The Journal of Prevention of Alzheimer's Disease最新文献

{"title":"Psychosocial stressors and cognitive function: An analysis using data from the English longitudinal study of ageing.","authors":"Jiahao Li, Natalia Ortí-Casañ, Irem Bayraktaroglu, Giulia Mozzanica, Feng Zhang, Jocelien D A Olivier, Ulrich L M Eisel","doi":"10.1016/j.tjpad.2025.100232","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100232","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence suggests that psychosocial stressors-such as financial strain, caregiving responsibilities, disability, and limiting long-term illnesses-may contribute to accelerated cognitive decline in older adults. However, the heterogeneity of stressor profiles and their distinct impact on specific cognitive domains remain poorly understood.</p><p><strong>Objective: </strong>To examine the associations between varying burdens of psychosocial stressors and cognitive function over a 10-year period using data from the English Longitudinal Study of Ageing (ELSA).</p><p><strong>Methods: </strong>We used longitudinal data from wave 4 (2008-2009) to wave 9 (2018-2019) of ELSA, comprising 10,893 participants aged ≥50 years at baseline who had valid measurements of psychosocial stressors and cognitive outcomes. Psychosocial stressors-financial strain, caregiving, disability, and limiting long-term illness-were assessed as binary indicators and summed into three categories (No Stressors, One Stressor, Multiple Stressors). Cognitive function was assessed using an overall global cognition score and scores of three specific domains: memory, executive function, and orientation. Baseline associations were examined via multiple linear regression, while linear mixed-effects models evaluated longitudinal trajectories of cognitive change. All models were progressively adjusted for demographic, lifestyle, and clinical covariates.</p><p><strong>Results: </strong>At baseline, participants reporting multiple stressors (18.2 % of the sample) had significantly lower global cognitive and executive function scores compared to those with no stressors (43.3 %). Over the 10-year follow-up, a higher stress burden predicted faster declines in global cognition, memory, and executive function. These associations remained robust after adjusting for sociodemographic characteristics, health behaviors, and chronic conditions. Random intercept and random slope models yielded consistent findings, indicating a dose-response relationship between stress burden and cognitive deterioration.</p><p><strong>Conclusion: </strong>Older adults experiencing multiple psychosocial stressors face an elevated risk of both lower initial cognitive function and accelerated decline over time. These findings underscore the importance of identifying and mitigating modifiable stressors-such as financial strain and caregiving demands-to potentially preserve cognitive health in later life. Interventions tailored to individuals with higher stress burdens may be especially beneficial in slowing cognitive deterioration.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100232"},"PeriodicalIF":4.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to an anti-inflammatory diet is associated with lower Alzheimer's disease mortality: A modifiable risk factor in a national cohort.","authors":"Ching-Chi Hsu, Shiow-Ing Wang, Sebastian Yu, Eric S Lin, James Cheng-Chung Wei","doi":"10.1016/j.tjpad.2025.100221","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100221","url":null,"abstract":"<p><strong>Background: </strong>Chronic neuroinflammation contributes to Alzheimer's disease (AD) pathogenesis, and diet is a modifiable factor influencing inflammation. The impact of an anti-inflammatory diet on AD-specific mortality remains unclear.</p><p><strong>Objectives: </strong>To examine the association between adherence to an anti-inflammatory diet (measured as the percentage of dietary energy from anti-inflammatory foods) and AD-specific mortality, as well as all-cause mortality, in a large national cohort, and to determine whether associations differ by sex or race/ethnicity.</p><p><strong>Methods: </strong>We analyzed 18,795 U.S. adults (≥18 years) from the 2007-2014 National Health and Nutrition Examination Survey. Anti-inflammatory diet adherence was defined as the percentage of total energy intake from anti-inflammatory foods, categorized as 0 %, <5 %, 5-9.99 %, or ≥10 %. Outcomes were AD-specific mortality and all-cause mortality ascertained via the National Death Index. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality across intake categories, adjusting for demographic, lifestyle, and health factors. Analyses were stratified by sex, race/ethnicity, and age (≥45 years for AD mortality).