Xia Li

Background: Health economic evidence comparing diagnostic strategies for Alzheimer’s disease (AD) in China is lacking. This study aimed to assess the cost-effectiveness of AD cerebrospinal fluid (CSF) biomarkers versus Amyloid β positron emission tomography (Aβ-PET) across the diagnostic and treatment pathway of AD in China.Methods: A decision-tree model was developed to simulate the diagnostic pathway, with an attached Markov model for five-year treatment.Findings: Compared with Aβ-PET, CSF biomarkers achieved similar diagnostic accuracy and quality-adjusted life years at lower costs. From the societal perspective, CSF biomarkers reduced the cost per timely and accurate diagnosis by 34.9% and total costs by $282. From the healthcare system perspective, reductions were 32.9% and $224 respectively. CSF biomarkers was cost-effective from both perspectives.Interpretation: CSF biomarkers is a cost-effective alternative to Aβ-PET for early AD diagnosis in China, providing significant economic and clinical benefits. Its adoption could improve diagnostic access and reduce the overall burden of AD.

Background: The global population is undergoing significant aging, with the elderly facing prominent physical and mental health challenges. Geriatric depression is becoming increasingly prevalent, imposing a heavy burden on healthcare and caregiving. This study employs network analysis to explore the relationship between geriatric depressive symptoms and the Big Five personality traits, aiming to provide a theoretical basis for preventing and intervening in geriatric depression.Methods: A total of 585 residents aged 60 and above, with an average age of 67.14 ± 5.26 years, were included in this study. The Geriatric Depression Scale-15 was used to assess depressive symptoms, and the 60-item version of the Big Five Personality Inventory was used to assess personality traits. The network model was constructed in R using the qgraph, bootnet, and networktools packages, applying LASSO regularization with EBIC for model selection. Network centrality was evaluated using Strength and Bridge Strength as indicators. Meanwhile, network comparison analyses were conducted for different genders.Results: The model included 45 edges, 29 of which had non-zero estimates, with an average edge weight of 0.038. Openness had negative connections with withdrawal apathy-vigor (WAV) and hopelessness; Conscientiousness had a negative connection with dysphoric mood; Extraversion had a negative connection with WAV; Agreeableness had a negative connection with anxiety; and Neuroticism had positive connections with dysphoric mood, WAV, anxiety, memory complaints, and hopelessness. According to the strength centrality ranking, the top four nodes were Neuroticism, Conscientiousness, dysphoric mood, and hopelessness. The nodes with higher bridge strength were Neuroticism, dysphoric mood, and WAV. The analysis stratified by gender revealed that Neuroticism consistently exhibited the highest strength and bridge strength. In terms of the strength of depressive symptoms, dysphoric mood was most prominent in males, while hopelessness was most significant in females. Regarding bridge strength, anxiety symptoms had the highest bridge strength in males, whereas dysphoric mood had the highest bridge strength in females.Conclusion: Different personality traits show varied associations with geriatric depressive symptoms. Neuroticism is crucial in the Personality–Depressive Symptoms network, and gender differences exist in this relationship. These findings may offer guidance for the prevention and treatment of depressive symptoms in older adults.

The rising global prevalence of Alzheimer's disease (AD) and mild cognitive impairment (MCI) underscores the urgent need to elucidate their underlying pathogenic mechanisms.

Introduction Late-life depression (LLD) is a global public health issue, often accompanied by cognitive impairments that can exacerbate the severity of depression and impair social functioning. Despite being a well-established treatment for LLD, the suitability of problem-solving therapy (PST) for individuals with LLD and varying degrees of cognitive impairments warrants further investigation. This paper presents the protocol for a systematic review and meta-analysis of randomised controlled trials (RCTs) aimed at evaluating the effectiveness and acceptability of PST for this specific demographic. Methods/analysis Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we will conduct a systematic review to synthesise existing research on PST for individuals in this demographic. We will comprehensively search multiple databases and sources, including PubMed, EMBASE, the Cochrane Database and APA PsycNET from inception to October 2023, without language, publication year or type restrictions. Relevant studies will be manually screened from the references. Only RCTs involving PST for LLD will be included. The primary efficacy outcome will be the standardised mean difference in total scores on continuous depression severity scales across different comparison arms. Data extraction will be conducted independently by two reviewers (CH and J-JW), and methodological rigour will be assessed using the Cochrane Risk of Bias assessment tool. Subgroup and sensitivity analyses will be performed to investigate the impact of concomitant cognitive impairments and to evaluate the robustness of the findings. Ethics and dissemination The meta-analysis project is expected to be ethically unproblematic and does not require approval from a research ethics committee. The results of this study will be shared through articles in scholarly peer-reviewed journals and presentations in various formats, both print and digital. PROSPERO registration number CRD42023473782