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Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Several authors of this paper participated in the development of DESDE-LTC (LSC, JAS, MRGC). These authors do not have any commercial interest in this instrument.

Background: This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia., Methods: The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT)., Results: A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes., Conclusions: Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: This study evaluates and describes the pattern of services provided for people living with multiple sclerosis (MS) in a local area as a starting point for a more global assessment., Methods: A health care ecosystem approach has been followed using an internationally standardized service classification instrument-the Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC)-to identify and describe all services providing care to people with MS in the Australian Capital Territory, Australia. Available services were classified according to the target population into those specifically dedicated to people living with MS and those providing general neurologic services, both public and private, and across both social and health sectors., Results: A limited range of services was available. There were no local facilities providing or coordinating multidisciplinary integrated care specific to people with MS. Subspecialty services specific to MS were limited in number (6 of the 28 services), and use of specialist services provided in neighboring states was frequently reported. Overall, very few services were provided outside the core health sector (4%)., Conclusions: The provision of care to people living with MS in the Australian Capital Territory is fragmented and relies heavily on generic neurology services in the public and private sectors. More widespread use of the DESDE-LTC as a standardized method of service classification in MS will facilitate comparison with other local areas, allow monitoring of changes over time, and permit comparison with services provided for other health conditions (eg, dementia, mental disorders)., Competing Interests: FINANCIAL DISCLOSURES: The authors declare no conflicts of interest., (© 2023 Consortium of Multiple Sclerosis Centers.)

Introduction: Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas., Methods: The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters., Results: The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL., Discussion: In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas., Competing Interests: DR participated in the design and authorship of this manuscript, is a Principal Advisor and Research Director at WAPHA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Salinas-Perez, Gutierrez-Colosia, Garcia-Alonso, Furst, Tabatabaei-Jafari, Kalseth, Perkins, Rosen, Rock and Salvador-Carulla.)

Objective: Immigrants' mental health is a growing public health concern. Neighbourhood characteristics in the host society may contribute to the poor mental health observed among immigrants. In this study, we aimed to investigate the association between neighbourhood-level social fragmentation and socioeconomic characteristics with psychological distress among immigrants and non-immigrants living in Australia., Methodology: We conducted cross-sectional secondary data analysis of 228,039 participants from the Sax Institute's 45 and Up Study, with psychological distress measured with the Kessler 10 (K10) and area-level social fragmentation and economic advantage/disadvantage measured at the statistical area level 1 (areas containing approximately 400 people). Multilevel logistic models were used to examine the extent to which differences across the least and most fragmented and economic advantage/disadvantage neighbourhoods contributed to the prevalence of high psychological distress (K10 score ⩾ 22)., Results: Immigrants accounted for about 23% of the sample. Slightly more immigrants (34.8%) compared to non-immigrants (32.9%) lived in fragmented areas. Although immigrants were over represented in areas with socioeconomic advantage (40% vs 33.9%), the prevalence of high psychological distress in neighbourhoods with higher social fragmentation and socioeconomic disadvantage was higher in immigrants than non-immigrants. Immigrants had 17% (95% confidence interval = [12%, 22%]) higher odds of having high psychological distress compared to non-immigrants. There was no evidence of an interaction between social fragmentation or socioeconomic disadvantage and immigrant status. Living in fragmented or socioeconomically disadvantaged areas was associated with higher psychological distress among immigrants and non-immigrants. English as a second language and low annual income were significant predictors of psychological distress in immigrants over and above area-level characteristics., Conclusion: Immigrants are vulnerable to mental health issues, but the characteristics of the area they live in are also important. Helping immigrants settle into well-integrated and economically advantaged areas may decrease the possibility of mental health issues.

