A Systematic Review and Meta-Analysis on the Prevalence of Dementia in Europe: Estimates from the Highest-Quality Studies Adopting the DSM IV Diagnostic Criteria
Authors: Bacigalupo, Ilaria | Mayer, Flavia | Lacorte, Eleonora | Di Pucchio, Alessandra | Marzolini, Fabrizio | Canevelli, Marco | Di Fiandra, Teresa | Vanacore, Nicola
Article Type: Research Article
Abstract: Background: Dementia, including Alzheimer’s disease (AD), is one of the most burdensome medical conditions. Usually, the reviews that aim at calculating the prevalence of dementia include estimates from studies without assessing their methodological quality. Alzheimer’s Disease International (ADI) proposed a score to assess the methodological quality of population-based studies aimed at estimating the prevalence of dementia. During the last three years, the European Commission has funded three projects (Eurodem, EuroCoDe, and ALCOVE) in order to estimate the prevalence of dementia in Europe. Objective: The aim of this study was to perform a systematic review and meta-analysis of data on the …prevalence of dementia in Europe derived from studies that included only subjects with a diagnosis of dementia according to the DSM IV criteria, and that had a high quality score according to ADI criteria. Methods: We considered the studies selected by the two projects EuroCoDe (1993–2007) and Alcove (2008–2011), and we performed a new bibliographic search. For the systematic review, we only selected the subset of articles that included subjects with a diagnosis of dementia according to the DSM IV criteria. The studies were qualitatively assessed using the ADI tool. Results: The meta-analysis considered 9 studies that were carried out in Europe between 1993 and 2018 including a total of 18,263 participants, of which 2,137 were diagnosed with dementia. The prevalence rate standardized for age and sex resulted 7.1%. Discussion: This is the first systematic review on the prevalence of dementia in Europe considering only high-quality studies adopting the same diagnostic criteria (i.e., DSM IV). Show more
Keywords: Dementia epidemiology, prevalence studies, systematic review
DOI: 10.3233/JAD-180416
Citation: Journal of Alzheimer's Disease, vol. 66, no. 4, pp. 1471-1481, 2018
Mild Cognitive Impairment in the Migrant Population Living in Europe: An Epidemiological Estimation of the Phenomenon
Authors: Canevelli, Marco | Zaccaria, Valerio | Lacorte, Eleonora | Cova, Ilaria | Remoli, Giulia | Bacigalupo, Ilaria | Cascini, Silvia | Bargagli, Anna Maria | Pomati, Simone | Pantoni, Leonardo | Vanacore, Nicola
Article Type: Research Article
Abstract: Background: The construct of mild cognitive impairment (MCI) is triggering growing clinical and research interest. The detection of MCI may be affected by diverse ethno-cultural determinants possibly influencing the personal and social perception of the individual cognitive functioning as well as the reliability of objective cognitive assessment. These challenges may acquire special relevance in subjects with a migration background and composing ethnic minority groups. Objective: The present study is aimed at providing an estimate of the number of MCI cases occurring in the migrant population living in the extended European Union (EU) in 2018. Methods: The number of MCI cases …in older migrants living in Europe and in each of the 32 considered countries was estimated by multiplying the number of migrants, provided by Eurostat, with the age-specific prevalence rates, derived by the harmonized data produced by the COSMIC collaboration and based on different operational definitions of MCI. Results: Nearly 686,000 cases of MCI were estimated in the extended EU by applying age-specific prevalence rates based on the International Working Group criteria. Higher figures were obtained when the Clinical Dementia Rating- and the Mini Mental State Examination-based criteria were applied. The proportion of MCI cases in migrant subjects ranged from 1.1% (Romania) to 54.1% (Liechtenstein) (median: 8.4%; IQR: 4.7%–14.2%). Conclusions: MCI represents and will increasingly constitute a relevant issue in the migrant population living in Europe. The present data reinforce the need of developing approaches and models of care that may be diversity-sensitive and inclusive for a culturally variegated population. Show more
Keywords: Cognitive disorders, health disparities, migration, mild cognitive impairment, neuroepidemiology
DOI: 10.3233/JAD-191012
Citation: Journal of Alzheimer's Disease, vol. 73, no. 2, pp. 715-721, 2020
Reversible Mild Cognitive Impairment: The Role of Comorbidities at Baseline Evaluation