</p><p><strong>Results: </strong>Participants with 0 % anti-inflammatory intake had a higher all-cause mortality risk (HR 3.82, 95 % CI 1.18-12.33) compared to those with ≥10 % intake. In the overall analysis, 0 % anti-inflammatory intake showed a trend of reduced AD-specific mortality although its did not reach statistical significance after full adjustment (HR 3.04, 95 % CI 0.74-12.46 vs. ≥10 % intake; p>0.05). Notably, the inverse association between anti-inflammatory diet and AD mortality emerged in subgroup analyses. Male participants and non-Hispanic White participants with 0 % intake had the highest AD mortality hazards (HR 12.83 and 3.77, respectively, vs. ≥10 % intake), indicating significant risk reductions with anti-inflammatory diet in these groups. In contrast, no significant associations were observed in female or non-White subgroups. Even a modest intake of anti-inflammatory foods (≥10 % of calories) was associated with lower AD mortality risk in the above subgroups and with lower all-cause mortality overall.</p><p><strong>Conclusion: </strong>Greater consumption of anti-inflammatory foods was associated with lower all-cause and a trend toward lower AD-specific mortality. The observed protective effects were confined to certain subpopulations (notably men and non-Hispanic Whites). Even a small portion of the diet (10 % of calories) being anti-inflammatory was linked to reduced mortality risk in these groups, suggesting that achievable dietary changes could have an impact. These findings support modifying dietary content is a practical, low-cost intervention that could mitigate neuroinflammation to reduce AD mortality risk.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100221"},"PeriodicalIF":4.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The coupling of global brain activity and cerebrospinal fluid flow as a potential predictive marker of brain amyloid-β accumulation.","authors":"Yuya Tanaka, Koji Kamagata, Yuya Saito, Kaito Takabayashi, Rinako Iseki, Wataru Uchida, Christina Andica, Akifumi Hagiwara, Akihiko Wada, Toshiaki Akashi, Osamu Abe, Shigeki Aoki","doi":"10.1016/j.tjpad.2025.100228","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100228","url":null,"abstract":"<p><strong>Background: </strong>Impaired cerebrospinal fluid (CSF) clearance is thought to contribute to amyloid-β (Aβ) accumulation in Alzheimer's disease (AD). Global brain activity-CSF flow coupling (gBOLD-CSF coupling), measured through resting-state functional MRI, reflects CSF clearance capacity. A higher coupling value indicates weaker coupling. Its potential as a predictive marker for Aβ accumulation remains unclear.</p><p><strong>Objectives: </strong>This study aims to determine whether weaker gBOLD-CSF coupling precedes Aβ accumulation in cognitively normal, Aβ-negative individuals and to explore its predictive potential for amyloid conversion.</p><p><strong>Design: </strong>A longitudinal observational study using Alzheimer's Disease Neuroimaging Initiative (ADNI) data.</p><p><strong>Setting: </strong>Data from ADNI-participating sites.</p><p><strong>Participants: </strong>16 cognitively normal participants, initially Aβ-negative: seven fast-converters (transitioned to Aβ-positive within two years) and nine slow-converters (remained Aβ-negative for at least two years).</p><p><strong>Measurements: </strong>gBOLD-CSF coupling was calculated as the Pearson correlation coefficient between global Blood-Oxygen-Level-Dependent (BOLD) and CSF inflow signals. Group differences in gBOLD-CSF coupling were analyzed, along with partial correlation analyses between gBOLD-CSF coupling and annual changes in Aβ biomarkers and cognitive scores.</p><p><strong>Results: </strong>Fast-converters showed significantly higher gBOLD-CSF coupling values, indicating weaker coupling (Cohen's d = 1.76, p = 0.012). Coupling values positively correlated with annual changes in Aβ-PET SUVR (r = 0.594, p = 0.054) and negatively with MoCA scores (r = -0.654, p = 0.021).</p><p><strong>Conclusion: </strong>Weaker gBOLD-CSF coupling precedes brain Aβ accumulation, indicating its potential as a predictive marker for amyloid conversion. Future studies should refine clinical thresholds for early intervention strategies in AD prevention.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100228"},"PeriodicalIF":4.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial comment to: Breaking barriers: Delivering therapeutics to the brain in Alzheimer's disease.","authors":"Bart De Strooper, Philip Scheltens, Stephen Salloway","doi":"10.1016/j.tjpad.2025.100229","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100229","url":null,"abstract":"","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100229"},"PeriodicalIF":4.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring multidomain intervention programs to reduce cognitive and physical decline in older adults: Examining rural-urban differences in a nationwide cluster-randomized controlled trial.","authors":"Min-Yin Ho, Wei-Ju Lee, Ko-Han Yen, Chih-Kuang Liang, Li-Ning Peng, Ming-Hsien Lin, Ching-Hui Loh, Fei-Yuan Hsiao, Liang-Kung Chen","doi":"10.1016/j.tjpad.2025.100231","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100231","url":null,"abstract":"<p><strong>Background: </strong>Frailty and cognitive impairment are major challenges in aging populations. Multidomain interventions targeting physical, cognitive, and nutritional health show promise; however, evidence on rural-urban differences in efficacy remains limited.