Introduction: Geographical information system (GIS) and spatial analysis have an emerging role in the understanding and management of health-related outcomes. However, there is a knowledge gap about the extent to which GIS has supported multiple Sclerosis (MS) research. Therefore, this review aimed to explore the types of GIS applications and the complexity of their visualisation in MS research., Methods: A systematic scoping review was conducted based on York's five-stage framework. PubMed, Scopus and Web of Science were searched for relevant studies published between 2000 and 2020 using a comprehensive search strategy based on the main concepts related to GIS and MS. Grounded, inductive analysis was conducted to organize studies into meaningful application areas. Further, we developed a tool to assess the visualisation complexity of the selected papers., Results: Of 3,723 identified unique citations, 42 papers met our inclusion criteria for the final review. One or more of the following types of GIS applications were reported by these studies: (a) thematic mapping (37 papers); (b) spatial cluster detection (16 papers); (c) risk factors detection (16 papers); and (d) health access and planning (two papers). In the majority of studies (88%), the score of visualisation complexity was relatively low: three or less from the range of zero to six., Conclusions: Although the number of studies using GIS techniques has dramatically increased in the last decade, the use of GIS in the areas of MS access and planning is still under-researched. Additionally, the capacity of GIS in visualising complex nature of MS care system is not yet fully investigated., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest. This work was supported by Incubator Grant funded by MS Research Australia (application number: 19–0656). Title of the project: Analysis and mapping of service availability and pattern of care for multiple sclerosis in the Australian Capital Territory region., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Variation exists in the patterns of alcohol and other drug (AOD) use and related impacts across geographic locations and over time. Understanding the existing AOD service system and the local context that it operates within is fundamental to optimize service provision. This article describes and compares the availability, placement capacity, and diversity of AOD services in urban and rural regions in Australia., Method: The Description and Evaluation of Services and DirectoriEs (DESDE) tool was used to categorize the service delivery system for AOD care in selected urban and rural regions in Australia., Results: This study found that although AOD services (303 main types of care) were available across all study regions, there was consistently very limited availability of services targeting young people (n = 39, 13%) or older adults (n = 1, <1%). There were also very limited services addressing comorbidities. Availability and diversity of services varied across study areas. Outpatient and residential care were the most available services, whereas day care services were absent in most areas., Conclusions: By describing the capacity of identified available services within the study regions, this study provides baseline information to inform changes to policy and practice and a foundation for monitoring and modeling service changes over time. This information provides evidence useful for optimal planning. However, it should be combined with local knowledge and stakeholder expertise to ensure that local area service needs are addressed.

Background: Dementia is a major global health challenge and the impact of built and social environments' characteristics on dementia risk have not yet been fully evaluated., Objective: To investigate associations between built and social environmental characteristics and diagnosed dementia cases and estimated dementia risk., Methods: We recruited 25,511 patients aged 65 and older from family physicians' practices. We calculated a dementia risk score based on risk and protective factors for patients not diagnosed with dementia. Our exposure variables were estimated for each statistical area level 1: social fragmentation, nitrogen dioxide, public open spaces, walkability, socio-economic status, and the length of main roads. We performed a multilevel mixed effect linear regression analysis to allow for the hierarchical nature of the data., Results: We found that a one standard deviation (1-SD) increase in NO2 and walkability score was associated with 10% higher odds of any versus no dementia (95% CI: 1%, 21% for NO2 and 0%, 22% for walkability score). For estimated future risk of dementia, a 1-SD increase in social fragmentation and NO2 was associated with a 1% increase in dementia risk (95% CI: 0, 1%). 1-SD increases in public open space and socioeconomic status were associated with 3% (95% CI: 0.95, 0.98) and 1% decreases (95% CI: 0.98, 0.99) in dementia risk, respectively. There was spatial heterogeneity in the pattern of diagnosed dementia and the estimated future risk of dementia., Conclusion: Associations of neighborhood NO2 level, walkability, public open space, and social fragmentation with diagnosed dementia cases and estimated future risk of dementia were statistically significant, indicating the potential to reduce the risk through changes in built and social environments.

