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Skenandore DW, Zuelsdorff M, Umucu E, Clark LR, Walaszek A, Chin NA, Wyman MF, Carlsson C, Johnson SC, Asthana S, Lambrou NH, Bouges S, Benton SF, Gleason CE. P2-564: AMERICAN INDIAN RESEARCH OF COGNITION (ARC): THE IMPACT OF RACIAL DIFFERENCES ON CEREBROVASCULAR RISK FACTORS, COGNITIVE PERFORMANCE AND WHITE MATTER LESION BURDEN. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zuelsdorff M, Bendlin BB, Okonkwo OC, Sprecher KE, Clark LR, Plante DT, Wyman MF, Chin NA, Benton SF, Lambrou NH, Asthana S, Johnson SC, Gleason CE. P3-540: IMPLICATIONS OF SLEEP DISPARITIES FOR COGNITIVE TEST PERFORMANCE AMONG AFRICAN AMERICAN AND WHITE OLDER ADULTS: PRELIMINARY EVIDENCE FROM TWO WISCONSIN COHORTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Betthauser TJ, Jonaitis E, Koscik RL, Allison SL, Cody KA, Erickson CM, Converse AK, Murali D, Barnhart TE, Stone CK, Clark LR, Christian B, Johnson SC. IC-P-117: RETROSPECTIVE COGNITIVE DECLINE IS ASSOCIATED WITH NEUROFIBRILLARY TANGLES AND BETA-AMYLOID PLAQUES MEASURED BY [F-18]MK-6240 AND [C-11]PIB IN LATE-MIDDLE AGED PERSONS CLINICALLY UNIMPAIRED AT BASELINE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jonaitis E, Clark LR, Betthauser TJ, Allison SL, Mueller KD, Hermann BP, Chappell RJ, Johnson SC, Koscik RL. P2-472: CONDITIONAL STANDARDS: IDENTIFYING CUTOFFS FOR PREDICTING AD SURROGATES USING TRADITIONAL AND MACHINE LEARNING METHODS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Koscik RL, Betthauser TJ, Jonaitis E, Allison SL, Clark LR, Hermann BP, Mueller KD, Chin NA, Carlsson C, Christian B, Johnson SC. O4-04-04: PIB(+) CHRONICITY PROVIDES UNIQUE INFORMATION ABOUT COGNITIVE DECLINE AND NFT DEVELOPMENT: RESULTS FROM THE WISCONSIN REGISTRY FOR ALZHEIMER'S PREVENTION. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Van Hulle CA, Clark LR, Bendlin BB, Gleason CE, Johnson SC, Hunt JF, Norton DL, Okonkwo OC, Blazel H, Asthana S, Carlsson C. P4-247: ASSOCIATION OF CARDIOVASCULAR RISK AND SUBJECTIVE MEMORY COMPLAINTS IN HEALTHY MIDDLE AGED ADULTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Merluzzi AP, Vogt NM, Norton D, Jonaitis E, Clark LR, Carlsson CM, Johnson SC, Asthana S, Blennow K, Zetterberg H, Bendlin BB. Differential effects of neurodegeneration biomarkers on subclinical cognitive decline. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:129-138. [PMID: 31011623 PMCID: PMC6462765 DOI: 10.1016/j.trci.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Neurodegeneration appears to be the biological mechanism most proximate to cognitive decline in Alzheimer's disease. We test whether t-tau and alternative biomarkers of neurodegeneration-neurogranin and neurofilament light protein (NFL)-add value in predicting subclinical cognitive decline. METHODS One hundred fifty cognitively unimpaired participants received a lumbar puncture for cerebrospinal fluid and at least two neuropsychological examinations (mean age at first visit = 59.3 ± 6.3 years; 67% female). Linear mixed effects models were used with cognitive composite scores as outcomes. Neurodegeneration interactions terms were the primary predictors of interest: age × NFL or age × neurogranin or age × t-tau. Models were compared using likelihood ratio tests. RESULTS Age × NFL accounted for a significant amount of variation in longitudinal change on preclinical Alzheimer's cognitive composite scores, memory composite scores, and learning scores, whereas age × neurogranin and age × t-tau did not. DISCUSSION These data suggest that NFL may be more sensitive to subclinical cognitive decline compared to other proposed biomarkers for neurodegeneration.
