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Mar 2017 DOI 10.14302/issn.2474-7785.jarh-16-1348
Srisuwan PatsriCorresponding author
Outpatient and Family Medicine Department, Phramongkutklao Hospital, Bangkok, Thailand;
Background and Objective: Cognitive stimulation training was effective in reducing risk of cognitive decline and dementia in patients with mild cognitive impairment. The present study aimed to explore factors that contribute to regular participation and practice cognitive stimulation training for elderly patients with mild cognitive impairment. Materials and Methods: Data were collected through individual face-to-face interviews with 25 elderly subjects with mild cognitive impairment, and analyzed using interpretive description method. Results: Five core themes emerged from the analysis of data: (i) program with four subthemes of “interesting session, ” “effective teaching materials,” “suitable duration and frequency” and “small group activities;” (ii) group facilitators with three subthemes of “good explanation,” “always facilitate” and “friendly personality;” (iii) homework assignments with two subthemes of “suitable content” and “can adapt in daily living;” (iv) family members with two subthemes of “supporting” and “sharing;” (v) before and after class notification. Conclusion: Increasing awareness of holistic factors including in clinic and at home should be emphasized in planning cognitive stimulation training. Having an effective program and facilitators and collaboration from family member were the keys of successful training.
Mar 2016 DOI 10.14302/issn.2476-1710.jdt-15-719
Dhikav VikasCorresponding author
Postgraduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, INDIA
This clinical study explores associations among basal serum cortisol, depressive symptoms, and medial temporal lobe atrophy in patients with MCI and Alzheimer's disease. It discusses stress‑axis dysregulation as a potential contributor to neurodegeneration and outlines implications for assessment and intervention.
Aug 2026
Dale E. BredesenCorresponding author
Background/Objectives The etiology and pathophysiology of neurodegenerative diseases are incompletely understood, and the treatments largely ineffective. A unifying theory that explains otherwise poorly understood observations may help to enhance therapeutic outcomes. Methods Here is proposed a unifying theory of neurodegenerative disease, the Pr2 theory, describing the origin, pathophysiology, optimal evaluation and treatment of patients, explanation of observations not explained by previous theories, and implications for further research and translation. The theory proposes that neurodegenerative diseases represent network insufficiencies, networks jeopardized by antagonistic pleiotropy. Through repeated evolutionary selection for performance over durability, highly functional and finely tuned neural subnetworks subserving key survival features such as lethal force and behavioral modification have evolved at the expense of durability and reserve. The Pr2 theory focuses on the physiology associated with the causes of neurodegeneration rather than the pathology that is largely reactive but has been the focus of the lion’s share of the research and attempted treatment of neurodegenerative diseases. Results Initial translation of the Pr2 theory to a precision medicine approach to cognitive decline has led to superior outcomes compared to other therapeutic approaches, and at least in some cases, sustained improvement for over a decade has been achieved. Conclusions The proposed theory explains key features of neurodegenerative disease pathophysiology and suggests novel therapeutic targets. Initial predictions have been validated in two proof-of-concept trials and one randomized controlled trial for patients with mild cognitive impairment or early-stage dementia.