Background: Individuals with mild cognitive impairment (MCI) are at high risk of progression to Alzheimer's disease (AD) dementia, but some remain stable. There is a need to identify those at higher risk of progression to improve patient management and outcomes., Objective: To evaluate the trajectory of plasma neurofilament light chain (pNFL) prior to progression from MCI to AD dementia, the performance of pNFL, in combination with the Mini-Mental State Examination (MMSE), as a predictor of progression from MCI to AD dementia and to inform clinicians on the use of pNFL as a predictive biomarker., Methods: Participants (n = 440) with MCI and longitudinal follow-up (mean = 4.2 years) from the AD Neuroimaging Initiative dataset were included. pNFL as a marker for neurodegeneration and the MMSE as a cognitive measure were investigated as simple/practical predictors of progression. The risk of progressing from MCI to AD dementia associated with pNFL and MMSE scores was assessed using Cox and logistic regression models., Results: The current risk of progression to AD dementia was 37%higher in individuals with high pNFL (> 56 ng/L) compared to those with average pNFL (≤40 ng/L). A combination of baseline pNFL and MMSE could differentiate those who progressed within 5 years (AUC = 0.75) from stable individuals. Including change in MMSE over 6-12 months further improved the model (AUC = 0.84)., Conclusion: Our findings reveal that combining pNFL with a simple dementia screener (MMSE) can reliably predict whether a person with MCI is likely to progress to AD dementia within 5 years.

Background: This paper outlines the need for a health systems approach and rapid response strategy for gathering information necessary for policy decisions during pandemics and similar crises. It suggests a new framework for assessing the phases of the pandemic., Method: The paper draws its information and conclusions from a rapid synthesis and translation process (RSTP) of a series of webinars and online discussions from the Pandemic-Mental Health International Network (Pan-MHIN) - policy experts from across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK and the USA. While the initial focus of this research was on mental health, COVID-19 has raised much broader issues and questions for health planners., Results: We identified gaps affecting the capacity to respond effectively and quickly, including in relation to system indicators, the inadequacy of the prior classification of the phases of the pandemic, the absences of a healthcare ecosystem approach, and the quick shift to digital technologies. The strengths and weaknesses of COVID-19 responses across different systems, services, sites and countries been identified and compared, including both low and high impacted areas., Conclusions: There is an urgent need for managerial epidemiology based on healthcare ecosystem research encompassing multidisciplinary teams, visualization tools and decision analytics for rapid response. Policy and healthcare context played a key role in the response to COVID-19. Its severity, the containment measures and the societal response varied greatly across sites and countries. Understanding this variation is vital to assess the impact of COVID-19 in specific areas such as ageing or mental health., (© 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.)

Aim: To summarise commonalities and variations in the mental health response to COVID-19 across different sites and countries, with a view to better understanding key steps not only in crisis management, but for future systemic reform of mental health care., Method: We conducted a Rapid Synthesis and Translation Process of lessons learned from an international panel of experts, collecting on the ground experiences of the pandemic as it evolved in real time. Digital conferencing and individual interviews were used to rapidly acquire knowledge on the COVID-19 outbreak across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK, and the USA., Results: COVID-19 has had massive impacts on mental health care internationally. Most systems were under-resourced and under-prepared, struggling to manage both existing and new clients. There were significant differences between sites, depending on the explosivity the pandemic and the readiness of the mental health system. Integrated, community mental health systems exhibited greater adaptability in contrast to services which depended on face-to-face and hospital-based care. COVID-19 has demonstrated the need for a new approach to rapid response to crisis in mental health. New decision support system tools are necessary to ensure local decision-makers can effectively respond to the enormous practical challenges posed in these circumstances., Conclusions: The process we have undertaken has generated clear lessons for mental health policymakers worldwide, beyond pandemic planning and response to guide next steps in systemic mental health reform. Key here is achieving some balance between national leadership and local context adaptation of evidence., (© 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.)

Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.

