sensitivity to MEM’s therapeutic effects. Objective: To begin to test this possibility, we studied MEM effects on PPI and related measures in AD patients. Methods: 18 carefully screened individuals with AD (mean age = 72.8 y; M:F=9 : 9) completed double-blind order-balanced testing with MEM (placebo versus 20 mg), assessing acoustic startle magnitude, habituation, PPI, and latency. Results: Fifteen out of 18 participants …exhibited reliable startle responses. MEM did not significantly impact startle magnitude or habituation. Compared to placebo responses, PPI was significantly increased after MEM (p  < 0.04; d  = 0.40); this comparison reached a large effect size for the 60 ms interval (d  = 0.62), where maximal MEM effects on PPI were previously detected. Prepulses reduced peak startle latency (“latency facilitation”) and this effect was amplified after MEM (p  = 0.03; d  = 0.41; for 60 ms intervals, d  = 0.69). No effects of MEM were detected on cognition, nor were MEM effects on startle associated with cognitive or clinical measures. Conclusion: MEM enhances prepulse effects on startle magnitude and latency in AD; these changes in PPI and latency facilitation with MEM suggest that these measures can be used to detect an AD patient’s neural sensitivity to acute MEM challenge. Studies in progress will determine whether such a “biomarker” measured at the outset on treatment can predict sensitivity to MEM’s therapeutic effects. Show more

Keywords: Alzheimer’s disease, memantine, neurocognition, prepulse inhibition

DOI: 10.3233/JAD-220769

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 355-362, 2023

Authors: Abbate, Carlo | Trimarchi, Pietro D. | Fumagalli, Giorgio G. | Gallucci, Alessia | Tomasini, Emanuele | Fracchia, Stefania | Rebecchi, Isabella | Morello, Elisabetta | Fontanella, Anna | Parisi, Paola M.R. | Tartarone, Federica | Giunco, Fabrizio | Ciccone, Simona | Nicolini, Paola | Lucchi, Tiziano | Arosio, Beatrice | Inglese, Silvia | Rossi, Paolo D.

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) is clinically heterogeneous, including the classical-amnesic (CA-) phenotype and some variants. Objective: We aim to describe a further presentation we (re)named confabulation-misidentification (CM-) phenotype. Methods: We performed a retrospective longitudinal case-series study of 17 AD outpatients with the possible CM-phenotype (CM-ADs). Then, in a cross-sectional study, we compared the CM-ADs to a sample of 30 AD patients with the CA-phenotype (CA-ADs). The primary outcome was the frequency of cognitive and behavioral features. Data were analyzed as differences in percentage by non-parametric Chi Square and mean differences by parametric T-test. …Results: Anterograde amnesia (100%) with early confabulation (88.2%), disorientation (88.2%) and non-infrequently retrograde amnesia (64.7%) associated with reduced insight (88.2%), moderate prefrontal executive impairment (94.1%) and attention deficits (82.3%) dominated the CM-phenotype. Neuropsychiatric features with striking misidentification (52.9%), other less-structured delusions (70.6%), and brief hallucinations (64.7%) were present. Marked behavioral disturbances were present early in some patients and very common at later stages. At the baseline, the CM-ADs showed more confabulation (p  < 0.001), temporal disorientation (p  < 0.02), misidentification (p  = 0.013), other delusions (p  = 0.002), and logorrhea (p  = 0.004) than the CA-ADs. In addition, more social disinhibition (p  = 0.018), reduction of insight (p  = 0.029), and hallucination (p  = 0.03) persisted at 12 months from baseline. Both the CA- and CM-ADs showed anterior and medial temporal atrophy. Compared to HCs, the CM-ADs showed more right fronto-insular atrophy, while the CA-ADs showed more dorsal parietal, precuneus, and right parietal atrophy. Conclusion: We described an AD phenotype resembling diencephalic rather than hippocampal amnesia and overlapping the past-century description of presbyophrenia. Show more

Keywords: Alzheimer’s disease, amnesia, confabulation, delusions, memory rehabilitation, misidentification, presbyophrenia

DOI: 10.3233/JAD-220919

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 363-388, 2023

Authors: Maćkowiak, Maria | Libura, Agnieszka | Phillipson, Lyn | Szcześniak, Dorota | Rymaszewska, Joanna