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Bangen KJ, Weigand AJ, Thomas KR, Delano-Wood L, Clark LR, Eppig J, Werhane ML, Edmonds EC, Bondi MW. Cognitive dispersion is a sensitive marker for early neurodegenerative changes and functional decline in nondemented older adults. Neuropsychology 2019; 33:599-608. [PMID: 30896235 DOI: 10.1037/neu0000532] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Intraindividual cognitive variability (IIV), a measure of within-person variability across cognitive measures at a single time point, is associated with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Little is known regarding brain changes underlying IIV, or the relationship between IIV and functional ability. Therefore, we investigated the association between IIV and cerebral atrophy in AD-vulnerable regions and everyday functioning in nondemented older adults. METHOD 736 Alzheimer's Disease Neuroimaging Initiative (ADNI) participants (285 cognitively normal [CN]; 451 MCI) underwent neuropsychological testing and serial MRI over 2 years. Linear mixed effects models examined the association between baseline IIV and change in entorhinal cortex thickness, hippocampal volume, and everyday functioning. RESULTS Adjusting for age, sex, apolipoprotein E genotype, amyloid-β positivity, and mean level of cognitive performance, higher baseline IIV predicted faster rates of entorhinal and hippocampal atrophy, as well as functional decline. Higher IIV was associated with both entorhinal and hippocampal atrophy among MCI participants but selective vulnerability of the entorhinal cortex among CN individuals. CONCLUSIONS IIV was associated with more widespread medial temporal lobe (MTL) atrophy in individuals with MCI relative to CN, suggesting that IIV may be tracking advancing MTL pathologic changes across the continuum of aging, MCI, and dementia. Findings suggest that cognitive dispersion may be a sensitive marker of neurodegeneration and functional decline in nondemented older adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Racine AM, Merluzzi AP, Adluru N, Norton D, Koscik RL, Clark LR, Berman SE, Nicholas CR, Asthana S, Alexander AL, Blennow K, Zetterberg H, Kim WH, Singh V, Carlsson CM, Bendlin BB, Johnson SC. Association of longitudinal white matter degeneration and cerebrospinal fluid biomarkers of neurodegeneration, inflammation and Alzheimer's disease in late-middle-aged adults. Brain Imaging Behav 2019; 13:41-52. [PMID: 28600739 PMCID: PMC5723250 DOI: 10.1007/s11682-017-9732-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alzheimer's disease (AD) is characterized by substantial neurodegeneration, including both cortical atrophy and loss of underlying white matter fiber tracts. Understanding longitudinal alterations to white matter may provide new insights into trajectories of brain change in both healthy aging and AD, and fluid biomarkers may be particularly useful in this effort. To examine this, 151 late-middle-aged participants enriched with risk for AD with at least one lumbar puncture and two diffusion tensor imaging (DTI) scans were selected for analysis from two large observational and longitudinally followed cohorts. Cerebrospinal fluid (CSF) was assayed for biomarkers of AD-specific pathology (phosphorylated-tau/Aβ42 ratio), axonal degeneration (neurofilament light chain protein, NFL), dendritic degeneration (neurogranin), and inflammation (chitinase-3-like protein 1, YKL-40). Linear mixed effects models were performed to test the hypothesis that biomarkers for AD, neurodegeneration, and inflammation, or two-year change in those biomarkers, would be associated with worse white matter health overall and/or progressively worsening white matter health over time. At baseline in the cingulum, phosphorylated-tau/Aβ42 was associated with higher mean diffusivity (MD) overall (intercept) and YKL-40 was associated with increases in MD over time. Two-year change in neurogranin was associated with higher mean diffusivity and lower fractional anisotropy overall (intercepts) across white matter in the entire brain and in the cingulum. These findings suggest that biomarkers for AD, neurodegeneration, and inflammation are potentially important indicators of declining white matter health in a cognitively healthy, late-middle-aged cohort.
