Silvan Licher

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Verified

Silvan verified their affiliation via an institutional email.

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• GP trainee | MD | PhD
• Professor (Assistant) at Erasmus MC

Background A recent systematic review recommended seven multimorbidity indices for predicting mortality. However, their performance have not been assessed. Aim To determine the performance of recommended prediction models for mortality among patients with multimorbidity in the general population. Method We selected seven multimorbidity indices ai...

Objectives: We investigated the association between adverse childhood events, personality disorders and multimorbidity in older adults. Methods: This is a cross-sectional analysis in a population of older adults including 40 people with a personality disorder and 75 healthy controls. The Childhood Traumatic Events Scale was used to assess advers...

Treatment with anti-amyloid-β monoclonal antibodies slowed cognitive decline in recent RCTs in patients with mild cognitive impairment (MCI) and early dementia due to Alzheimer’s disease (AD). However, stringent trial eligibility criteria may affect generalisability to clinical practice. We extracted eligibility criteria for trials of aducanumab, l...

INTRODUCTION Young‐onset dementia is often diagnosed late, leaving gaps in understanding its impact on employment, income, and social security. METHODS Analyzing health insurance claims and medical records, we studied 16,010 young‐onset dementia cases and 129,616 matched controls. Using a non‐parametric event study, we assessed earnings, earnings...

Objective: To determine gender differences in career progression of physicians. Design: Retrospective cohort study. Method: We examined career progression until 2023 of 715 physicians who received their PhD in the Netherlands in 2007/2008. We also pooled data from 7 national grant programs from 2005 up until Jan 1, 2023. Results: Fifteen yea...

Background Treatment with monoclonal antibodies against amyloid‐β slowed cognitive decline in recent randomized clinical trials in patients with mild cognitive impairment (MCI) and early dementia due to Alzheimer’s disease (AD). However, trial eligibility criteria may affect generalizability to clinical practice. Methods We extracted eligibility c...

Background The expected seasonal recurrence of (new variants of) COVID‐19 and the emergence of other airborne infectious diseases underscore the need for a sustainable healthcare preparedness strategy. It is particularly essential to ensure equitable access to healthcare for individuals with chronic diseases, including dementia and Parkinson’s Dise...

Objective To summarise available evidence on time to nursing home admission and death among people with dementia, and to explore prognostic indicators. Design Systematic review and meta-analysis. Data sources Medline, Embase, Web of Science, Cochrane, and Google Scholar from inception to 4 July 2024. Eligibility criteria for selecting studies Lo...

Background Urgent medical treatment is crucial after stroke and transient ischemic attack (TIA), but hindered by extensive prehospital delays. Public education campaigns based on FAST (Face-Arm-Speech-Time) have improved response after major stroke, but not minor stroke and TIA. We aimed to provide strategies to improve public education on a nation...

Background A sustainable pandemic preparedness strategy is essential to ensure equitable access to healthcare for individuals with neurodegenerative diseases. Moreover, it is vital to provide clinicians and researchers in the neurodegenerative disease fields with resources and infrastructure to ensure continuity of their work during a (health) cris...

Background Obesity may affect an individual’s immune response and subsequent risk of infection, such as a SARS-CoV-2 infection. It is less clear whether overweight and long-term obesity also constitute risk factors. We investigated the association between the degree and duration of overweight and obesity and SARS-CoV-2 infection. Methods We analyz...

Background During the COVID-19 pandemic, global trends of reduced healthcare-seeking behaviour were observed. This raises concerns about the consequences of healthcare avoidance for population health. Aim To determine the association between healthcare avoidance during the early stages of the COVID-19 pandemic and all-cause mortality. Design and...

Background Treatment with monoclonal antibodies against amyloid-β slowed cognitive decline in recent randomized clinical trials in patients with mild cognitive impairment (MCI) and early dementia due to Alzheimer’s disease (AD). However, stringent trial eligibility criteria may affect generalizability of these findings to clinical practice. Method...

Background Detailed community-based perspectives on patient experiences with telemedicine are currently lacking, yet essential to assess clinical applicability of telemedicine during and beyond pandemics, alike COVID-19. The aim of this study was to expose patient perspectives on virtual compared to in-person consultations, including determinants o...

Objective: General practitioners (GP) are often the first medical professionals to treat musculoskeletal complaints. Yet the impact of COVID-19 on primary care utilisation for musculoskeletal complaints is largely unknown. This study quantifies the impact of the pandemic on primary care utilisation for musculoskeletal complaints and specifically o...

