Variability in the validity and reliability of outcome measures identified in a systematic review to assess treatment efficacy of cognitive enhancers for Alzheimer’s Dementia
Charlene SoobiahMina TadrousSimon R. KnowlesErik BlondalHuda AshoorMarco GhassemiPaul A. KhanJoanne HoAndrea C. TriccoSharon E. Straus
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Introduction Selection of optimal outcome measures is a critical step in a systematic review; inclusion of uncommon or non-validated outcome measures can impact the uptake of systematic review findings. Our goals were to identify the validity and reliability of outcome measures used in primary studies to assess cognition, function, behaviour and global status; and, to use these data to select outcomes for a systematic review (SR) on treatment efficacy of cognitive enhancers for Alzheimer’s Dementia (AD). Methods Articles fulfilling the eligibility criteria of the SR were included in a charting exercise to catalogue outcome measures reported. Outcome measures were then assessed for validity and reliability. Two independent reviewers abstracted data on outcome measures and validity and reliability reported for cognition, function, behaviour and global status. Results 129 studies were included in the charting exercise; 57 outcome measures were identified for cognition, 21 for function, 13 for behaviour and 10 for global status. A total of 35 (61%) cognition measures, 10 (48%) functional measures, 8 (61%) behavioural measures and four (40%) of global status measures were only used once in the literature. Validity and reliability information was found for 51% of cognition measures, 90% of function and global status measures and 100% of behavioural measures. Conclusions While a large number of outcome measures were used in primary studies, many of these were used only once. Reporting of validity and reliability varied in AD studies of cognitive enhancers. Core outcome sets should be used when available; when they are not available researchers need to balance frequency of reported outcome measures, their respective validity and reliability, and preferences of knowledge users. Systematic review registration CRD#42012001948Keywords:
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Alzheimer's disease is the most common form of dementia, representing 60-80% of cases, and ageing is the primary risk factor for the development of Alzheimer's disease. The objective of this study was to examine the chance of developing dementia (i.e. mild cognitive impairment (MCI), Alzheimer's disease) among geriatric people in Bangladesh.This study included 390 adult citizens of Bangladesh (age range: 60-70 years). The Takeda Three Colors Combination (TTCC) test was used to detect the prevalence of MCI and mild dementia among the subjects, and then the Clinical Dementia Rating was used to determine the level of dementia.The subjects who were aged 60-65 years included 154 with MCI, 76 with mild dementia, 1 with moderate dementia, 4 with severe dementia, and 29 without dementia. The subjects who were aged 66-70 years included 75 with MCI, 36 with mild dementia, 0 with moderate dementia, 2 with severe dementia, and 13 without dementia. The sensitivity of the TTCC was 75% and 58% for the mild dementia and MCI groups, respectively, and the specificity was 52%. The odds ratio of incorrect responses to the TTCC was 3.42 (95% confidence interval: 1.63-7.21) for subjects with mild dementia compared those without dementia. However, the TTCC outcomes revealed no significant differences between the MCI and non-dementia groups. The results showed no significant associations between cognitive decline/developing dementia and social status/occupation.The outcomes of this study indicated that most of the subjects had MCI or mild dementia and were farmers aged 60-65 years.
Clinical Dementia Rating
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Background: The knowledge and awareness of dementia among the public have been poorly estimated by the regional center for dementia.
Methods: To assess the feasibility of dementia care facilities and the attitudes of community members toward dementia care facilities, we conducted semi-structured interviews with patients and caregivers who utilize regional centers for dementia. The questionnaires consisted of an assessment of the understanding of dementia, the items and amount requested for facility use and satisfaction with dementia care facilities.
Results: A total of 151 residents completed this questionnaire form. The rate of interest in
dementia was very high, 48.3% of total responses; however, the knowledge and familiarity
with dementia were very low in comparison to the rate of interest (36.4%, 37.1%, respectively).
Most of the responders suggested that more precise and easily understandable information should be provided by the regional center for dementia.
Conclusion: The public need for dementia care facilities is very high, despite their minimal understanding of dementia. Therefore, it is crucial for the public to receive urgent preventive education. and a conversion of knowledge regarding dementia.
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We performed a retrospective study of 145 consecutive patients referred on suspicion of dementia. We were particularly interested in the occurrence of reversible dementia. Dementia was defined with reference to the ICD-10 criteria.All patients underwent a clinical neurological examination, a battery of blood tests, and a CT scan of the brain.Dementia was found in 63% and in only 4% was it potentially reversible: Three patients had subnormal cobalamin and one patient had normal pressure hydrocephalus. However, treatment did not influence the state of dementia. Hence, patients with reversible dementia were not identified in this study. In the group without dementia one patient had a meningoma. Mental depression was the most common "second" diagnosis in both groups.The number of patients with potential dementia was surprisingly small. We conclude that most patients with reversible dementia are detected by their general practitioner and that the majority of patients suspected of dementia can be diagnosed by the general practitioner, especially if access to CT scans is further liberalised.