Authors: Grande, Giulia | Cucumo, Valentina | Cova, Ilaria | Ghiretti, Roberta | Maggiore, Laura | Lacorte, Eleonora | Galimberti, Daniela | Scarpini, Elio | Clerici, Francesca | Pomati, Simone | Vanacore, Nicola | Mariani, Claudio
Article Type: Research Article
Abstract: The prognostic value of mild cognitive impairment (MCI) is being questioned, with some MCI subjects reverting to normal cognition (NC). The reversion rate varies mostly depending on the study design, the setting, and both MCI and NC definitions. Previous studies have focused on the profile of subjects who revert to NC, but the role of comorbidities has not been entirely investigated. We aimed to evaluate the proportion of MCI subjects who revert to NC in a memory clinic context, focusing on the role of comorbidities. Between 2004 and 2013, 374 MCI subjects were recruited. During a mean time of 32 …± 25.5 months, 21 subjects (5.6%) reverted to NC. Subjects who reverted to NC were younger (p = 0.0001), more educated (p = 0.0001), had a better global cognition (p = 0.0001), as assessed by the Mini-Mental State Examination (MMSE) and suffered from more comorbidities (p = 0.002), as assessed by Cumulative Illness Rating Scale (CIRS) than those who developed dementia. The Cox Regression Model, constructed to adjust for the confounders, showed that the higher were the MMSE (HR = 1.83, CI 95%: 1.07–3.11) and the CIRS score (HR = 1.3, CI 95% 0.88–1.92) at baseline, the higher was the probability of returning to NC than developing dementia, though the last association was not significant. Subjects who reverted to NC were more frequently affected by respiratory (p = 0.002), urologic (p = 0.012), and psychiatric (p = 0.012) diseases. The cognitive performance of subjects with medical comorbidities could benefit from preventive strategies aimed at treating the underlying diseases. Show more
Keywords: Comorbidity, dementia, mild cognitive impairment, prevention
DOI: 10.3233/JAD-150786
Citation: Journal of Alzheimer's Disease, vol. 51, no. 1, pp. 57-67, 2016
A National Survey of Centers for Cognitive Disorders and Dementias in Italy
Authors: Canevelli, Marco | Di Pucchio, Alessandra | Marzolini, Fabrizio | Mayer, Flavia | Massari, Marco | Salvi, Emanuela | Palazzesi, Ilaria | Lacorte, Eleonora | Bacigalupo, Ilaria | Di Fiandra, Teresa | Vanacore, Nicola
Article Type: Research Article
Abstract: Background: Italy has one of the oldest populations in the World and more than one million dementia cases can be estimated at the national level. Objective: The objectives of this national survey include: 1) to report the administrative features and the professional competencies of Centers for Cognitive Disorders and Dementias (CCDDs); 2) to document possible discrepancies by geographic macro-area; and 3) to identify the features of CCDDs that are associated with a better quality in the provision of care. Methods: A survey of Italian CCDDs was conducted between February 2014 and December 2015. A list of CCDDs was obtained through …direct interactions with designed delegates from each Italian region. A questionnaire was defined on five sections concerning: 1) location of the CCDD; 2) access to the CCDD; 3) organization of the CCDD; 4) services and treatments provided; and 5) quantitative data on the activities of the CCDD. Results: Overall, 577 out of the 597 eligible CCDDs returned the completed survey questionnaire (response rate: 96.6%): 260 (45.1%) from Northern Italy, 103 (17.8%) from Central Italy, and 214 (37.1%) from Southern-Islands Italy. More than a third of CCDDs were open only once or twice weekly. A median of 450 (IQR: 200–800) patients regularly attended these services. Most patients (70%) were affected by dementia or mild cognitive impairment (19%). Conclusion: We have provided a snapshot of the organization and activities of CCDDs in Italy and documented existing inequalities in the provision of care. Show more
Keywords: Cognitive disorders, dementia, healthcare services, memory clinics, public health, services, survey
DOI: 10.3233/JAD-210634
Citation: Journal of Alzheimer's Disease, vol. 83, no. 4, pp. 1849-1857, 2021
Safety and Efficacy of Monoclonal Antibodies for Alzheimer’s Disease: A Systematic Review and Meta-Analysis of Published and Unpublished Clinical Trials
Authors: Lacorte, Eleonora | Ancidoni, Antonio | Zaccaria, Valerio | Remoli, Giulia | Tariciotti, Leonardo | Bellomo, Guido | Sciancalepore, Francesco | Corbo, Massimo | Lombardo, Flavia L. | Bacigalupo, Ilaria | Canevelli, Marco | Piscopo, Paola | Vanacore, Nicola
Article Type: Systematic Review
