Clinical Research Directory

Dementia and Kidney Disease: Epidemiological Approaches to Risk Factors and Treatment Strategies

Kidney disease and dementia are both common in older adults, posing a significant burden on individuals and society. Growing evidence suggests that there may be links between the kidney and the brain. However, few studies have explored how these two conditions are connected in the general population. Understanding this link could help improve care for people living with either or both conditions. This observational project aims to explore the two-way relationship between kidney disease and dementia. The main questions the investigators want to answer are: 1. Does kidney disease increase the risk or worsen the progression of dementia? 2. Does having dementia increase the risk or worsen the progression of kidney disease (both chronic and acute)? 3. Do reno-protective drugs help protect cognitive decline? 4. Do anti-dementia drugs help preserve kidney function? To answer these questions, the investigators will analyze data collected over a period of 12 years, including people diagnosed with dementia, kidney disease, or both, using several large Swedish and international health registries: 1. The Swedish Dementia Registry (SveDem) 2. The Stockholm CREAtinine Measurements (SCREAM) project 3. The Swedish Renal Registry (SRR) 4. The GeroCovid Cohort 5. The Registry of Dementia of Girona (ReDeGi) 6. Cognitive impairment cohort from memory clinic, Karolinska University Hospital This study will apply both traditional and advanced epidemiological methods, including multivariable regression, survival analysis, mixed-effects models, and machine learning (ML) techniques to examine long-term trends and associations.

Comparison of Therapeutic Strategies With Cholinesterase Inhibitors (SOS TRIAL)

Cholinesterase inhibitors (CI) remain the only drugs with a recognized efficacy in mild to moderate Alzheimer's disease (AD) in spite of enormous research efforts. However, these drugs presented as "symptomatic treatment" of AD are considered as having only a weak effect on the course of AD. The reimbursement of these drugs is regularly challenged due to the lack of evidence for the impact of these drugs on milestones stages of AD evolution (survival without severe dementia, restriction in Basic Activities of Daily Living - BADL) and on major consequences in public health (hospitalization and institutionalization). The great majority of previous randomized controlled trials conducted with CI have had a too short duration and the end points were limited to cognition (ADAS Cog scale), IADL (Instrumental Activities of Daily Living) function and Global Impression of Change. New evidences from the DOMINO trial (1) conducted in UK, independently of the pharmaceutical industry, showed that the true effect of CI might be more to avoid or to delay the cognitive or functional decline in AD than to improve patients; the institutionalisation (2) was also delayed. However, this trial was conducted in patients with moderate to severe AD, and the interest of the drugs at the mild to moderate stage remains questionable. The investigators have shown that a good surrogate marker of survival without severe dementia would be an increase of ADAS Cog scale of more than six points (3). A post hoc reanalysis of the pivotal RCT with two CI showed that in mild to moderate patients, CI was associated with a 15% decrease of patients with a deterioration of ADAS-Cog of more than six points in six months. Thus at the beginning of dementia the real effect of CI might be more of delaying the cognitive and functional decline, than to improve the patients. The main objective of the SOS trial is to demonstrate that the benefit of CI at the early phase of dementia is the same as at the later phase.