Objectives: To investigate the cross-sectional association between measures of menstruation history (including menopausal status, age of menopause, age of menarche, and duration of reproductive stage) and brain volume., Methods: Women (aged 45 to 79 years) from the UK Biobank were included (n = 5,072) after excluding those who had (1) hysterectomy or bilateral oophorectomy, (2) ever used menopausal hormone therapy, (3) ever had a stroke, or (4) were perimenopausal. Multiple linear hierarchical regression models were computed to quantify the cross-sectional association between measures of menstruation history and brain volume. Sensitivity analysis based on propensity matching for age (and other demographic/health covariates) were applied to estimate differences in brain volumes between matched premenopausal and postmenopausal women., Results: Postmenopausal women had 1.06% (95% confidence interval [CI]; 1.05-1.06) and 2.17% (95% CI, 2.12-2.22) larger total brain volume (TBV) and hippocampal volumes (HV), respectively, than premenopausal women. Sensitivity analysis with age matched samples produced consistent results (TBV: 0.82%, 95% CI, 0.25-1.38; HV: 1.33%, 95% CI, 0.01-2.63). For every year increase in age above 45 years, postmenopausal women experienced 0.23% greater reduction in TBV than premenopausal women (95% CI, -0.60 to -0.14), which was not observed for HV. Moreover, every 1 year delayed onset of menopause after 45 was associated with 0.32% (95% CI, -0.35 to -0.28) and 0.31% (95% CI, -0.40 to -0.22) smaller TBV and HV, respectively. Every additional year in age of menarche was associated with 0.10% (95% CI, 0.04-0.16) larger TBV, which was not detected for HV. Similarly, every 1 year increase in duration of reproductive stage was associated with 0.09% smaller TBV (95% CI, -0.15 to -0.03), which was not detected for HV., Conclusions: Menopause may contribute to brain volume beyond typical aging effects. Furthermore, early age of menarche, delayed age of menopause and increasing duration of reproductive stage were negatively associated with brain volume. Further research is required to determine whether the negative association between age of menopause and HV is potentially an indicator of future vulnerability for dementia., Competing Interests: Financial disclosures/conflicts of interest: AA was supported by an Australian Government Research Training Program (AGRTP) Domestic and Fee-Offset Scholarships. The other authors have nothing to disclose., (Copyright © 2020 by The North American Menopause Society.)

Objectives: This study aimed to investigate the predictive value of cognitive/functional measures in combination with hippocampal volume (HCV) on the probability of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD)., Methods: The Rey Auditory Verbal Learning Test for immediate memory, Mini-Mental State Examination, a functional assessment for independent daily activities and Alzheimer's Disease Assessment Scale were used as cognitive/functional measures and HCV as neuroimaging measure. Logistic regression and Cox proportional hazard analyses were used to explore the measures' predictive values for AD conversion and time to conversion., Results: The probability of conversion from MCI to AD was associated with cognitive function, but this was moderated by HCV: higher at lower HCV and lower at higher HCV. General cognitive/functional measures were less predictive than immediate memory in predicting time to conversion to AD at small HCVs., Conclusion: Effectiveness of cognitive measures and subtle functional abnormality in predicting conversion from MCI to AD is dependent on HCV, thus combined evaluation should be considered. A combination of HCV and immediate memory appear to perform best in predicting time to conversion., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This study aimed to investigate cross-sectional and longitudinal associations between fat mass (i.e., body mass index [BMI], waist circumference [WC], and waist to hip ratio [WTHR]) and hippocampal volumes., Methods: UK Biobank participants (N = 20,395) aged 40 to 70 years (mean follow-up = 7.66 years), were included and categorized into one of four groups, which represented their baseline fat mass status and trajectory of change by follow-up assessment: normal weight to overweight/obesity, overweight/obesity to normal weight (ON), normal weight stable (NS), or overweight/obesity stable (OS). Regression models used NS (WC < 80 cm in women and < 94 cm in men; WTHR < 0.85 in women and < 0.90 in men; BMI < 25 kg/m 2 in women and men) as the reference group. Hippocampal volumes were automatically segmented using the FMRIB Software Library., Results: Compared with NS, OS (BMI: B = -62.23 [SE = 16.76]; WC: B = -145.56 [SE = 16.97]; WTHR: B = -101.26 [SE = 19.54]) and ON (BMI: B = -61.1 [SE = 30.3]; WC: B = -93.77 [SE = 24.96]; WTHR: B = -69.92 [SE = 26.22]) had significantly lower hippocampal volumes., Conclusions: The detrimental effects of overweight/obesity may extend beyond the duration of overweight/obesity itself., (© 2020 The Obesity Society.)