</p><p><strong>Objectives: </strong>To evaluate the impact of rural-urban disparities on the clinical efficacy of a 12-month multidomain intervention for cognitive and physical outcomes in older adults.</p><p><strong>Design: </strong>Cluster-randomized controlled trial.</p><p><strong>Setting: </strong>Community clusters in five cities/counties across Taiwan.</p><p><strong>Participants: </strong>A total of 1082 adults aged ≥65 years from 40 community clusters were randomized to intervention or control groups.</p><p><strong>Intervention: </strong>The intervention group received a 12-month program including physical exercise (45 min/session), cognitive training (1 hour/session), and nutritional guidance (15 min/session). The control group received telephone-based health education. This trial was registered at ClinicalTrials.gov (NCT03056768) MEASUREMENTS: Outcomes included walking speed, grip strength, physical activity (METs), frailty (CHS score), and cognitive function (MoCA), assessed at baseline, 6, and 12 months.</p><p><strong>Results: </strong>Urban participants showed significantly greater gains in visuospatial/executive function at the 12 month (rural-urban difference 0.63, 95 % CI: 0.26 -1.03), and walking speed at the 12 month (rural-urban difference 0.12 m/s, 95 % CI: 0.05 - 0.19). Rural participants demonstrated better improvements in grip strength at the 12 month (rural-urban difference -2.59 kg, 95 % CI: -3.91 - -1.27) and language function (rural-urban difference -0.38, 95 % CI: -0.68 - -0.09). Frailty reduction was more pronounced in urban areas at the 12 month (-0.21, 95 % CI: -0.38 - -0.03, p = 0.025), but showed minimal change in the rural participants.</p><p><strong>Conclusion: </strong>Rural-urban disparities influence the effectiveness of multidomain interventions. Tailored strategies are needed to optimize health outcomes across diverse settings.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100231"},"PeriodicalIF":4.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose- and pattern- physical activity is associated with lower risk of dementia.","authors":"Yan Wang, Fangyu Li, Shuman Cao, Jianping Jia","doi":"10.1016/j.tjpad.2025.100223","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100223","url":null,"abstract":"<p><strong>Background: </strong>The amount and pattern of physical activity that benefits cognitive health remain unclear.</p><p><strong>Methods: </strong>Participants from the UK Biobank cohort who had a full week of accelerometer-based moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) data were included in the analysis. The data for dementia diagnosis were collected from 2006 to 2024. Associations between the incidence of all-cause dementia, Alzheimer's disease (AD), vascular dementia (VaD), and PA amounts and patterns were assessed using Cox proportional hazards regression models. The analysis included 1) comparing MVPA gradients with reference group performing less than 150 min/week; 2) classifying MVPA patterns as effective intensive (≥300 min/week with ≥50 % of MVPA in 1-2 days), effective regular (≥300 min/week not up to effective intensive), and ineffective (<300 min/week); 3) performing stratified analyses by age, sex, and APOE ε4 carrier status; and 4) evaluating the association between LPA and dementia risk among participants classified as ineffective MVPA levels.</p><p><strong>Results: </strong>91,512 individuals (mean [SD] age, 56.03[7.8] years; 55.9 % female) were included. Compared with participants performing <150 min of MVPA per week, those accumulating 150-299 min/week, whether through concentrated (1-2 days) or regular pattern, did not show significantly lower dementia incidence. However, accumulating >300 min/week of MVPA was associated with a reduced risk. When stratified at 300 min/week of MVPA, hazard ratios for dementia were 0.73 (95 % CI: 0.60-0.89) for the weekend pattern and 0.79 (95 % CI: 0.64-0.98) for the regular pattern. For ineffective MVPA, engaging in >840 min/week of LPA was associated with lower dementia incidence.</p><p><strong>Conclusions: </strong>Accumulating >300 min/week of MVPA, whether concentrated within 1-2 days or distributed evenly across the week, was associated with a decreased risk of dementia. Additionally, higher levels of LPA partially compensated for low MVPA in lowering dementia risk.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100223"},"PeriodicalIF":4.