Article Type: Research Article

Abstract: Background: With the increasing incidences of dementia in aging societies, attention should be paid to the social context in which people with dementia live. One of its aspects is language transmitting beliefs, perceptions, and behavioral patterns. An analysis of understanding the diagnostic label of dementia may reveal the role of semantics in the process of social cognition of this disease. Objective: The overall aim of this study was to investigate the understanding of the word dementia (otępienie ) in the Polish language. Methods: Frame semantics approach was applied. The structure of semantic information was uncovered with …the concept of frame utilizing The National Corpus of Polish (the biggest corpus of contemporary Polish language of 1,500 million words). Additional data was collected from Polish speaking adults in Poland. Results: The analyses allowed to identify the otępienie frame for Polish and verify how its elements are filled in by the general population, indicating the selectivity of colloquial knowledge about dementia. Dementia deviates from the prototypical disease. Need to care for the person with dementia outweighs treatment options. The cognitive symptoms and characteristics of the subject are salient. The perceptions of people with dementia embedded in semantics of the diagnostic label might create a basis for prejudicial attitudes among lay part of the society. Conclusion: Findings give foundation to further studies on relationship between semantics and social cognition of dementia which has a real impact on the social and clinical situation of people with dementia and may facilitate formulation of tailored messages aimed at building dementia-friendly society. Show more

Keywords: Dementia, language, semantics, social cognition, social stigma

DOI: 10.3233/JAD-220633

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 389-406, 2023

Authors: Hu, Li-Tian | Xie, Xiao-Yong | Zhou, Gui-Feng | Wen, Qi-Xin | Song, Li | Luo, Biao | Deng, Xiao-Juan | Pan, Qiu-Ling | Chen, Guo-Jun

Article Type: Research Article

Abstract: Background: Accumulation of hyperphosphorylated Tau (pTau) contributes to the formation of neurofibrillary tangles in Alzheimer’s disease (AD), and targeting Tau/pTau metabolism has emerged as a therapeutic approach. We have previously reported that mitochondrial 3-hydroxy-3-methylglutaryl-COA synthase 2 (HMGCS2) is involved in AD by promoting autophagic clearance of amyloid-β protein precursor via ketone body-associated mechanism, whether HMGCS2 may also regulate Tau metabolism remains elusive. Objective: The present study was to investigate the role of HMGCS2 in Tau/p degradation. Methods: The protein levels of Tau and pTau including pT217 and pT181, as well as autophagic markers LAMP1 and LC3-II …were assessed by western blotting. The differentially regulated genes by HMGCS2 were analyzed by RNA sequencing. Autophagosomes were assessed by transmission electron microscopy. Results: HMGCS2 significantly decreased Tau/pTau levels, which was paralleled by enhanced formation of autophagic vacuoles and prevented by autophagic regulators chloroquine, bafilomycin A1, 3-methyladenine, and rapamycin. Moreover, HMGCS2-induced alterations of LAMP1/LC3-II and Tau/pTau levels were mimicked by ketone body acetoacetate or β-hydroxybutyrate. Further RNA-sequencing identified ankyrin repeat domain 24 (ANKRD24) as a target gene of HMGCS2, and silencing of ANKRD24 reduced LAMP1/LC3-II levels, which was accompanied by the altered formation of autophagic vacuoles, and diminished the effect of HMGCS2 on Tau/pTau. Conclusion: HMGCS2 promoted autophagic clearance of Tau/pTau, in which ketone body and ANKRD24 played an important role. Show more

Keywords: Alzheimer’s disease, ANKRD24, autophagy, HMGCS2, ketone body, Tau

DOI: 10.3233/JAD-220640

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 407-426, 2023

Authors: Königsberg, Alina | Belau, Matthias H. | Ascone, Leonie | Gallinat, Jürgen | Kühn, Simone | Jensen, Märit | Gerloff, Christian | Cheng, Bastian | Thomalla, Götz