Objective: Data: Fat mass has been shown to increase in aging women; however, the extent to which menopausal status mediates these changes remains unclear. The purpose of this review was to determine (1) how fat mass differs in quantity and distribution between premenopausal and postmenopausal women, (2) whether and how age and/or menopausal status moderates any observed differences, and (3) which type of fat mass measure is best suited to the detection of differences in fat mass between groups., Study: This review with metaanalyses is reported according to Metaanalysis of Observational Studies in Epidemiology guidelines., Study Appraisal and Synthesis Methods: Studies (published up to May 2018) were identified via PubMed to provide fat mass measures in premenopausal and postmenopausal women. We included 201 cross-sectional studies in the metaanalysis, which provided a combined sample size of 1,049,919 individuals and consisted of 478,734 premenopausal women and 571,185 postmenopausal women. Eleven longitudinal studies were included in the metaanalyses, which provided a combined sample size of 2472 women who were premenopausal at baseline and postmenopausal at follow up., Results: The main findings of this review were that fat mass significantly increased between premenopausal and postmenopausal women across most measures, which included body mass index (1.14 kg/m 2 ; 95% confidence interval, 0.95-1.32 kg/m 2 ), bodyweight (1 kg; 95% confidence interval, 0.44-1.57 kg), body fat percentage (2.88%; 95% confidence interval, 2.13-3.63%), waist circumference (4.63 cm; 95% confidence interval, 3.90-5.35 cm), hip circumference (2.01 cm; 95% confidence interval, 1.36-2.65 cm), waist-hip ratio (0.04; 95% confidence interval, 0.03-0.05), visceral fat (26.90 cm 2 ; 95% confidence interval, 13.12-40.68), and trunk fat percentage (5.49%; 95% confidence interval, 3.91-7.06 cm 2 ). The exception was total leg fat percentage, which significantly decreased (-3.19%; 95% confidence interval, -5.98 to -0.41%). No interactive effects were observed between menopausal status and age across all fat mass measures., Conclusion: The change in fat mass quantity between premenopausal and postmenopausal women was attributable predominantly to increasing age; menopause had no significant additional influence. However, the decrease in total leg fat percentage and increase in measures of central fat are indicative of a possible change in fat mass distribution after menopause. These changes are likely to, at least in part, be due to hormonal shifts that occur during midlife when women have a higher androgen (ie, testosterone) to estradiol ratio after menopause, which has been linked to enhanced central adiposity deposition. Evidently, these findings suggest attention should be paid to the accumulation of central fat after menopause, whereas increases in total fat mass should be monitored consistently across the lifespan., (Copyright © 2019 Elsevier Inc. All rights reserved.)