Introduction: Dementia prevention trials have so far shown little benefit of multidomain interventions against cognitive decline. Recruitment strategies in these trials often centre around dementia risk or cardiovascular risk profile, but it is uncertain whether this leads to inclusion of individuals who may benefit most from the intervention. We...

Introduction The Horizon-2020 funded JoinUs4Health project combines concepts of Responsible Research and Innovation (RRI) and crowdsourcing to promote innovation by citizen engagement in cohort research. Three of the 11 project partners run cohort studies: University Medicine Greifswald, Germany (UMG; Study of Health in Pomerania since 1997), Erasm...

Background Multimorbidity poses a major challenge for care coordination. However, data on what non-communicable diseases lead to multimorbidity, and whether the lifetime risk differs between men and women are lacking. We determined sex-specific differences in multimorbidity patterns and estimated sex-specific lifetime risk of multimorbidity in the...

Background and objectives Although there is evidence of disruption in acute cerebrovascular and cardiovascular care during the COVID-19 pandemic, its downstream effect in primary care is less clear. We investigated how the pandemic affected utilization of cerebrovascular and cardiovascular care in general practices (GPs) and determined changes in G...

Background For informed decision making on diagnosis, prognosis and care of dementia, physicians and patients rely on the transportability and applicability of evidence from published studies into daily clinical practice. It is uncertain, however, whether routine clinical assessment of dementia is sufficiently captured in contemporary research. Me...

Background Various trials have investigated the effects of multidomain lifestyle interventions on cognitive decline, but with limited clinical benefit. This could be due to these trials targeting older individuals with elevated cardiovascular risk factors, who often already qualify for preventive intervention. We aimed to determine clinical implica...

Background During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dw...

Seasonal variation in cognitive function and underlying cerebral hemodynamics in humans has been suggested, but not consistently shown in previous studies. We assessed cognitive function in 10,276 participants from the population-based Rotterdam Study, aged 45 years and older without dementia, at baseline and at subsequent visits between 1999 and 2...

Background: Various clinical studies have provided estimates of life expectancy of patients with mild cognitive impairment (MCI) from outpatient clinics, but whether these apply to community-dwelling individuals at home or in primary care is uncertain. Methods: Within the population-based Rotterdam Study, we studied life expectancy with and with...

Introduction Responsible Research and Innovation (RRI) may offer opportunities to counteract declining response in cohort research, which has been observed worldwide for years. RRI involves engagement of multiple societal groups in research and easier access to science results and education. More targeted and wider communication of cohort findings...

Importance For informed decision making on diagnosis and treatment of dementia, physicians and their patients rely on the generalizability of evidence from published studies to clinical practice. However, it is uncertain whether everyday care of elderly patients with dementia is sufficiently captured in contemporary research. Objective To systemat...

Intracranial arteriosclerosis has been increasingly recognized as a risk factor for cognitive impairment and even dementia. A possible mechanism linking intracranial arteriosclerosis to cognitive impairment and dementia involves structural brain changes including cerebral small vessel disease (CSVD). To assess whether intracranial carotid artery ca...

Purpose: We propose a methodology for responsible crowdsourcing and explore how such methodology can be used to foster organizational learning. Approach: In the JoinUs4Health project, we created an online platform that connects consultive mechanisms that are typical in crowdsourcing with deeper co-creation processes in smaller groups to enable diff...

The Rotterdam Study is an ongoing prospective, population-based cohort study that started in 1989 in the city of Rotterdam, the Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. It focuses on cardiovascular, endocrine, hepatic,...

The Rotterdam Study is an ongoing prospective, population-based cohort study that started in 1989 in the city of Rotterdam, the Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. It focuses on cardiovascular, endocrine, hepatic,...

Background The etiology of dementia may partly be underpinned by impaired lung function via systemic inflammation and hypoxia. Objective To prospectively examine the association between chronic obstructive pulmonary disease (COPD) and subclinical impairments in lung function and the risk of dementia. Methods In the Rotterdam Study, we assessed th...

Early-life environmental factors have been suggested in the pathophysiology of dementia. Season of birth has previously been used as a proxy for these external exposures. We investigated the link between season of birth and the risk of dementia and further explored underlying pathways by studying structural brain changes on MRI. From the Dutch, pop...

