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Enregistrement W3211083802 · doi:10.1016/s2666-7568(21)00257-9

Dementia prevention needs funding

2021· letter· en· W3211083802 sur OpenAlexaff
Larry W. Chambers, Charles Alessi, Muir Gray

Notice bibliographique

RevueThe Lancet Healthy Longevity · 2021
Typeletter
Langueen
DomaineMedicine
ThématiqueDementia and Cognitive Impairment Research
Établissements canadiensWestern UniversityLondon Health Sciences CentreMcMaster UniversityImpact
Organismes subventionnairesnon disponible
Mots-clésDementiaMedicineBusinessPsychologyInternal medicine

Résumé

récupéré en direct d'OpenAlex

The US Food and Drug Administration approval of aducanumab1Alexander GC Knopman DS Emerson SS et al.Revisiting FDA approval of aducanumab.N Engl J Med. 2021; 385: 769-771Crossref PubMed Scopus (54) Google Scholar highlights the disconnect between evidence and our response to population ageing and the associated increase of people who are at high risk of dementia.The approval of aducanumab heightens discussion about what constitutes necessary and sufficient evidence around the licensing of novel therapeutic interventions, particularly with regard to the selection of surrogate endpoints.Studies of aducanumab show reductions in amyloid, which can be a sufficient condition for approving the drug. However, it is not a necessary condition because there are other outcomes that should be measured in trials of aducanumab for dementia treatment. For example, if aducanumab does not reduce amyloid, it could still have an effect on behavioural outcomes such as ability to manage financial affairs, maintain self-care and personal hygiene, clean living space, and drive.2Committee on the Public Health Dimensions of Cognitive AgingBoard on Health Sciences PolicyInstitute of MedicineCognitive aging: progress in understanding and opportunities for action. National Academies Press, Washington, DC2015Google ScholarDementia risk reduction in the general population is largely ignored and programmes are not deployed globally despite there being robust and unequivocal evidence for delaying or preventing dementia.The certainty of the evidence regarding the effects of dementia prevention3Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (1799) Google Scholar, 4Anstey KJ Ee N Eramudugolla R A systematic review of meta-analyses that evaluate risk factors for dementia to evaluate the quantity, quality, and global representativeness of evidence.J Alzheimers Dis. 2019; 70: S165-S186Crossref PubMed Scopus (53) Google Scholar is much greater than the effect of dementia treatment.5Fink HA Linskens EJ MacDonald R et al.Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia.Ann Intern Med. 2020; 172: 656-668Crossref PubMed Scopus (28) Google Scholar Systematic reviews on the treatment of dementia with anti-amyloid drugs have shown borderline (4% absolute risk reduction)5Fink HA Linskens EJ MacDonald R et al.Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia.Ann Intern Med. 2020; 172: 656-668Crossref PubMed Scopus (28) Google Scholar or no absolute effects and the use of amount of amyloid in the brain as the main outcome used in these trials is questionable.By contrast, systematic reviews about dementia prevention are more precise, showing absolute positive effects (40% absolute risk reduction)3Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (1799) Google Scholar on three outcomes. First, protecting the brain from harmful effects due to situations such as poor sleep, stress, and prescribed and self-prescribed drugs. Second, keeping oxygen supply flowing to the brain. Finally, keeping engaged and positive, continuing to socialise, find new challenges, and resist negative thoughts of inevitable decline.Governmental and non-governmental organisations should focus on the evidence and highlight simple but effective lifestyle changes that anyone can make. Everyone can take positive action to increase their so-called brainability. The Lancet Commission on dementia prevention, intervention, and care3Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (1799) Google Scholar is important and can be used to inform action policies. The US Food and Drug Administration approval of aducanumab1Alexander GC Knopman DS Emerson SS et al.Revisiting FDA approval of aducanumab.N Engl J Med. 2021; 385: 769-771Crossref PubMed Scopus (54) Google Scholar highlights the disconnect between evidence and our response to population ageing and the associated increase of people who are at high risk of dementia. The approval of aducanumab heightens discussion about what constitutes necessary and sufficient evidence around the licensing of novel therapeutic interventions, particularly with regard to the selection of surrogate endpoints. Studies of aducanumab show reductions in amyloid, which can be a sufficient condition for approving the drug. However, it is not a necessary condition because there are other outcomes that should be measured in trials of aducanumab for dementia treatment. For example, if aducanumab does not reduce amyloid, it could still have an effect on behavioural outcomes such as ability to manage financial affairs, maintain self-care and personal hygiene, clean living space, and drive.2Committee on the Public Health Dimensions of Cognitive AgingBoard on Health Sciences PolicyInstitute of MedicineCognitive aging: progress in understanding and opportunities for action. National Academies Press, Washington, DC2015Google Scholar Dementia risk reduction in the general population is largely ignored and programmes are not deployed globally despite there being robust and unequivocal evidence for delaying or preventing dementia. The certainty of the evidence regarding the effects of dementia prevention3Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (1799) Google Scholar, 4Anstey KJ Ee N Eramudugolla R A systematic review of meta-analyses that evaluate risk factors for dementia to evaluate the quantity, quality, and global representativeness of evidence.J Alzheimers Dis. 2019; 70: S165-S186Crossref PubMed Scopus (53) Google Scholar is much greater than the effect of dementia treatment.5Fink HA Linskens EJ MacDonald R et al.Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia.Ann Intern Med. 2020; 172: 656-668Crossref PubMed Scopus (28) Google Scholar Systematic reviews on the treatment of dementia with anti-amyloid drugs have shown borderline (4% absolute risk reduction)5Fink HA Linskens EJ MacDonald R et al.Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia.Ann Intern Med. 2020; 172: 656-668Crossref PubMed Scopus (28) Google Scholar or no absolute effects and the use of amount of amyloid in the brain as the main outcome used in these trials is questionable. By contrast, systematic reviews about dementia prevention are more precise, showing absolute positive effects (40% absolute risk reduction)3Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (1799) Google Scholar on three outcomes. First, protecting the brain from harmful effects due to situations such as poor sleep, stress, and prescribed and self-prescribed drugs. Second, keeping oxygen supply flowing to the brain. Finally, keeping engaged and positive, continuing to socialise, find new challenges, and resist negative thoughts of inevitable decline. Governmental and non-governmental organisations should focus on the evidence and highlight simple but effective lifestyle changes that anyone can make. Everyone can take positive action to increase their so-called brainability. The Lancet Commission on dementia prevention, intervention, and care3Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (1799) Google Scholar is important and can be used to inform action policies. We declare no competing interests.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.

