3 results
Accuracy of dopaminergic imaging as a biomarker for mild cognitive impairment with Lewy bodies
- Gemma Roberts, Paul C. Donaghy, Jim Lloyd, Rory Durcan, George Petrides, Sean J. Colloby, Sarah Lawley, Joanna Ciafone, Calum A. Hamilton, Michael Firbank, Louise Allan, Nicola Barnett, Sally Barker, Kirsty Olsen, Kim Howe, Tamir Ali, John-Paul Taylor, John O'Brien, Alan J. Thomas
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- Journal:
- The British Journal of Psychiatry / Volume 218 / Issue 5 / May 2021
- Published online by Cambridge University Press:
- 23 December 2020, pp. 276-282
- Print publication:
- May 2021
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- Article
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Background
Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but its diagnostic accuracy at the mild cognitive impairment (MCI) stage remains uncertain.
AimsTo provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at the MCI stage to either support or refute its inclusion as a biomarker for the diagnosis of MCI with Lewy bodies.
MethodWe conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computerised tomography (123I-FP-CIT SPECT) in 144 patients with MCI. Images were rated as normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up consensus diagnosis based on the presence of core features of Lewy body disease was used as the reference standard.
ResultsAt latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26 possible MCI with Lewy bodies and 57 MCI due to Alzheimer's disease. The sensitivity of baseline FP-CIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52–77%), specificity 88% (76–95%) and accuracy 76% (68–84%), with positive likelihood ratio 5.3.
ConclusionsIt is over five times as likely for an abnormal scan to be found in probable MCI with Lewy bodies than MCI due to Alzheimer's disease. Dopaminergic imaging appears to be useful at the MCI stage in cases where Lewy body disease is suspected clinically.
Prospective predictors of decline v. stability in mild cognitive impairment with Lewy bodies or Alzheimer's disease
- Calum A. Hamilton, Fiona E. Matthews, Paul C. Donaghy, John-Paul Taylor, John T. O'Brien, Nicola Barnett, Kirsty Olsen, Ian G. McKeith, Alan J. Thomas
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- Journal:
- Psychological Medicine / Volume 51 / Issue 15 / November 2021
- Published online by Cambridge University Press:
- 05 May 2020, pp. 2590-2598
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Background
Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD).
MethodsA prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function.
ResultsThree distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline.
ConclusionsThese results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms – particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.
Chapter 11 - Policy, Financing and Implementation
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- By Catherine Mitchell, Janet L. Sawin, Govind R. Pokharel, Daniel Kammen, Zhongying Wang, Solomone Fifita, Mark Jaccard, Ole Langniss, Hugo Lucas, Alain Nadai, Ramiro Trujillo Blanco, Eric Usher, Aviel Verbruggen, Rolf Wüstenhagen, Kaoru Yamaguchi, Douglas Arent, Greg Arrowsmith, Morgan Bazilian, Lori Bird, Thomas Boermans, Alex Bowen, Sylvia Breukers, Thomas Bruckner, Sebastian Busch, Elisabeth Clemens, Peter Connor, Felix Creutzig, Peter Droege, Karin Ericsson, Chris Greacen, Renata Grisoli, Erik Haites, Kirsty Hamilton, Jochen Harnisch, Cameron Hepburn, Suzanne Hunt, Matthias Kalkuhl, Heleen de Koninck, Patrick Lamers, Birger Madsen, Gregory Nemet, Lars J. Nilsson, Supachai Panitchpakdi, David Popp, Anis Radzi, Gustav Resch, Sven Schimschar, Kristin Seyboth, Sergio Trindade, Bernhard Truffer, Sarah Truitt, Dan van der Horst, Saskia Vermeylen, Charles Wilson, Ryan Wiser, David de Jager, Antonina Ivanova Boncheva
- Edited by Ottmar Edenhofer, Ramón Pichs-Madruga, Youba Sokona, Kristin Seyboth, Susanne Kadner, Timm Zwickel, Patrick Eickemeier, Gerrit Hansen, Steffen Schlömer, Christoph von Stechow, Patrick Matschoss
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- Book:
- Renewable Energy Sources and Climate Change Mitigation
- Published online:
- 05 December 2011
- Print publication:
- 21 November 2011, pp 865-950
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Summary
Executive Summary
Renewable energy can provide a host of benefits to society. In addition to the reduction of carbon dioxide (CO2) emissions, governments have enacted renewable energy (RE) policies to meet a number of objectives including the creation of local environmental and health benefits; facilitation of energy access, particularly for rural areas; advancement of energy security goals by diversifying the portfolio of energy technologies and resources; and improving social and economic development through potential employment opportunities. Energy access and social and economic development have been the primary drivers in developing countries whereas ensuring a secure energy supply and environmental concerns have been most important in developed countries.
An increasing number and variety of RE policies–motivated by a variety of factors–have driven substantial growth of RE technologies in recent years. Government policies have played a crucial role in accelerating the deployment of RE technologies. At the same time, not all RE policies have proven effective and efficient in rapidly or substantially increasing RE deployment. The focus of policies is broadening from a concentration almost entirely on RE electricity to include RE heating and cooling and transportation.
RE policies have promoted an increase in RE capacity installations by helping to overcome various barriers. Barriers specific to RE policymaking (e.g., a lack of information and awareness), to implementation (e.g., a lack of an educated and trained workforce to match developing RE technologies) and to financing (e.g., market failures) may further impede deployment of RE.