A key question for the design of clinical trials for Alzheimer's disease (AD) is whether the timing of conversion from mild cognitive impairment (MCI) to AD can be predicted. This is also an important question for the clinical management of MCI. This study aims to address this question by exploring the contribution of baseline brain volume and annual volume change, using Cox regression, in predicting the time to conversion. Individuals with MCI, who converted to AD (n = 198), reverted to normal (n = 38), or remained stable (n = 96) for at least five years, were included in this study. The results revealed that the volumes of all the brain areas considered were predictive of the time to conversion from MCI to AD. Annual change in volume was also predictive of the time to conversion but only when initial volumes were above a certain threshold. This is important because it suggests that reduction in atrophy rate, which is the outcome of some clinical trials, is not inevitably associated with delay in conversion from MCI to AD., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The current challenge in clinical practice is to identify those with mild cognitive impairment (MCI), who are at greater risk of Alzheimer's disease (AD) conversion in the near future. The aim of this study was to assess a clinically practical new hippocampal index-hippocampal volume normalized by cerebellar volume (hippocampus to cerebellum volume ratio) used alone or in combination with scores on the Mini-Mental State Examination, as a predictor of conversion from MCI to AD. The predictive value of the HCCR was also contrasted to that of the hippocampal volume to intracranial volume ratio. The findings revealed that the performance of the combination of measures was significantly better than that of each measure used individually. The combination of Mini-Mental State Examination and hippocampal volume, normalized by the cerebellum or by intracranial volume, accurately discriminated individuals with MCI who progress to AD within 5 years from other MCI types (stable, reverters) and those with intact cognition (area under receiver operating curve of 0.88 and 0.89, respectively). Normalization by cerebellar volume was as accurate as normalization by intracranial volume with the advantage of being more practical, particularly for serial assessments., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: While acceleration in age-related cerebral atrophy has been well documented in Alzheimer's disease, the cerebellar contributions to this effect have not been thoroughly investigated., Objective: This study investigated cerebellar volume and atrophy rate using magnetic resonance imaging in individuals with normal cognition (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD)., Methods: Two hundred twenty-nine CN, 398 MCI and 191 AD participants of stage I ADNI database with screening scans were evaluated for cerebellar volume. Of those, 758 individuals with two or more follow-up scans were categorized into stable, converted, and reverted CN, MCI and AD and evaluated for cerebellar atrophy rate., Results: Cerebellar volume was 2.5% larger in CN than in those with AD but there were no differences between CN and MCI and MCI and AD in cross-sectional analysis. Similarly, the atrophy rate was 49% larger in AD and 64% larger in MCI who converted to AD but no difference was detected between CN and MCI. There were no association between education and APOEe4 and cerebellar volume or cerebellar atrophy across the diagnostic groups., Conclusion: Cerebellar atrophy contributes to Alzheimer's clinical progression but mostly at the late stage of the disease. However, even in the late stage shrinkage rate is less than the average of the shrinkage in the cerebrum and is not associated with AD moderators. This suggests that cerebellar involvement is secondary to cerebral involvement and can be due to network connection spread regardless of the primary pathology. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc. Hum Brain Mapp 38:3141-3150, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc. Hum Brain Mapp 38:3141-3150, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Introduction: Although mild cognitive impairment (MCI) diagnosis is mainly based on cognitive assessment, reliable estimates of structural changes in specific brain regions, that could be contrasted against normal brain aging and inform diagnosis, are lacking. This study aimed to systematically review the literature reporting on MCI-related brain changes., Methods: The MEDLINE database was searched for studies investigating longitudinal structural changes in MCI. Studies with compatible data were included in the meta-analyses. A qualitative review was conducted for studies excluded from meta-analyses., Results: The analyses revealed a 2.2-fold higher volume loss in the hippocampus, 1.8-fold in the whole brain, and 1.5-fold in the entorhinal cortex in MCI participants., Discussion: Although the medial temporal lobe is likely to be more vulnerable to MCI pathology, atrophy in this brain area represents a relatively small proportion of whole brain loss, suggesting that future investigations are needed to identify the source of unaccounted volume loss in MCI.

Objective: Abstinence-based therapy (ABT) and methadone maintenance therapy (MMT) are common methods of treatment in heroin dependence as both suppress subjective feeling of drug craving. However, it is not clear whether the neural basis of craving suppression is similar in both types of treatments. In this study, we compared brain activation during pictorial presentation of heroin-related cues in ABT and MMT groups to understand the neural basis of drug craving in these groups., Methods: Three groups of subjects (successful ABT and MMT clients and healthy control) underwent functional magnetic resonance imaging, while heroin-related cues and neutral cues were presented to them. In addition, subjective cue-elicited craving has been measured using drug drive questionnaire before and after imaging., Result: Self-report of craving was not different between ABT and MMT groups before and after scanning. Anterior cingulate cortex and inferior frontal gyrus showed higher activations in ABT than in healthy control. Inferior frontal gyrus and superior temporal gyrus showed higher activity in ABT than in MMT. Lingual gyrus and cerebellum showed higher activity in MMT than in healthy control., Conclusions: Heroin avoidance may be achieved by MMT or ABT; however, the neural mechanism underlying these therapeutic methods differs.