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    • When a clinician diagnoses a person with AD the

    2023-02-20

    When a clinician diagnoses a person with AD, the person is transformed into a patient with the disease. The person is a member of a patient group associated with behaviors, abilities, and experiences related both formally and informally to the diagnosis [10]. The diagnostic label implies what signs and symptoms the person may have and may be expected to develop [2]. It is also linked to predictions about the patient's future, such as prognosis and life expectancy. Stereotypes about AD center on it being a chronic and debilitating neurodegenerative disease. The diagnosis is strongly associated with the loss of capacity, suffering, disability, economic losses, and other undesirable features [8]. These associations inform widely held ideas about the characteristics of a person who has AD. These ideas lead to stereotypes that focus on the later stages of disease when a person is most impaired and fully dependent for care [12], [13], [14], [15]. These ideas lead people to act in ways that undermine a person's competency, identity, sense of normality, self-control, and social capital. This may include pressuring an individual to retire prematurely or habitually interrupting to finish the individual's sentences. This can have deleterious effects on how persons living with dementia and caregivers feel about themselves and what they choose to do or not do [6].
    The effects of advances in neuroimaging A recent conceptual framework outlines how results from neuroimaging and other biomarker-based tests might be used to diagnose AD and how negative AD biomarker results may be used to rule out the disease as the cause of cognitive decline [87]. Biomarker tests will change what it means to live with the knowledge of “having” this disease, particularly the experience of calculating molarity of a solution in those identified in preclinical stages of disease. They will also have important consequences for symptomatic individuals who learn a negative result. We focus only on the former group in the following discussion.
    Considerations for practice
    Public policy
    Conclusion Neuroimaging and other advances that allow an early diagnosis of AD are creating opportunities to reduce stigma through research, clinical practice, and public policy. They offer hope but also raise concern for how individuals may be affected by this knowledge. The effects on the psychological and social functioning of those who receive an early diagnosis, to date, remain largely unknown and unstudied.
    Acknowledgments
    Introduction Outputs of many physiological systems display intrinsic self-similarity, or fractal patterns, across a wide range of temporal scales from seconds up to 24 hours, suggesting an underlying fractal regulatory mechanism [1], [2]. Fractal regulation (FR) challenges the traditional theory of homeostasis as it indicates that the physiological systems do not simply settle down to a stable state [1], [3], [4], [5]. Numerous studies have provided an overwhelming evidence that FR is a hallmark of healthy physiology, imparting considerable physiological advantage in terms of plasticity and adaptability (i.e., system integrity despite vastly changing conditions) [1], [3], [4], [5]. For instance, FR in cardiac function is degraded with aging and under varied pathological conditions [6]; and such degradation is associated with decreased survival in patients with stroke or myocardial infarction [7], [8], [9]. Our previous cross sectional study revealed that FR in motor activity is degraded with aging and in Alzheimer's disease (AD) [10], and in a short longitudinal study, we found that the degradation of FR in motor activity over time is associated with cognitive decline in very old adults with dementia [11]. The goal of the present study is to determine whether FR perturbation at baseline in older individuals without dementia is associated with increased risk of the development of AD dementia and mild cognitive impairment (MCI) and rate of cognitive decline. To achieve this goal, we analyzed the data of 1097 older adults participating in the Memory and Aging Project (MAP) at Rush AD Center [12]. Subjects have been followed up for up to 11 years at the time of analysis. FR at baseline was evaluated using wrist actigraphy continuously monitored for up to 10 days. To evaluate the cognitive function and to identify AD dementia and MCI development, a battery of 21 neuropsychological tests and a detailed clinical evaluation were administered each year during the baseline and follow-up assessments. We hypothesized that subjects with more degraded FR at baseline were at increased risk for incident AD dementia and MCI and had a faster cognitive decline.