Background: Previous studies identifying hearing loss as a promising modifiable risk factor for cognitive decline mostly adjusted for baseline age solely. As such a faster cognitive decline at a higher age, which is expected considering the non-linear relationship between cognition and age, may have been overlooked. Therefore it remains uncertain...

Background Brain-derived neurotropic factor (BDNF) plays a vital role in neuronal survival and plasticity and facilitates long-term potentiation, essential for memory. Alterations in BDNF signaling have been associated with cognitive impairment, dementia, and Alzheimer’s disease. Although peripheral BDNF levels are reduced in dementia patients, it...

Importance Advanced glycation end products (AGEs) and their receptor (RAGE) are implicated in the pathophysiological processes of dementia and potentially underlie the association of diabetes with neurodegeneration. However, longitudinal studies examining this association are lacking. Objective To determine whether markers of the AGE-RAGE system a...

Background Advanced glycation end products (AGEs) and their receptor (RAGE) are implicated in the pathophysiology of dementia and potentially underlie the relation between diabetes and neurodegeneration. We determined the link between two proteins involved in the AGE‐RAGE system, namely Extracellular Newly identified RAGE binding protein (EN‐RAGE)...

Background Reliable prognosis of mild cognitive impairment (MCI) in terms of life expectancy (LE) with and without dementia is important to inform patients and their relatives, as well as health policy makers, but data from unselected older populations are scarce. Method Between 2002 and 2015, all participants aged 60‐105 years of the population‐b...

Background Environmental exposures early in life are important for shaping brain development. Season of birth as a proxy for these exposures has been associated with the risk of brain diseases in adolescence and mid‐life, such as schizophrenia and depression. We investigated the link between season of birth and risk of dementia. We further explored...

The International Multimorbidity Symposium was held in November 2019 at Western University to achieve three main objectives: to discuss progress and findings from various jurisdictions; to facilitate collaboration through group discussion to identify strategies to move multimorbidity research forward; and to create concrete plans to ensure advances...

Background To establish trajectories of cognitive and motor function, and to determine the sequence of change across individual tests in community-dwelling individuals aged 45-90 years. Methods Between 1997-2016, we repeatedly assessed cognitive function with five tests in 9,514 participants aged 45-90 years from the population-based Rotterdam Stu...

Objective Observational data can be used to attempt to emulate a target trial of statin use and estimate analogues of intention-to-treat and per-protocol effects on dementia risk. Methods Using data from a prospective cohort study in the Netherlands, we conceptualized a sequence of “trials” in which eligible individuals ages 55-80 years were class...

Background To date, dementia prediction models have been exclusively developed and tested in high-income countries (HICs). However, most people with dementia live in low-income and middle-income countries (LMICs), where dementia risk prediction research is almost non-existent and the ability of current models to predict dementia is unknown. This st...

CSF biomarkers, including total-tau, neurofilament light chain (NfL) and amyloid-β, are increasingly being used to define and stage Alzheimer's disease. These biomarkers can be measured more quickly and less invasively in plasma and may provide important information for early diagnosis of Alzheimer's disease. We used stored plasma samples and clini...

There is a wide interest in biomarkers that capture the burden of detrimental factors as these accumulate with the passage of time, i.e., increasing age. Telomere length has received considerable attention as such a marker, because it is easily quantified and it may aid in disentangling the etiology of dementia or serve as predictive marker. We det...

Background Variation in blood pressure may relate to dementia risk via autonomic disturbance or hemodynamic mechanisms, but the long-term associations are unclear. We aimed to determine whether blood pressure variation over a period of years, considering both magnitude and direction, is associated with the risk of dementia. Methods and findings In...

The exact etiology of dementia is still unclear, but both genetic and lifestyle factors are thought to be key drivers of this complex disease. The recognition of familial patterns of dementia has led to the discovery of genetic factors that have a role in the pathogenesis of dementia, including the apolipoprotein E (APOE) genotype and a large and s...

Introduction: Poor gait has recently emerged as a potential prodromal feature of cognitive decline and dementia. We assessed to what extent various aspects of poor gait are independently associated with cognitive decline and incident dementia. Methods: We leveraged detailed quantitative gait (GAITRite!) and cognitive assessments in 4258 dementia-fr...

Objective: To determine the long-term association of hemoglobin levels and anemia with risk of dementia, and explore underlying substrates on brain MRI in the general population. Methods: Serum hemoglobin was measured in 12,305 participants without dementia of the population-based Rotterdam Study (mean age 64.6 years, 57.7% women). We determined...

