{"title":"Practice effects and amyloid deposition: preliminary data on a method for enriching samples in clinical trials.","authors":"Kevin Duff, Norman L Foster, John M Hoffman","doi":"10.1097/WAD.0000000000000021","DOIUrl":"https://doi.org/10.1097/WAD.0000000000000021","url":null,"abstract":"<p><p>Clinical trials in Alzheimer disease are moving toward prevention studies in prodromal individuals with amyloid burden. However, methods are needed to identify individuals expected to be amyloid positive for these studies to be feasible and cost-effective. The current study sought to determine whether short-term practice effects on cognitive tests can identify those with notable uptake on amyloid imaging. Twenty-five, nondemented older adults (15 cognitively intact, 10 with mild cognitive impairment) underwent amyloid imaging through F-flutemetamol and 2 cognitive testing sessions across 1 week to determine practice effects on a visual memory test. Results indicated that, whereas F-flutemetamol uptake showed little association with baseline performance on a visual memory test (r=-0.04, P=0.85), it was significantly correlated with practice effects across 1 week on that same memory measure (r=-0.45, P=0.02), with greater uptake being associated with lower practice effects. The odds ratio of notable F-flutemetamol uptake was 5 times higher in individuals with low practice effects compared with high practice effects. Although these preliminary results need to be replicated in larger samples, short-term practice effects on cognitive tests may provide an affordable screening method to identify individuals who are amyloid positive, which could enrich samples for preventative clinical trials in Alzheimer disease. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"247-52"},"PeriodicalIF":2.1,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0000000000000021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40298396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fernando Torrente, Mariángeles Pose, Ezequiel Gleichgerrcht, Teresa Torralva, Pablo López, Marcelo Cetkovich-Bakmas, Facundo Manes
{"title":"Personality changes in dementia: are they disease specific and universal?","authors":"Fernando Torrente, Mariángeles Pose, Ezequiel Gleichgerrcht, Teresa Torralva, Pablo López, Marcelo Cetkovich-Bakmas, Facundo Manes","doi":"10.1097/WAD.0000000000000030","DOIUrl":"https://doi.org/10.1097/WAD.0000000000000030","url":null,"abstract":"<p><p>Previous studies about personality changes in dementia suggest that they may be due to the disruption of the biological basis of personality traits, and hence, that they are disease specific and universal. However, evidence about its specificity is still limited and scarce regarding culturally diverse populations. Accordingly, our aim was to compare personality changes in Argentinean patients with Alzheimer disease, behavioral variant of frontotemporal dementia, and primary progressive aphasia. The closest living relatives of patients diagnosed with Alzheimer disease (n=19), behavioral variant of frontotemporal dementia (n=16), and primary progressive aphasia (n=15) were asked to complete 2 versions of the personality inventory NEO Personality Inventory-Revised, one for assessing patients' premorbid personality traits, and the other for assessing current traits. All groups showed changes in several domains and facets of the NEO Personality Inventory-Revised. Globally, the observed pattern of changes was fairly consistent with previous studies based on the same model of personality. Nevertheless, our results regarding disease-specificity were less conclusive. Even if there were some indicators of specific differences between groups, most traits varied similarly across the 3 groups, revealing a pattern of generalized changes in personality expression after illness onset. More studies are needed that help to distinguish real personality changes from other affective or cognitive symptoms that accompany dementia, as well as further data from culturally diverse populations. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"261-8"},"PeriodicalIF":2.1,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0000000000000030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40296822","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}
Tamara L Hayes, Thomas Riley, Nora Mattek, Misha Pavel, Jeffrey A Kaye
