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Biostatistics, Ethics, Data Management, Research Design and Community Engagement(BEDRoC) Core
Biostatistics, Ethics, Data Management, Research Design and Community Engagement (BEDRoC) Core Abstract The Biostatistics, Ethics, Data Management, Research Design and Community Engagement (BEDRoC) Core will promote and support aging with serious illness science for the Center for Aging with Serious Illness (CASI). BEDRoC will provide expertise in statistical design and analysis, research ethics, and community engagement for all components of CASI. The Core's services will support the Research Project Leaders (RPLs) and Pilot Project Leaders (PPLs) and build capacity for the broader Dartmouth Health aging research community to conduct rigorous, impactful research to inform and improve care delivery for older adults with serious illness. BEDRoC includes expertise in mixed methods approaches that feature both quantitative and qualitative research methods to provide a comprehensive understanding of the complex issues related to aging with serious illness, ethical approaches to consent in research trials, multidimensional quality of life measurement, and innovative modeling approaches to studying clinical decision making. BEDRoC faculty have actively collaborated in study planning with each RPL, serving as both mentors and experienced collaborators on the three different projects involving decision aids for patients considering carotid revascularization, a patient-reported outcome-directed referral intervention to improve referral rates to palliative care services, and a pilot trial for a virtual/home-based exercise and a weight management osteoarthritis treatment program in older patients with osteoarthritis and multimorbidity. The BEDRoC Core will further support CASI by establishing an innovative training curriculum with workshops, tutorials, resources, and services, offered locally to RPLs and PPLs and extended to regional and national investigators in the IDeA network. In addition to their primary individual project mentors, each RPL will receive training and guidance from BEDRoC leaders through co-mentoring and RPL-focused works-in-progress sessions. BEDRoC will also provide access to a comprehensive inventory of patient-reported outcomes instruments, which are crucial in geriatric research to provide validated measures of health status, quality of life and functional ability outcomes. BEDRoC will coordinate with the Administrative and Mentoring Core to integrate community advisors in guiding their activities in support of the RPLs. BEDRoC will also enable research collaboration with and within the larger Dartmouth and IDeA investigator communities. The BEDRoC Core will build capacity for aging research and disseminate new resources to RPLs and PPLs, including innovative solutions created through robust community engagement. These services, resources, and solutions will ensure all projects operate in a cohesive, complementary, and collaborative manner to study approaches to improving the health of older patients with serious illness.
Multimorbidity in the ageing human brain: lessons from neuropathological assessment
Age-associated dementias are neuropathologically characterized by the identification of hallmark intracellular and extracellular deposition of proteins, i.e., hyperphosphorylated-tau, amyloid-β, and α-synuclein, or cerebrovascular lesions. The neuropathological assessment and staging of these pathologies allows for a diagnosis of a distinct disease, e.g., amyloid-β plaques and hyperphosphorylated tau pathology in Alzheimer's disease. Neuropathological assessment in large scale cohorts, such as the UK’s Brains for Dementia Research (BDR) programme, has made it increasingly clear that the ageing brain is characterized by the presence of multiple age-associated pathologies rather than just the ‘pure’ hallmark lesion as commonly perceived. These additional pathologies can range from low/intermediate levels, that are assumed to have little if any clinical significance, to a full-blown mixed disease where there is the presence of two distinct diseases. In our recent paper (McAleese et al. 2021 Concomitant neurodegenerative pathologies contribute to the transition from mild cognitive impairment to dementia, https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12291, Alzheimer's & Dementia), using the BDR cohort, we investigated the frequency of multimorbidity and specifically investigated the impact of additional low-level pathology on cognition. In this study, of 670 donated post-mortem brains, we found that almost 70% of cases exhibited multimorbidity and only 22% were considered a pure diagnosis. Importantly, no case of Lewy Body dementia or vascular dementia was considered pure. A key finding is that the presence of low levels of additional pathology increased the likelihood of having mild dementia vs mild cognitive impairment by almost 20-fold, indicating low levels of additional pathology do impact the clinical progression of a distinct disease. Given the high prevalence and the potential clinical impact, cerebral multimorbidity should be at the forefront of consideration in dementia research.
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