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing the science of recruitment for Alzheimer's clinical trials: Challenges and opportunities.","authors":"Paul Aisen, Desi Peneva, Maria-Alice Manetas, Mireille Jacobson, Dana Goldman, Niranjan Bose, Phyllis Barkman Ferrell, V K Vu, Rema Raman","doi":"10.1016/j.tjpad.2025.100230","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100230","url":null,"abstract":"<p><p>Despite recent advancements in Alzheimer's disease therapeutics and diagnostics, significant challenges remain in accelerating participant recruitment-particularly among diverse populations-and ensuring equitable access to clinical trials. This paper summarizes discussions and recommendations from the 2024 Roundtable on Advancing the Science of Recruitment for Inclusive Alzheimer's Disease Clinical Trials, hosted by the USC Clinical Trial Recruitment Lab (CTRL). Bringing together 40 leading experts from across the Alzheimer's clinical trial ecosystem in the U.S., including thought leaders from academia, industry, government and philanthropy, the Roundtable examined critical barriers to inclusivity and explored emerging recruitment approaches. Discussions highlighted the need for strategies that expand patient access, remove systemic barriers, and foster inclusivity in clinical research.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100230"},"PeriodicalIF":4.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of cardiovascular risk factors on plasma biomarkers in prediction of Alzheimer's and cerebrovascular neuropathology.","authors":"Camilo Bermudez, Jeremy A Syrjanen, Nikki H Stricker, Alicia Algeciras-Schimnich, Naomi Kouri, Walter K Kremers, Ronald C Petersen, Clifford R Jack, David S Knopman, Dennis W Dickson, Darren M Rothberg, Christina M Moloney, Baayla D C Boon, Aivi T Nguyen, R Ross Reichard, Melissa E Murray, Michelle M Mielke, Prashanthi Vemuri, Jonathan Graff-Radford","doi":"10.1016/j.tjpad.2025.100224","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100224","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Plasma biomarkers for Alzheimer's disease and neurodegeneration have shown accurate prediction of underlying neuropathology. However, chronic cardiovascular risk factors such as diabetes and hypertension are associated with plasma biomarker levels and can influence the accurate prediction of underlying neuropathologic changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To understand the interaction between plasma biomarkers of Alzheimer's disease and neurodegeneration with cardiovascular risk factors in relation to neuropathologic change in a heterogenous population to ascertain a more accurate utilization of these biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective, case-control study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Population-based, Olmstead county, Minnesota, USA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Three-hundred and fifty-one participants (aged 87.4 ± 7.5 years) with brain autopsy and antemortem plasma biomarker testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Plasma biomarker testing for Aβ42/40, p-tau181, GFAP, and NfL using Quanterix Simoa assays. Cardiovascular risk factors were quantified by a composite score of cardiovascular metabolic conditions (CMC) consisting of a binary history of diabetes, congestive heart failure, stroke, coronary artery disease, atrial fibrillation, hypertension, or dyslipidemia. Plasma biomarkers and cardiovascular metabolic conditions score were Z-scored and neuropathologic scales were binarized into high and low categories. Outcomes included elevated microvascular (Kalaria) and macrovascular (Strozyk) neuropathologic scales as well as Alzheimer's disease neuropathologic change (ADNC), Thal phase, Braak stage, and neuritic plaque score. Multivariate logistic regression models incorporated interaction terms between plasma biomarkers and CMC while controlling for age, sex, cognitive impairment, and BMI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We observed that at higher cardiovascular metabolic conditions score, the association between GFAP and overall ADNC (OR = 0.61 [0.42, 0.89]), Thal phase (OR = 0.48 [0.33, 0.71]), and Braak Stage (OR = 0.56 [0.37, 0.84]), became weaker, while the association with Strozyk score (OR = 1.65 [1.11, 2.46]) was stronger with higher CMC. Meanwhile, at higher CMC Aβ42/40 became more strongly negative with high Braak stage (OR = 0.63 [0.47, 0.85]), neuritic plaque score (OR 0.70 [0.52, 0.95]), Kalaria score (OR = 0.71 [0.57, 0.88]), and Strozyk score (OR = 0.60 [0.43, 0.83]). The association between p-tau181 and Thal phase (OR = 1.43 [1.00, 2.04]) was stronger at higher CMC while the association between p-tau181 and Strozyk score (OR = 0.47 [0.31, 0.71]) was weaker at higher CMC. There was no interaction between NfL and CMC score for any metric of neuropathologic change.