{"title":"Sleep habits in mild cognitive impairment.","authors":"Tamara L Hayes, Thomas Riley, Nora Mattek, Misha Pavel, Jeffrey A Kaye","doi":"10.1097/WAD.0000000000000010","DOIUrl":"https://doi.org/10.1097/WAD.0000000000000010","url":null,"abstract":"<p><p>We explored the relationship between sleep disturbances and mild cognitive impairment (MCI) in community-dwelling seniors. Recent evidence suggests that sleep habits are differentially compromised in different subtypes of MCI, but the relationship between sleep disruption and MCI remains poorly understood. We gathered daily objective measures of sleep disturbance from 45 seniors, including 16 with MCI (mean age, 86.9±4.3 y), over a 6-month period. We also collected self-report measures of sleep disturbance. Although there were no differences between groups in any of our self-report measures, we found that amnestic MCI (aMCI) volunteers had less disturbed sleep than both nonamnestic MCI (naMCI) and cognitively intact volunteers, as measured objectively by movement in bed at night (F2,1078=4.30, P=0.05), wake after sleep onset (F2,1078=41.6, P<0.001), and number of times up at night (F2,1078=26.7, P<0.001). The groups did not differ in total sleep time. In addition, the aMCI group had less day-to-day variability in these measures than the intact and naMCI volunteers. In general, the naMCI volunteers showed a level of disturbed sleep that was intermediate to that of aMCI and intact volunteers. These differences in sleep disruption between aMCI and naMCI may be related to differences in the pathology underlying these MCI subtypes. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"145-50"},"PeriodicalIF":2.1,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0000000000000010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40256041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kumar B Rajan, Kimberly A Skarupski, Heather E Rasmussen, Denis A Evans
{"title":"Gene-environment interaction of body mass index and apolipoprotein E ε4 allele on cognitive decline.","authors":"Kumar B Rajan, Kimberly A Skarupski, Heather E Rasmussen, Denis A Evans","doi":"10.1097/WAD.0000000000000013","DOIUrl":"https://doi.org/10.1097/WAD.0000000000000013","url":null,"abstract":"<p><p>Genetic variation alone may not account for common chronic disease susceptibility. Rather, an interaction between genetic and environmental factors may clarify the underlying disease mechanism. Hence, we tested whether body mass index (BMI) modified the genetic association of the apolipoprotein E ε4 allele with cognitive decline. The data came from a longitudinal population-based sample of 4055 participants interviewed at 3-year intervals from 1993 to 2012. Cognitive function was assessed using a standardized global cognitive score and BMI was assessed at baseline and classified as normal, overweight, and obese. There were 1374 (34%) participants with the ε4 allele. In normal BMI participants, cognitive decline was 0.048 units/y without the ε4 allele, and increased by an additional 0.031 units/y with the ε4 allele. In overweight participants, cognitive decline was 0.038 units/y without the ε4 allele, and increased by an additional 0.026 units/y with the ε4 allele. Finally, in obese participants, cognitive decline was 0.038 units/y without the ε4 allele, and increased by an additional 0.014 units/y with the ε4 allele. The association of ε4 allele with cognitive decline was significantly lower in obese participants compared with normal BMI participants (P=0.003), thereby suggesting significant gene-environment interaction on cognitive decline. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"134-40"},"PeriodicalIF":2.1,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0000000000000013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40256042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiong Wu, Eric J Tchetgen Tchetgen, Theresa L Osypuk, Kellee White, Mahasin Mujahid, M Maria Glymour
{"title":"Combining direct and proxy assessments to reduce attrition bias in a longitudinal study.","authors":"Qiong Wu, Eric J Tchetgen Tchetgen, Theresa L Osypuk, Kellee White, Mahasin Mujahid, M Maria Glymour","doi":"10.1097/WAD.0b013e31826cfe90","DOIUrl":"https://doi.org/10.1097/WAD.0b013e31826cfe90","url":null,"abstract":"<p><p>Retaining severely impaired individuals poses a major challenge in longitudinal studies of determinants of dementia or memory decline. In the Health and Retirement Study (HRS), participants complete direct memory assessments biennially until they are too impaired to complete the interview. Thereafter, proxy informants, typically spouses, assess the subject's memory and cognitive function using standardized instruments. Because there is no common scale for direct memory assessments and proxy assessments, proxy reports are often excluded from longitudinal analyses. The Aging, Demographics, and Memory Study (ADAMS) implemented full neuropsychological examinations on a subsample (n=856) of HRS participants, including respondents with direct or proxy cognitive assessments in the prior HRS core interview. Using data from the ADAMS, we developed an approach to estimating a dementia probability and a composite memory score on the basis of either proxy or direct assessments in HRS core interviews. The prediction model achieved a c-statistic of 94.3% for DSM diagnosed dementia in the ADAMS sample. We applied these scoring rules to HRS core sample respondents born 1923 or earlier (n=5483) for biennial assessments from 1995 to 2008. Compared with estimates excluding proxy respondents in the full cohort, incorporating information from proxy respondents increased estimated prevalence of dementia by 12 percentage points in 2008 (average age=89) and suggested accelerated rates of memory decline over time. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"207-12"},"PeriodicalIF":2.1,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0b013e31826cfe90","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30916918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jorge Alves, Rosana Magalhães, Roger E Thomas, Oscar F Gonçalves, Agavni Petrosyan, Adriana Sampaio
