Nadja Smailagic

Reporting standards for studies of diagnostic test accuracy in dementia: The STARDdem Initiative

Objective: To provide guidance on standards for reporting studies of diagnostic test accuracy for dementia disorders. Methods: An international consensus process on reporting standards in dementia and cognitive impairment (STARDdem) was established, focusing on studies presenting data from which sensitivity and specificity were reported or could be derived. A working group led the initiative through 4 rounds of consensus work, using a modified Delphi process and culminating in a face-to-face consensus meeting in October 2012. The aim of this process was to agree on how best to supplement the generic standards of the STARD statement to enhance their utility and encourage their use in dementia research. Results: More than 200 comments were received during the wider consultation rounds. The areas at most risk of inadequate reporting were identified and a set of dementia-specific recommendations to supplement the STARD guidance were developed, including better reporting of patient selection, the reference standard used, avoidance of circularity, and reporting of test-retest reliability. Conclusion: STARDdem is an implementation of the STARD statement in which the original checklist is elaborated and supplemented with guidance pertinent to studies of cognitive disorders. Its adoption is expected to increase transparency, enable more effective evaluation of diagnostic tests in Alzheimer disease and dementia, contribute to greater adherence to methodologic standards, and advance the development of Alzheimer biomarkers.

Group-Based Parenting Programs for Improving Parenting and Psychosocial Functioning: A Systematic Review

Parental psychosocial health can have a significant effect on the later psychological health of the child. Parenting programs have been shown to have an effect on the emotional and behavioral adjustment of children, and this review examined such programs’ effect on parental psychosocial well-being. We searched a range of electronic databases and included randomized controlled trials that compared a group-based parenting program with a control condition and used at least 1 standardized measure of parental psychosocial health. We used a random effects meta-analysis, and we report standardized mean differences (SMD) and 95% confidence intervals (CI) for all outcomes. We included 48 studies with 4,937 participants and evaluated 3 types of programs: behavioral, cognitive-behavioral, and multimodal. Overall, we find parents’ participation in group-based parenting programs is associated with statistically significant short-term improvements in depression (SMD -0.17, 95% CI -0.28 to -0.07), anxiety (SMD -0.22, 95% CI -0.43 to -0.01), stress (SMD -0.29, 95% CI -0.42 to -0.15), anger (SMD -0.60, 95% CI -1.00 to -0.20), guilt (SMD -0.79, 95% CI -1.18 to -0.41), confidence (SMD -0.34, 95% CI -0.51 to -0.17) and satisfaction with the partner relationship (SMD -0.28, 95% CI -0.47 to -0.09). However, only stress and confidence continued to be significant at the 6-month follow-up, and none were significant at 1year. The findings of this review support the use of parenting programs to improve the short-term psychosocial wellbeing of parents. Further training might be required to ensure that these benefits are maintained.

Plasma and CSF Aß for the diagnosis of Alzheimer's disease dementia and other dementias in mild cognitive impairment: A Cochrane Systematic Review

determined a value (optical density units) for pPKR that could discriminate AD patients from control subjects with a sensitivity of 91.1% and a specificity of 94.3%. Among AD patients, T-PKR and pPKR levels correlate with CSF p181tau levels. Some AD patients with normal CSF As, T-tau, or p181tau levels had abnormal T-PKR and pPKR levels. Conclusions: The evaluation of CSF T-PKR and pPKR levels can discriminate between AD patients and NDC and could help to improve the biochemical diagnosis of AD. Because PKR is pro-apoptotic and pro-inflammatory, this kinase represents a valid pharmacological target to slow the inexorable cognitive decline of AD patients.

Aβ and the dementia syndrome: Simple versus complex perspectives

The amyloid cascade hypothesis (ACH) has dominated strategy in dementia research for decades despite evidence of its limitations including known heterogeneity of the dementia syndrome in the population and the narrow focus on a single molecule – the amyloid beta protein (Aβ) as causal for all Alzheimer‐type dementia. Other hypotheses relevant to Aβ are the presenilin (PS) hypothesis (PSH) relating to the involvement of PS in the generation of Aβ, and the amyloid precursor protein (APP) matrix approach (AMA), relating to the complex and dynamic breakdown of APP, from which Aβ derives.