BACKGROUND:Obstructive sleep apnea (OSA) is associated with Alzheimer's disease (AD) risk. Racial-, ethnic-, and sex-specific mechanisms of OSA and AD risk were examined. METHODS:We analyzed data from 3978 polysomnography patients without cognitive decline aged ≥ 60 including 663 OSA+ patients (284 non-Hispanic White, 207 Black, 172 Hispanic) matched to OSA- cohorts (1:1, n = 663; 1:4, n = 2652) and followed for AD through 2013. RESULTS:During the 8.5 (standard deviation 1.4) year period, 358 patients developed AD. AD risk was higher for Black (adjusted hazard ratio [aHR] 2.24 [1.24-2.71]), Hispanic (aHR 1.73, [1.38-3.51]), White (aHR 1.83, [1.21-3.37]), male (aHR 2.38, [1.31-3.47]), and female (aHR 1.37, [1.14-2.41]) patients. Hypoxia, sleep fragmentation, and sleep duration (p < 0.01) were associated with increased risk. Black and Hispanic, and female patients showed stronger effects for hypoxia and duration, and fragmentation, respectively. DISCUSSION:Hypoxia, fragmentation, and duration may underlie racial-, ethnic-, and sex-specific effects of AD risk.
BACKGROUND:Hearing, vision and cognitive impairments are common yet frequently underrecognized among older adults. Although these impairments affect quality of life, functional independence and psychological well-being, there are no published data on the prevalence and consequences of these impairments in relation to Australian home care populations. This protocol outlines a cross-sectional investigation into the prevalence of hearing, vision and cognitive impairments and their associations with quality of life, functional ability and psychosocial well-being among older Australians receiving home care services. METHODS:A total of 369 participants aged 65 years and older will be recruited from home care services across Australia. Standardized assessment tools will be used to assess hearing, vision and cognitive function, quality of life, daily living activities, mental health and social participation. Multi-variable regression models will explore the impact of sensory and cognitive impairments on health and well-being outcomes. DISCUSSION:With ageing populations, it is increasingly important to support older people to live independently in their own homes rather than needing to move into residential aged care. This study will facilitate understanding of the prevalence and impact of sensory and cognitive impairments among the older Australian home care population. Findings may inform strategies to support health ageing in place, including service planning, care coordination and workforce training. PATIENT OR PUBLIC CONTRIBUTION:Older adults receiving home care services and individuals with lived experience of sensory and cognitive impairments contributed to the study design. A Patient and Public Involvement advisory group and a stakeholder steering group will guide study implementation.
The DAWN study aims to investigate Alzheimer's disease (AD) genetics and underlying biological markers in a global population including African Americans (AA: 4,000) and Hispanic/Latinos (HI: 4,000) ascertained in the US and indigenous Africans (AF: 5,000) through collaboration with the African Dementia Consortium (AfDC) from 10 African counties. These 13,000 participants include AD cases and individuals with mild (MCI) or no cognitive impairment (NCI). To understand the underlying blood-based AD biomarkers profile of this unique cohort, we are analyzing the plasma levels of pTau181, neurofilament light chain (NFL), and Glial fibrillary acidic protein (GFAP). We measured pTau181 and NFL, and GFAP with Simoa chemistry using the pTau181 AdvantageV2 and NEUROLOGY 4-PLEX A assays, respectively, on the Quanterix HD-X instrument. Our preliminary cohort consisted of 174 AF (86 AD; 88 NCI) from Nigeria and Ghana study sites, 254 AA (24 AD; 102 MCI; 85 NCI), and 166 HI (44 AD; 61 MCI; 62 NCI). Linear mixed-effect regression models adjusted for age, sex, population substructure and relatedness followed by Bonferroni correction were applied to identify biomarker differences. There were no significant differences between the ancestral groups within the diagnostic categories for any of the biomarkers measured. Plasma pTau181 concentrations were increased in AD relative to NCI in all three populations ( p = 5.1x10 -4 , 9.6x10 -5 , 5.1x10-4 in AA, AF, and HI respectively) and AD relative to MCI ( p = 0.012, 0.0014 in AA and HI respectively), though no differences were noted between MCI and NCI. Interestingly, GFAP and NFL were highly significantly increased in AF AD vs NCI ( p = 4.5x10 -9 , 7.9x10 -7 for GFAP and NFL respectively) and in HI ( p = 7.9x10 -8 , 1.6x10 -6 for GFAP and NFL respectively), but no differences noted in AA. These results suggest AD biomarkers are generalizable across global populations, with baseline values being consistent. However, there are notable differences, particularly in NFL and GFAP levels, which may reflect underlying differences in environmental or genetic influences on AD. Ultimately, increasing sample sizes and combining genomic, biomarker, and social and environmental data will increase understanding of genetic risk of AD.
The burden of Acute Myocardial Infarction (AMI) is growing in sub-Saharan Africa. In Tanzania, uptake of diagnostic testing and evidence-based therapy for AMI is suboptimal. We aimed to describe current gaps in evidence-based AMI care in a Tanzanian emergency department (ED) and estimate the potential benefit of closing key performance gaps. Adults presenting with chest pain or dyspnea to the Kilimanjaro Christian Medical Centre (KCMC) ED were prospectively enrolled from February to September 2023 and their diagnostic tests and treatments were recorded. Thirty days following enrollment, a follow-up telephone survey was administered to assess mortality and medication use. Key performance metrics included the proportion of participants receiving both electrocardiography (ECG) and cardiac biomarker testing, as well as the proportion of participants with AMI receiving evidence-based therapies. To estimate the benefits of closing performance gaps, the annualized number of participants not receiving each evidence-based therapy was divided by published numbers needed to treat (NNTs) for each intervention. An exploratory analysis was conducted using performance metrics at KCMC and published national incidence data to estimate the potential benefits of closing performance gaps in AMI care at scale across Tanzania. Of 275 enrolled participants, 41 (14.9