{"title":"Is there evidence for cognitive intervention in Alzheimer disease? A systematic review of efficacy, feasibility, and cost-effectiveness.","authors":"Jorge Alves, Rosana Magalhães, Roger E Thomas, Oscar F Gonçalves, Agavni Petrosyan, Adriana Sampaio","doi":"10.1097/WAD.0b013e31827bda55","DOIUrl":"10.1097/WAD.0b013e31827bda55","url":null,"abstract":"<p><p>Several studies have shown that cognitive intervention may be beneficial for people with Alzheimer disease (AD), but literature reviews conducted so far, have yielded mixed and inconclusive results. In this work, through an extensive bibliographic search, we aim: (1) to analyze the efficacy of cognitive intervention in patients diagnosed with AD; (2) to provide an estimate of the feasibility of cognitive intervention; and (3) to review available cost-effectiveness data of this approach. Four randomized controlled trials of cognitive intervention, for patients diagnosed with AD that incorporated cognitive intervention and mock intervention control conditions, were included in the analysis. Only the domain of global cognitive functioning, as measured by Mini-Mental State Examination, showed significant intervention effects. No effects were observed in the remaining domains. Concerning feasibility, high rates of completion and adherence were found. A single randomized controlled trial, with unspecified dementia, suggested cognitive intervention to be cost-effective. Given the currently available dearth of well-controlled and focused trials in AD, these results should be carefully interpreted and remain to be confirmed in the future. There is a clear need for more high-quality research. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"195-203"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31158399","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}
Marco Canevelli, Giuseppina Talarico, Giuseppe Tosto, Fernanda Troili, Gian Luigi Lenzi, Giuseppe Bruno
{"title":"Rivastigmine in the treatment of hypersexuality in Alzheimer disease.","authors":"Marco Canevelli, Giuseppina Talarico, Giuseppe Tosto, Fernanda Troili, Gian Luigi Lenzi, Giuseppe Bruno","doi":"10.1097/WAD.0b013e31825c85ae","DOIUrl":"https://doi.org/10.1097/WAD.0b013e31825c85ae","url":null,"abstract":"<p><p>Inappropriate sexual behaviors (ISB) represent uncommon and often misdiagnosed clinical disorders among patients with Alzheimer disease. So far, no randomized clinical trials regarding the treatment of ISB in demented people have been conducted, but available data from case series and isolated case reports suggest the efficacy of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, antiandrogens, and H2-receptor antagonists. Controversial data exist on the therapeutic influence of cholinesterase inhibitors on sexual disorders. In the present article, we describe the case of an Alzheimer disease patient presenting hypersexuality, successfully treated with rivastigmine. Thus, we perform a revision of the existing literature regarding the therapeutical effect of cholinesterase inhibitors in the treatment of ISB. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"287-8"},"PeriodicalIF":2.1,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0b013e31825c85ae","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30678148","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}
Deliane van Vliet, Marjolein E de Vugt, Sebastian Köhler, Pauline Aalten, Christian Bakker, Yolande A L Pijnenburg, Myrra J F J Vernooij-Dassen, Raymond T C M Koopmans, Frans R J Verhey
{"title":"Awareness and its association with affective symptoms in young-onset and late-onset Alzheimer disease: a prospective study.","authors":"Deliane van Vliet, Marjolein E de Vugt, Sebastian Köhler, Pauline Aalten, Christian Bakker, Yolande A L Pijnenburg, Myrra J F J Vernooij-Dassen, Raymond T C M Koopmans, Frans R J Verhey","doi":"10.1097/WAD.0b013e31826cffa5","DOIUrl":"https://doi.org/10.1097/WAD.0b013e31826cffa5","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether there are differences between young-onset dementia and late-onset dementia in awareness levels and whether awareness is differentially associated with affective symptoms in both groups. The present study assesses possible differences between young-onset (YO-AD) and late-onset Alzheimer disease (LO-AD) in awareness levels and the association between awareness and affective symptoms.</p><p><strong>Methods: </strong>This study included 142 YO-AD and 126 LO-AD patients and their caregivers from 2 prospective studies. The participants were assessed 3 times during 1 year. Awareness was assessed using the Guidelines for the Rating of Awareness Deficits, and affective symptoms were assessed using the anxiety and depression items of the Neuropsychiatric Inventory. Population-averaged logistic regressions were used to analyze awareness and its association with affective symptoms.