Article Type: Research Article

Abstract: Background: Subjective cognitive decline (SCD) is considered to be a preliminary stage of dementia, and its prevalence is increasing with age. Objective: We aimed to study the association of SCD with health-related quality of life (HRQoL) in a large population-based sample. Methods: We analyzed data of the first 10,000 participants from the Hamburg City Health Study in Germany, a single center prospective cohort study, aged between 45 and 74 years that scored higher than 25 points in the Mini-Mental State Examination and had no known pre-existing dementia. HRQoL was assessed by the EQ-5D-5 L index, as well …as the mental (MCS) and physical component summary (PCS) score of the Short Form-8. We computed linear regression analyses with 99% bias-corrected and accelerated (BCa) confidence intervals (CI) from 10,000 bootstrap samples to investigate the association between SCD and different indicators of HRQoL, while controlling for depression (PHQ-9), age, sex, and education as potential confounders. Results: Of 7,799 eligible participants (mean (SD) age 62.01 (8.41) years, 51.1% female), 3,708 (47.5%) reported SCD. Participants with SCD were older (62.7 versus 61.4 years) and more frequently female (54.2% versus 48.2%). SCD was independently associated with a lower EQ-5D-5 L index (β=–0.01, 99% BCa CI = [–0.020, –0.003], p  < 0.001) and PCS (β=–1.00, 99% BCa CI = [–1.48, –0.51], p  < 0.001) but not with MCS score. Conclusion: In a population of middle-aged to elderly participants, there is a significant negative association between SCD and HRQoL across different instruments of HRQoL measurement independent of depression, demographics, and education. Show more

Keywords: Health-related quality of life, population-based study, prospective study, subjective cognitive decline

DOI: 10.3233/JAD-220659

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 427-436, 2023

Authors: Wu, Bang-Sheng | Zhang, Ya-Ru | Yang, Liu | Zhang, Wei | Deng, Yue-Ting | Chen, Shi-Dong | Feng, Jian-Feng | Cheng, Wei | Yu, Jin-Tai

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) patients rank among the highest levels of comorbidities compared to persons with other diseases. However, it is unclear whether the conditions are caused by shared pathophysiology due to the genetic pleiotropy for AD risk genes. Objective: To figure out the genetic pleiotropy for AD risk genes in a wide range of diseases. Methods: We estimated the polygenic risk score (PRS) for AD and tested the association between PRS and 16 ICD10 main chapters, 136 ICD10 level-1 chapters, and 377 diseases with cases more than 1,000 in 312,305 individuals without AD …diagnosis from the UK Biobank. Results: After correction for multiple testing, AD PRS was associated with two main ICD10 chapters: Chapter IV (endocrine, nutritional and metabolic diseases) and Chapter VII (eye and adnexa disorders). When narrowing the definition of the phenotypes, positive associations were observed between AD PRS and other types of dementia (OR = 1.39, 95% CI [1.34, 1.45], p  = 1.96E-59) and other degenerative diseases of the nervous system (OR = 1.18, 95% CI [1.13, 1.24], p  = 7.74E-10). In contrast, we detected negative associations between AD PRS and diabetes mellitus, obesity, chronic bronchitis, other retinal disorders, pancreas diseases, and cholecystitis without cholelithiasis (ORs range from 0.94 to 0.97, FDR < 0.05). Conclusion: Our study confirms several associations reported previously and finds some novel results, which extends the knowledge of genetic pleiotropy for AD in a range of diseases. Further mechanistic studies are necessary to illustrate the molecular mechanisms behind these associations. Show more

