The ACE-R and MMSE total scores are highly correlated. In this clinical sample of people with established AD, for an MMSE score of 24, the predicted ACE-R score was 67.9 with 95% confidence intervals of 61.6-75.4. The extra non-MMSE ACE-R items improve estimates of cognitive ability by 16%.

Climate change may affect the foraging success of bowhead whales Balaena mysticetus by altering the diversity and abundance of zooplankton species available as food. However, assessing climate-induced impacts first requires documenting feeding conditions under current environmental conditions. We collected seasonal movement and dive-behaviour data from 25 Eastern Canada-West Greenland bowheads instrumented with time-depth telemetry tags and used state-space models to examine whale movements and dive behaviours. Zooplankton samples were also collected in Cumberland Sound (CS) to determine species composition and biomass. We found that CS was used seasonally by 14 of the 25 tagged whales. Area-restricted movement was the dominant behaviour in CS, suggesting that the tagged whales allocated considerable time to feeding. Prey sampling data suggested that bowheads were exploiting energy-rich Arctic copepods such as Calanus glacialis and C. hyperboreus during summer. Dive behaviour changed seasonally in CS. Most notably, probable feeding dives were substantially shallower during spring and summer compared to fall and winter. These seasonal changes in dive depths likely reflect changes in the vertical distribution of calanoid copepods, which are known to suspend development and overwinter at depth during fall and winter when availability of their phytoplankton prey is presumed to be lower. Overall, CS appears to be an important year-round foraging habitat for bowheads, but is particularly important during the late summer and fall. Whether CS will remain a reliable feeding area for bowhead whales under climate change is not yet known.

As zooplanktivorous predators, bowhead whales (Balaena mysticetus) must routinely locate patches of prey that are energy-rich enough to meet their metabolic needs. However, little is known about how the quality and quantity of prey might influence their feeding behaviours. We addressed this question using a new approach that included: (1) multi-scale biologging and unmanned aerial system observations of bowhead whales in Cumberland Sound, Nunavut (Canada), and (2) an optical plankton counter (OPC) and net collections to identify and enumerate copepod prey species through the water column. The OPC data revealed two prey layers comprised almost exclusively of lipid-rich calanoid copepods. The deep layer contained fewer, but larger, particles (10% greater overall biomass) than the shallow prey layer. Dive data indicated that the whales conducted long deep Square-shaped dives (80% of dives; averaging depth of 260.4 m) and short shallow Square-shaped dives (16%; averaging depth of 22.5 m) to feed. The whales tended to dive proportionally more to the greater biomass of zooplankton that occurred at depth. Combining behavioural recordings with prey sampling showed a more complex feeding ecology than previously understood, and provides a means to evaluate the energetic balance of individuals under current environmental conditions.

ImportanceAmyloid positron emission tomography (PET) allows the direct assessment of amyloid deposition, one of the main hallmarks of Alzheimer disease. However, this technique is currently not widely reimbursed because of the lack of appropriately designed studies demonstrating its clinical effect.ObjectiveTo assess the clinical effect of amyloid PET in memory clinic patients.Design, Setting, and ParticipantsThe AMYPAD-DPMS is a prospective randomized clinical trial in 8 European memory clinics. Participants were allocated (using a minimization method) to 3 study groups based on the performance of amyloid PET: arm 1, early in the diagnostic workup (within 1 month); arm 2, late in the diagnostic workup (after a mean [SD] 8 [2] months); or arm 3, if and when the managing physician chose. Participants were patients with subjective cognitive decline plus (SCD+; SCD plus clinical features increasing the likelihood of preclinical Alzheimer disease), mild cognitive impairment (MCI), or dementia; they were assessed at baseline and after 3 months. Recruitment took place between April 16, 2018, and October 30, 2020. Data analysis was performed from July 2022 to January 2023.InterventionAmyloid PET.Main Outcome and MeasureThe main outcome was the difference between arm 1 and arm 2 in the proportion of participants receiving an etiological diagnosis with a very high confidence (ie, ≥90% on a 50%-100% visual numeric scale) after 3 months.ResultsA total of 844 participants were screened, and 840 were enrolled (291 in arm 1, 271 in arm 2, 278 in arm 3). Baseline and 3-month visit data were available for 272 participants in arm 1 and 260 in arm 2 (median [IQR] age: 71 [65-77] and 71 [65-77] years; 150/272 male [55%] and 135/260 male [52%]; 122/272 female [45%] and 125/260 female [48%]; median [IQR] education: 12 [10-15] and 13 [10-16] years, respectively). After 3 months, 109 of 272 participants (40%) in arm 1 had a diagnosis with very high confidence vs 30 of 260 (11%) in arm 2 (P < .001). This was consistent across cognitive stages (SCD+: 25/84 [30%] vs 5/78 [6%]; P < .001; MCI: 45/108 [42%] vs 9/102 [9%]; P < .001; dementia: 39/80 [49%] vs 16/80 [20%]; P < .001).Conclusion and RelevanceIn this study, early amyloid PET allowed memory clinic patients to receive an etiological diagnosis with very high confidence after only 3 months compared with patients who had not undergone amyloid PET. These findings support the implementation of amyloid PET early in the diagnostic workup of memory clinic patients.Trial RegistrationEudraCT Number: 2017-002527-21

Evolution occurs through natural selection whereby individuals with greater fitness contribute disproportionately more genetic information to future generations. In addition to this individual variation, populations will vary due to adaptations to different environmental selection pressures (Coulon et al., 2008;Orsini et al., 2008;Pauls et al., 2013). Population-level differences in average fitness could then vary geographically along an environmental gradient, such as altitude or latitude, based on location within the species' range (Kirkpatrick & Barton, 1997;Peterson et al., 2011). For example, sink populations at the periphery of a species' range are constantly in phenotypic flux due to the demographic challenges of living in an environment where species-specific traits are less well adapted compared to populations near the core of the species' range (Gaston,