</p><p><strong>Results: </strong>The odds for impaired awareness in LO-AD were more than double the odds in YO-AD. Intact awareness was associated with depressive symptoms but not with anxiety. This effect was more pronounced in YO-AD compared with LO-AD at baseline. High awareness at baseline did not predict incident affective symptoms.</p><p><strong>Conclusions: </strong>Caregivers and clinicians should be prepared for affective symptoms in YO-AD patients with high awareness. The higher awareness in the YO-AD group also has potential positive implications for this group.</p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"265-71"},"PeriodicalIF":2.1,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0b013e31826cffa5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30916919","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}
Jesse Mez, Stephanie Cosentino, Adam M Brickman, Edward D Huey, Jennifer J Manly, Richard Mayeux
{"title":"Dysexecutive versus amnestic Alzheimer disease subgroups: analysis of demographic, genetic, and vascular factors.","authors":"Jesse Mez, Stephanie Cosentino, Adam M Brickman, Edward D Huey, Jennifer J Manly, Richard Mayeux","doi":"10.1097/WAD.0b013e31826a94bd","DOIUrl":"https://doi.org/10.1097/WAD.0b013e31826a94bd","url":null,"abstract":"<p><p>The objective of this study was to compare the demographic and vascular characteristics and APOE genotypes of a dysexecutive subgroup of Alzheimer disease (AD) with an amnestic subgroup of AD early in the disease course. A total of 2224 participants from the National Alzheimer's Coordinating Center database who carried a diagnosis of mild cognitive impairment (n=1188) or mild AD (clinical dementia rating ≤1) (n=1036) were included in this study. A subset of the mild cognitive impairment (n=61) and mild AD (n=79) participants underwent an autopsy. A dysexecutive subgroup (n=587) was defined as having executive performance >1 SD worse than memory performance, and an amnestic subgroup (n=549) was defined conversely. Among the autopsy subset, the odds of an AD pathologic diagnosis were compared in the 2 subgroups. The demographics, APOE[Latin Small Letter Open E]4 status, and vascular risk factors were compared in the 2 subgroups. Among the autopsy subset, the odds of having an AD pathologic diagnosis did not differ between the dysexecutive and amnestic subgroups. Under an additive model, participants in the dysexecutive subgroup possessed the APOE[Latin Small Letter Open E]4 allele less frequently compared with those in the amnestic subgroup. The dysexecutive subgroup had a history of hypertension less frequently compared with the amnestic subgroup. These distinct characteristics add to accumulating evidence that a dysexecutive subgroup of AD may have a unique underlying pathophysiology. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"218-25"},"PeriodicalIF":2.1,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0b013e31826a94bd","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31665134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sun Ju Chung, Jae-Hong Lee, Seong Yoon Kim, Sooyeoun You, Mi Jung Kim, Joo-Yong Lee, Jaeyoung Koh
{"title":"Association of GWAS top hits with late-onset Alzheimer disease in Korean population.","authors":"Sun Ju Chung, Jae-Hong Lee, Seong Yoon Kim, Sooyeoun You, Mi Jung Kim, Joo-Yong Lee, Jaeyoung Koh","doi":"10.1097/WAD.0b013e31826d7281","DOIUrl":"https://doi.org/10.1097/WAD.0b013e31826d7281","url":null,"abstract":"<p><p>Recent genome-wide association studies (GWAS) have discovered several Alzheimer disease (AD) susceptibility loci. However, the identified susceptibility loci are substantially inconsistent across GWAS. We aimed to investigate the association of top associated variants in GWAS with AD in Korean population. We selected 86 single-nucleotide polymorphisms (SNPs) selected from 12 genes (ABCA7, APOE, BIN1, CD2AP, CD33, CLU, CR1, EPHA1, LRAT, MS4A6A, PCDH11X, and PICALM) and genotyped in 290 AD cases and 554 unrelated controls from the same region. Three SNPs [rs429358 in APOE: odds ratio (OR)=4.24, 95% confidence interval (CI)=3.01-5.96, P=1.23×10; rs2075650 in APOE: OR=3.57, 95% CI=2.51-5.06, P=1.23×10; and rs677909 in PICALM: OR=0.63, 95% CI=0.49-0.81, P=0.00036, log additive model] were significantly associated with AD susceptibility after correction for multiple testing. Six additional PICALM SNPs, 3 ABCA7 SNPs, and 1 APOE, CD33, and BIN1 SNPs each had significant uncorrected P values. There was no significant association for age at onset of AD. Our results confirm the association of PICALM gene (encoding phosphatidylinositol-binding protein) in addition to APOE gene with AD susceptibility in Korean population but did not show significant associations of other susceptibility loci with AD. </p>","PeriodicalId":520551,"journal":{"name":"Alzheimer disease and associated disorders","volume":" ","pages":"250-7"},"PeriodicalIF":2.1,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WAD.0b013e31826d7281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30904009","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}