Comment cette classification a été obtenuedéplier

Prédiction distillée sur la base complète

Imitation des enseignants

Ni prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.

score de la tête « metaresearch » (Codex)0,002
score de la tête « metaresearch » (Gemma)0,000
Version: codex-gemma-dda1882f352aStatut de validation: machine_predicted_unvalidated
Catégories candidatesIntégrité de la recherche, Charge utile insuffisante (le modèle a refusé de juger)
Catégories consensuellesaucune
DomaineSignal candidat: aucune · Signal consensuel: aucune
Devis d'étudeSignal candidat: Sans objet · Signal consensuel: Sans objet
GenreSignal candidat: Commentaire · Signal consensuel: Commentaire
Score de désaccord entre enseignants0,035
Score d'incertitude au seuil0,999

Scores Codex et Gemma par catégorie

CatégorieCodexGemma
Métarecherche0,0020,000
Méta-épidémiologie (sens strict)0,0000,000
Méta-épidémiologie (sens large)0,0010,000
Bibliométrie0,0000,001
Études des sciences et des technologies0,0000,000
Communication savante0,0000,000
Science ouverte0,0000,000
Intégrité de la recherche0,0000,003
Charge utile insuffisante (le modèle a refusé de juger)0,0020,000

Scores machine (provisoires)

Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.

Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.

Tête enseignante Opus0,120
Tête enseignante GPT0,391
Écart entre enseignants0,271 · la distance entre les deux têtes enseignantes sur ce seul travail
Statut de validationscore_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle

Classification

machine, non validée

Prédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.

Devis d'étudeSans objet
Domainenon disponible
GenreCommentaire

Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».

En bref

Citations1
Publié2021
Routes d'admission1
Résumé présentoui

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