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Understanding how cardiovascular risk factors can modulate plasma biomarkers is important for their interpretation with respect to underlying pathology and their ","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100224"},"PeriodicalIF":4.3,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Cardiorespiratory Fitness Measured by Metabolic Equivalents and the Risk of Alzheimer's and Related Dementias.","authors":"Edward Zamrini, Yan Cheng, Peter Kokkinos, Charity J Morgan, Charles Faselis, Helen M Sheriff, Yijun Shao, Xuemei Sui, Ali Ahmed, Qing Zeng","doi":"10.1016/j.tjpad.2025.100222","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100222","url":null,"abstract":"<p><strong>Background: </strong>Higher fitness levels have been reported to protect against Alzheimer's Disease and Related Dementias (ADRD). However, the association between changes in fitness over time and ADRD risk remains unknown. This study aims to identify clusters of metabolic equivalents (METs) trajectories and examine their correlation with incident ADRD.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted among Veterans with ≥3 standardized exercise treadmill tests (ETT) between 2000 and 2017. The exposure was change in fitness expressed in metabolic equivalents (METs). METs are based on treadmill speed, grade, and time. One MET is equivalent to 3.5 ml per kg of body weight per minute. The outcome was incident ADRD after the final ETT test, identified by diagnosis codes. Standardized METs scores were generated using mean and standard deviation for each age and sex stratum. Latent class growth analysis (LCGA) identified trajectory clusters. We assessed the association between clusters and ADRD using unadjusted Kaplan-Meier curves (overall and by age groups) and a multivariate Cox regression model adjusted for baseline characteristics at the first ETT.</p><p><strong>Results: </strong>A total of 75,851 veterans were included. The average number of ETTs was 4.0 ± 1.8, with the average time gap of 6.5 ± 3.8 years between first and last test. We identified five trajectory clusters: Group 1 (n = 22,485), Group 2 (n = 22,694), Group 3 (n = 6691), Group 4 (n = 19,386), and Group 5 (n = 4595). All groups, except for Group 3, showed a stable and slight improvement or decline over time, differing only in their initial standardized METs scores: Group 5 had the highest initial score, Group 1 had the lowest initial score, while Group 3 started out with a score almost as high as Group 4 and dropped to as low as Group 1. Compared to Group 1, Group 3 had a 12 % reduced risk of developing ADRD (HR = 0.88; 95 % CI: 0.77 - 1.01; p = 0.0660), with a greater reduction than Group 2 (10 %) but less than Group 4 (17 %) or Group 5 (24 %).</p><p><strong>Discussion: </strong>Our findings underscore the potential benefits of maintaining fitness to reduce the risk of ADRD with age. Although declining fitness levels are associated with an increased risk, the initial higher baseline fitness provides a degree of ongoing protection against ADRD.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100222"},"PeriodicalIF":4.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of the value-based price of a blood test for Alzheimer's disease pathology in primary and specialty care in the U.S.","authors":"Soeren Mattke, Jiahe Chen, Mark Hanson, Kim G Johnson, Cara Leahy, David A Merrill, Victoria Shada, Jorge G Ruiz","doi":"10.1016/j.tjpad.2025.100219","DOIUrl":"https://doi.org/10.1016/j.tjpad.2025.100219","url":null,"abstract":"<p><strong>Background: </strong>Blood tests for the pathology of Alzheimer's disease (AD) are emerging as alternative to amyloid PET scans and analysis of cerebrospinal fluid. (CSF). However, their economic value, which depends on test accuracy as well as effect on clinical decision-making, remains unclear.</p><p><strong>Methods: </strong>We use a Markov model to estimate the value-based price of a blood test with sensitivity of 88 % and specificity of 89 %, if labeled for triage and confirmation of the AD pathology in primary and specialty care. The value-based price was defined as price of the test, at which overall diagnostic cost per true positive case of early-stage AD would equate that under standard of care (identification in primary care and referral to specialty care based on the results of a brief cognitive test). Assumptions for the effect of test use on clinical decisions came from a structured expert consultation process.</p><p><strong>Results: </strong>If used in primary care, the value-based price would be $290 for a triage and $1150 for a confirmatory test, respectively, as use of PET or CSF testing would decline by 47 % and 86 %, respectively. If used in specialty care, i.e., after confirmation of early-stage cognitive impairment, the overall number of blood tests would decline. Consequently, the value-based price would increase to $450 for a triage test and $1950 for a confirmatory test.</p><p><strong>Conclusions: </strong>The results project substantial cost savings from implementing a blood test for AD pathology within the diagnostic pathway based on modeling results, which future research should confirm with actual data.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":" ","pages":"100219"},"PeriodicalIF":4.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}