BACKGROUND: Immunity has been suggested to be important in the pathogenesis of dementia. However, the contribution of innate versus adaptive immunity in the development of dementia is not clear. In this study, we aimed to investigate (1) the association between components of innate immunity (granulocytes and platelets) and adaptive immunity (lympho...

In cancer research, multistage models are used to assess the multistep process that leads to the onset of cancer. In view of biological and clinical similarities between cancer and dementia, we used these models to study Alzheimer's disease (AD). From the population-based Rotterdam Study, we included 9,362 non-demented participants, of whom 1,124 d...

Background Non-communicable diseases (NCDs) are leading causes of premature disability and death worldwide. However, the lifetime risk of developing any NCD is unknown, as are the effects of shared common risk factors on this risk. Methods and findings Between July 6, 1989, and January 1, 2012, we followed participants from the prospective Rotterd...

Longitudinal population-based data on effects of kidney dysfunction in the development of stroke and dementia remains inconclusive. We investigated associations of kidney function with risk of stroke and dementia in 5,993 community-dwelling individuals (mean age: 69.0 years, 57.2% women). We calculated estimated glomerular filtration rates based on...

Objective: Identification of individuals at high risk of dementia is essential for development of prevention strategies, but reliable tools are lacking for risk stratification in the population. The authors developed and validated a prediction model to calculate the 10-year absolute risk of developing dementia in an aging population. Methods: In a...

Background Time trends for dementia prevalence and incidence rates have been reported over the past seven decades in different countries and some have reported a decline. Objective To undertake a systematic review to critically appraise and provide an evidence-based summary of the magnitude and direction of the global changes in dementia prevalenc...

Objective To quantify the burden of common neurological disease in older adults in terms of lifetime risks, including their co-occurrence and preventive potential, within a competing risk framework. Methods Within the prospective population-based Rotterdam Study, we studied lifetime risk of dementia, stroke and parkinsonism between 1990 and 2016. A...

Background: The ability to engage in sexual activity and better cognitive functioning are both associated with better health. However, the association between cognitive functioning and sexual activity is understudied. Objective: To examine the association between cognitive functioning with sexual activity and physical tenderness among community-...

Hou et al. are to be commended for an in-depth systematic review of currently available dementia risk models that quantify the probability of developing dementia, covering both studies on community-dwelling individuals as well as clinic-based MCI studies. One of the key conclusions was that "the predictive ability of existing dementia risk models i...

To systematically review the literature for dementia prediction models for use in the general population and externally validate their performance in a head-to-head comparison. We selected four prediction models for validation: CAIDE, BDSI, ANU-ADRI and DRS. From the Rotterdam Study, 6667 non-demented individuals aged 55 years and older were assess...

Importance Retinal structures may serve as a biomarker for dementia, but longitudinal studies examining this link are lacking. Objective To investigate the association of inner retinal layer thickness with prevalent and incident dementia in a general population of Dutch adults. Design, Setting, and Participants From September 2007 to June 2012, p...

The most commonly encountered opening sentence in scientific publications about dementia undoubtedly relates to the overwhelming burden of disease. Finding an effective preventive or therapeutic intervention against dementia has been considered the most important unmet need in contemporary medicine. While efforts on tackling this devastating diseas...

Background: Total hippocampal volume has been consistently linked to cognitive function and dementia. Yet, given its complex and parcellated internal structure, the role of subregions of the hippocampus in cognition and risk of dementia remains relatively underexplored. We studied subregions of the hippocampus in a large population-based cohort to...

The most commonly encountered opening sentence in scientific publications about dementia undoubtedly relates to the overwhelming burden of disease. Finding an effective preventive or therapeutic intervention against dementia has been considered the most important unmet need in contemporary medicine. While efforts on tackling this devastating diseas...

Background Vitamin D has gained interest as a potentially modifiable risk factor for dementia because of its putative neuroprotective effects. However, longitudinal studies examining the association between vitamin D and dementia have provided inconsistent results. Objective To determine the relationship of serum vitamin D with prevalent and incid...

Objective: To determine if serum magnesium levels are associated with the risk of all-cause dementia and Alzheimer disease. Methods: Within the prospective population-based Rotterdam Study, we measured serum magnesium levels in 9,569 participants, free from dementia at baseline (1997-2008). Participants were subsequently followed up for incident...