Keywords: Alzheimer’s disease, genetic pleiotropy, PheWAS, polygenic risk score

DOI: 10.3233/JAD-220740

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 437-447, 2023

Authors: Tan, Wei Ying | Hargreaves, Carol | Chen, Christopher | Hilal, Saima

Article Type: Research Article

Abstract: Background: The major mechanisms of dementia and cognitive impairment are vascular and neurodegenerative processes. Early diagnosis of cognitive impairment can facilitate timely interventions to mitigate progression. Objective: This study aims to develop a reliable machine learning (ML) model using socio-demographics, vascular risk factors, and structural neuroimaging markers for early diagnosis of cognitive impairment in a multi-ethnic Asian population. Methods: The study consisted of 911 participants from the Epidemiology of Dementia in Singapore study (aged 60– 88 years, 49.6% male). Three ML classifiers, logistic regression, support vector machine, and gradient boosting machine, were developed. Prediction results of …independent classifiers were combined in a final ensemble model. Model performances were evaluated on test data using F1 score and area under the receiver operating curve (AUC) methods. Post modelling, SHapely Additive exPlanation (SHAP) was applied on the prediction results to identify the predictors that contribute most to the cognitive impairment prediction. Findings: The final ensemble model achieved a F1 score and AUC of 0.87 and 0.80 respectively. Accuracy (0.83), sensitivity (0.86), specificity (0.74) and predictive values (positive 0.88 negative 0.72) of the ensemble model were higher compared to the independent classifiers. Age, ethnicity, highest education attainment and neuroimaging markers were identified as important predictors of cognitive impairment. Conclusion: This study demonstrates the feasibility of using ML tools to integrate multiple domains of data for reliable diagnosis of early cognitive impairment. The ML model uses easy-to-obtain variables and is scalable for screening individuals with a high risk of developing dementia in a population-based setting. Show more

Keywords: Cognitive impairment, machine learning, socio-demographic, structural MRI, vascular risk factors

DOI: 10.3233/JAD-220776

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 449-461, 2023

Authors: Li, Jian-Guo | Blass, Benjamin E. | Praticò, Domenico

Article Type: Research Article

Abstract: Background: The endosomal retromer complex system is a key controller for trafficking of proteins. Downregulation of its recognition core proteins, such as VPS35, is present in Alzheimer’s disease (AD) brain, whereas its normalization prevents the development of AD pathology in a transgenic model with amyloid-β deposits and tau tangles. Objective: Assess the effect of targeting VPS35 after the AD pathology and memory impairments have developed. Methods: Twelve-month-old triple transgenic mice were treated with a small pharmacological chaperone, TPT-172, or vehicle for 14 weeks. At the end of this period, the effect of the drug on their …phenotype was evaluated. Results: While control mice had a decline of learning and memory, the group receiving the chaperone did not. Moreover, when compared with controls the treated mice had significantly less amyloid-β peptides and phosphorylated tau, elevation of post-synaptic protein, and reduction in astrocytes activation. Conclusion: Taken together, our findings demonstrate that pharmacologic stabilization of the retromer recognition core is beneficial also after the AD-like pathologic phenotype is established. Show more

Keywords: Alzheimer’s disease, amyloid-β, pharmacological chaperone, retromer complex, tau protein

DOI: 10.3233/JAD-220869

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 463-469, 2023

Authors: Quintana-Hernández, Domingo J. | Rojas-Hernández, Jaime | Santana-del Pino, Angelo | Céspedes Suárez, Carmen | Pellejero Silva, Mónica | Miró-Barrachina, María Teresa | Ibáñez Fernández, Ignacio | Estupiñán López, José Antonio | Borkel, Lucas F.

Article Type: Research Article

Abstract: Background: This longitudinal study addressed whether mindfulness practice prevents psychological and behavioral symptoms, especially mood disorders, in Alzheimer’s disease (AD). Objective: To assess the incidence of depression in the course of AD and to determine which non-pharmacological treatment (NPT) is most effective in preventing psychopathological symptoms. Methods: We conducted a longitudinal, non-inferiority and equivalence randomized clinical trial, repeated-measures design, with a control group and three experimental treatments: mindfulness, cognitive stimulation, and relaxation. Each experimental group performed three weekly sessions for two years. The pharmacological treatment of all participants was donepezil (10 mg). Participants were patients with probable …AD without diagnosed depression from the public neurology services of the Canary Health Service, Spain. Psychological evaluation was performed using the Geriatric Depression Scale (GDS), Hamilton Depression Rating Scale (HDRS), and Neuropsychiatric Inventory (NPI-Q). The statistical analysis included only patients who attended at least 75% of the sessions. A nonparametric, repeated-measures analysis was performed with Kruskal-Wallis H test and between-group differences with Mann-Whitney U test with Bonferroni correction (p  < 0.008). Effect size was calculated with partial eta-squared. Results: The results showed significant differences with large effect sizes (η2 p >0.14) between mindfulness and the rest of the experimental groups as well as the control in the GDS, HDRS, and NPI-Q scales. Conclusion: Compared to the other experimental groups, only mindfulness prevented the onset of depression and other psychopathologies in early-stage AD. Based on its effectiveness in maintaining cognitive functions and preventing psychopathology, we recommend mindfulness as the first-choice NPT for mild to moderate AD. Show more