Abstract: Background: Monoclonal antibodies (mAbs) are currently among the most investigated targets for potential disease-modifying therapies in Alzheimer’s disease (AD). Objective: Our objectives were to identify all registered trials investigating mAbs in MCI due to AD or AD at any stage, retrieve available published and unpublished data from all registered trials, and analyze data on safety and efficacy outcomes. Methods: A systematic search of all registered trials on ClinicalTrials.gov and EUCT was performed. Available results were searched on both platforms and on PubMed, ISI Web of Knowledge, and The Cochrane Library. Results: Overall, 101 studies were identified on 27 mAbs. Results …were available for 50 trials investigating 12 mAbs. For 18 trials, data were available from both published and unpublished sources, for 21 trials only from published sources, and for 11 trials only from unpublished sources. Meta-analyses of amyloid-related imaging abnormalities (ARIA) events showed overall risk ratios of 10.65 for ARIA-E and of 1.75 for ARIA-H. The meta-analysis of PET-SUVR showed an overall significant effect of mAbs in reducing amyloid (SMD –0.88), but when considering clinical efficacy, data on CDR-SB showed that treated patients had a statistically significant but clinically non-relevant lower worsening (MD –0.15). Conclusion: Our results suggest that the risk-benefit profile of mAbs remains unclear. Research should focus on clarifying the effect of amyloid on cognitive decline, providing data on treatment response rate, and accounting for minimal clinically important difference. Research on mAbs should also investigate the possible long-term impact of ARIA events, including potential factors predicting their onset. Show more
Keywords: Alzheimer’s disease, amyloid, meta-analysis, mild cognitive impairment, monoclonal antibodies, safety, systematic review, treatment outcome
DOI: 10.3233/JAD-220046
Citation: Journal of Alzheimer's Disease, vol. 87, no. 1, pp. 101-129, 2022
Case Identification and Characterization of Migrants with Dementia in the Lazio Region Using Health Administrative Data
Authors: Cascini, Silvia | Canevelli, Marco | Agabiti, Nera | Angelici, Laura | Davoli, Marina | Bacigalupo, Ilaria | Cova, Ilaria | Vanacore, Nicola | Pomati, Simone | Pantoni, Leonardo | Acampora, Anna | Bargagli, Anna Maria | Ancidoni, Antonio | Bacigalupo, Ilaria | Bellomo, Guido | Canevelli, Marco | Giusti, Angela | Lacorte, Eleonora | Palazzesi, Ilaria | Piscopo, Paola | Porrello, Mariacristina | Sciancalepore, Francesco | Vanacore, Nicola | Zambri, Francesca | Salvi, Emanuela | Acampora, Anna | Agabiti, Nera | Angelici, Laura | Bargagli, Anna Maria | Cascini, Silvia | Davoli, Marina | Cova, Ilaria | Maestri, Giorgia | Nicotra, Alessia | Pantoni, Leonardo | Pomati, Simone | Bruno, Giuseppe | Zaccaria, Valerio | Remoli, Giulia | Valletta, Martina | Di Blasio, Norina | De Fiore, Luca | Visco, Caterina
Article Type: Research Article
Abstract: Background: A crucial step for planning effective public health policies for migrants with dementia is the collection of data on the local dimensions of the phenomenon and patients’ characteristics. Objective: This study aimed to identify and characterize migrants with dementia in the Lazio region using health administrative databases. Methods: Residents with dementia aged 50 years or older, living in the Lazio region as of December 31, 2018, were identified using a validated algorithm based on hospital discharge(s), claims for antidementia drugs, and co-payment exemption for dementia. Migrants were defined as people born abroad and grouped in migrants from High Migratory …Pressure Countries (HMPCs) and Highly Developed Countries (HDCs). Overall and age-specific prevalence rates were estimated in native- and foreign-born patients. Results: Dementia was ascertained in 38,460 residents. Among them, 37,280 (96.9%) were born in Italy, 337 (0.9%) were migrants from HDCs, and 843 (2.2%) from HMPCs. Dementia prevalence was higher among natives (1.15%, 95% CI 1.14–1.16) relative to migrants from HDCs (0.60%, 95% CI 0.54–0.67) and HMPCs (0.29%, 95% CI 0.27–0.31). The prevalence of comorbidities did not differ between groups. Migrants with dementia had a lower likelihood of receiving antidementia treatments compared with natives (51.6% in migrants from HDCs, 49.3% in migrants from HMPCs, and 53.5% among Italians). Conclusion: Routinely collected data in healthcare administrative databases can support the identification of migrants with dementia. Migrants exhibited a lower age-standardized prevalence of registered dementia and lower access to dedicated treatments than Italians. These findings are suggestive of underdiagnosis and undertreatment of dementia in migrants. Show more
Keywords: Access to care, dementia, diversity, migrants, record linkage
DOI: 10.3233/JAD-221146
Citation: Journal of Alzheimer's Disease, vol. 92, no. 3, pp. 843-852, 2023