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Comparison of search strategies in systematic reviews of adverse effects to other systematic reviews
Abstract Background Research indicates that the methods used to identify data for systematic reviews of adverse effects may need to differ from other systematic reviews. Objectives To compare search methods in systematic reviews of adverse effects with other reviews. Methods The search methodologies in 849 systematic reviews of adverse effects were compared with other reviews. Results Poor reporting of search strategies is apparent in both systematic reviews of adverse effects and other types of systematic reviews. Systematic reviews of adverse effects are less likely to restrict their searches to MEDLINE or include only randomised controlled trials ( RCT s). The use of other databases is largely dependent on the topic area and the year the review was conducted, with more databases searched in more recent reviews. Adverse effects search terms are used by 72% of reviews and despite recommendations only two reviews report using floating subheadings. Conclusions The poor reporting of search strategies in systematic reviews is universal, as is the dominance of searching MEDLINE . However, reviews of adverse effects are more likely to include a range of study designs (not just RCT s) and search beyond MEDLINE .
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Background: Diabetes mellitus (DM) increases the risk of dementia in the elderly.However, its underlying mechanisms, its connection with Alzheimer disease and vascular cognitive impairment, and effects of therapy remain unclear.Objective: To test the hypothesis that DM promotes specific neuropathologic processes that contribute to dementia and that these processes may be suppressed by antidiabetic therapy.Design: A comprehensive neuropathologic assessment of all cases from a community-based study of incident dementia (Adult Changes in Thought Study) that underwent autopsies (n=259) and had information on DM status (n=196).Biochemical analysis was conducted on a subset of these cases with rapidly frozen brain tissue (n=57).Participants: Autopsy cases were divided into 4 groups: no DM/no dementia (DM-/dementia-), DM/no dementia (DMϩ/dementia-), no DM/dementia (DM-/ dementiaϩ), and DM/dementia (DMϩ/dementiaϩ).Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of dementia was assigned through a consensus of experts following biennial cognitive and physi-cal evaluations.Diabetes was diagnosed based on information obtained from participants' extensive medical records.Results: In cases without dementia (n = 125), neuropathologic and biochemical end points did not differ significantly by DM status.However, we observed 2 patterns of injury in patients with dementia (n=71) by their DM status.Individuals without DM but with dementia (DM-/dementiaϩ) had a greater amyloid- peptide load and increased levels of F 2 -isoprostanes in the cerebral cortex, while DMϩ/dementiaϩ patients had more microvascular infarcts and an increased cortical IL-6 (interleukin 6) concentration.The number of microvascular infarcts was greater in deep cerebral structures in patients with dementia whose diabetes was treated, whereas amyloid plaque load tended to be greater for untreated diabetic patients with dementia.Conclusions: These novel characterizations of 2 different patterns of cerebral injury in patients with dementia depending on DM status may have etiologic and therapeutic implications.
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In this article, we describe the strengths and weaknesses of several methods of locating systematic reviews, including electronic databases such as MEDLINE, Best Evidence (the electronic version of ACP Journal Club and Evidence-Based Medicine), and the Cochrane Library (a regularly updated source of reviews and controlled trials produced by the Cochrane Collaboration). We also present steps that can be used to critically appraise review articles; as an example, we use a systematic review that evaluates the gastrointestinal toxicity of various nonsteroidal anti-inflammatory drugs in the context of a clinical scenario.
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The Quasi-purchase system of research outcome is a research funds' system based upon research outcome. The thesis analyses the characteristics of research outcomes' honour under the quasi-purchase system of research outcome. It researches the evaluation of the follow-up impact of the honoured outcome. And make a greater impact on the honoured outcome for incentives and penalties for false results of the proposal.
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Ten to 33 percent of the patients who present for evaluation of dementia are found to have a potentially reversible cause of dementia such as a metabolic, structural, or psychiatric condition. Another group of patients who present with symptoms or complaints of impaired thinking are erroneously diagnosed as suffering from dementia. The author reviews the criteria for diagnosis of dementia, the laboratory and other tests advisable for use in evaluating the presence of dementia or guiding the treatment of irreversible dementia, and some factors that may lead to the misdiagnosis of dementia. He emphasizes that a thorough medical, psychiatric, and psychosocial evaluation of all patients presenting with cognitive impairments is essential.
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