Keywords: Alzheimer’s disease, cognitive stimulation, mindfulness, randomized clinical trial, relaxation

DOI: 10.3233/JAD-220889

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 471-481, 2023

Authors: Petrella, Jeffrey R. | Michael, Andrew M. | Qian, Min | Nwosu, Adaora | Sneed, Joel | Goldberg, Terry E. | Devanand, Davangere P. | Doraiswamy, P. Murali

Article Type: Research Article

Abstract: Background: Mild cognitive impairment (MCI) represents a high risk group for Alzheimer’s disease (AD). Computerized Cognitive Games Training (CCT) is an investigational strategy to improve targeted functions in MCI through the modulation of cognitive networks. Objective: The goal of this study was to examine the effect of CCT versus a non-targeted active brain exercise on functional cognitive networks. Methods: 107 patients with MCI were randomized to CCT or web-based crossword puzzles. Resting-state functional MRI (fMRI) was obtained at baseline and 18 months to evaluate differences in fMRI measured within- and between-network functional connectivity (FC) of the …default mode network (DMN) and other large-scale brain networks: the executive control, salience, and sensorimotor networks. Results: There were no differences between crosswords and games in the primary outcome, within-network DMN FC across all subjects. However, secondary analyses suggest differential effects on between-network connectivity involving the DMN and SLN, and within-network connectivity of the DMN in subjects with late MCI. Paradoxically, in both cases, there was a decrease in FC for games and an increase for the crosswords control (p  < 0.05), accompanied by lesser cognitive decline in the crosswords group. Conclusion: Results do not support a differential impact on within-network DMN FC between games and crossword puzzle interventions. However, crossword puzzles might result in cognitively beneficial remodeling between the DMN and other networks in more severely impaired MCI subjects, parallel to the observed clinical benefits. Show more

Keywords: Alzheimer’s disease, biomarkers, default mode network, digital therapeutics, functional MRI, mild cognitive impairment, neuroplasticity

DOI: 10.3233/JAD-220946

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 483-494, 2023

Authors: Daniel, E. Valerie | Kleiman, Michael J. | Galvin, James E.

Article Type: Research Article

Abstract: Background: African American and Hispanic older adults are reported to have up to a 2-fold higher risk of Alzheimer’s disease and related disorders (ADRD), but the reasons for this increased vulnerability have not been fully explored. The Vulnerability Index (VI) was designed to identify individuals who are at risk of developing cognitive impairment in the future, capturing 12 sociodemographic variables and modifiable medical comorbidities associated with higher ADRD risk. However, a prior limitation of the VI was that the original study cohort had limited diversity. We examined the association of the VI within and between non-Hispanic White, African American, and …Hispanic older adults with and without cognitive impairment and different socioeconomic strata enrolled in a community-based dementia screening study. Objective: To explore reasons for reported higher ADRD vulnerability in African Americans and Hispanics. Methods: In a cross-sectional study of 300 non-Hispanic White, African American, and Hispanic older adults with and without cognitive impairment, we studied the association between cognitive status, the VI, and socioeconomic status (SES). Results: When considering race/ethnicity, the presence of more vascular comorbidities drove greater vulnerability. When considering SES, vascular comorbidities played a less prominent role suggesting resources and access to care drives risk. The VI had differential effects on cognitive performance with the greatest effect in the earlier stages of impairment. Conclusion: Findings from this study provide a deeper understanding of the differential risk of ADRD in multicultural older adults captured by the VI and how barriers to healthcare access may increase vulnerability in racial/ethnic minorities. Show more

Keywords: Alzheimer’s disease, cognitive impairment, dementia, health disparities, mild cognitive impairment, race/ethnicity, risk assessment, risk factors, socioeconomic status, vulnerability

DOI: 10.3233/JAD-220959

Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 495-506, 2023