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Jonaitis EM, Koscik RL, Clark LR, Ma Y, Betthauser TJ, Berman SE, Allison SL, Mueller KD, Hermann BP, Van Hulle CA, Christian BT, Bendlin BB, Blennow K, Zetterberg H, Carlsson CM, Asthana S, Johnson SC. Measuring longitudinal cognition: Individual tests versus composites. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:74-84. [PMID: 31673596 PMCID: PMC6816509 DOI: 10.1016/j.dadm.2018.11.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction Longitudinal cohort studies of cognitive aging must confront several sources of within-person variability in scores. In this article, we compare several neuropsychological measures in terms of longitudinal error variance and relationships with biomarker-assessed brain amyloidosis (Aβ). Methods Analyses used data from the Wisconsin Registry for Alzheimer's Prevention. We quantified within-person longitudinal variability and age-related trajectories for several global and domain-specific composites and their constituent scores. For a subset with cerebrospinal fluid or amyloid positron emission tomography measures, we examined how Aβ modified cognitive trajectories. Results Global and theoretically derived composites exhibited lower intraindividual variability and stronger age × Aβ interactions than did empirically derived composites or raw scores from single tests. For example, the theoretical executive function outperformed other executive function scores on both metrics. Discussion These results reinforce the need for careful selection of cognitive outcomes in study design, and support the emerging consensus favoring composites over single-test measures. Identifying early cognitive change requires tests with low error variance. In a middle-aged sample, composites were less noisy than single tests. Global and theory-driven composites outperformed data-driven composites.
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Mueller KD, Koscik RL, Clark LR, Hermann BP, Johnson SC, Turkstra LS. The Latent Structure and Test-Retest Stability of Connected Language Measures in the Wisconsin Registry for Alzheimer's Prevention (WRAP). Arch Clin Neuropsychol 2018; 33:993-1005. [PMID: 29186313 PMCID: PMC6455482 DOI: 10.1093/arclin/acx116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/02/2017] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION While it is well known that discourse-related language functions are impaired in the dementia phase of Alzheimer's Disease (AD), the presymptomatic temporal course of discourse dysfunction are not known earlier in the course of AD. To conduct discourse-related studies in this phase of AD, validated psychometric instruments are needed. This study investigates the latent structure, validity, and test-retest stability of discourse measures in a late-middle-aged normative group who are relatively free from sporadic AD risk factors. METHODS Using a normative sample of 399 participants (mean age = 61), exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were conducted on 18 measures of connected language derived from picture descriptions. Factor invariance across sex and family history and longitudinal test-retest stability measures were calculated. RESULTS The EFA revealed a four-factor solution, consisting of semantic, syntax, fluency, and lexical constructs. The CFA model substantiated the structure, and factors were invariant across sex and parental history of AD status. Test-retest stability measures were within acceptable ranges. CONCLUSIONS Results confirm a factor structure that is invariant across sex and parental AD history. The factor structure could be useful in similar cohorts designed to detect early language decline in investigations of preclinical or clinical AD or as outcome measures in clinical prevention trials.
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Jonaitis E, Koscik RL, Berman SE, Allison SL, Mueller KD, Hermann BP, Clark LR, Johnson SC. P2‐506: INDIVIDUAL TESTS VERSUS COGNITIVE COMPOSITES IN WRAP: WITHIN‐PERSON VARIABILITY AND LONGITUDINAL ASSOCIATIONS WITH AMYLOID. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shouel HL, Koscik RL, Clark LR, Berman SE, Christian BT, Betthauser TJ, Oh JM, Rowley HA, Carlsson CM, Asthana S, Johnson SC. O2‐06‐04: DOES β‐AMYLOID BURDEN PREDICT COGNITIVE DECLINE STATUS IN ADULTS AT RISK FOR ALZHEIMER'S DISEASE? Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Russek NS, Berman SE, Lazar KK, Ma Y, Hoffman CA, Rivera LA, Austin B, Chappell RJ, Clark LR, Oh JM, Illingworth C, Zettenberg H, Blennow K, Dowling M, Jacobson L, Blazel H, Gleason CE, Bendlin BB, Asthana S, Rowley HA, Turski P, Johnson SC, Wieben O, Carlsson CM. P4‐305: IMPACT OF SIMVASTATIN ON CEREBRAL BLOOD FLOW, PULSATILITY INDEX, AND ALZHEIMER'S DISEASE BIOMARKERS: A CLINICAL TRIAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mueller KD, Koscik RL, Jonaitis E, Clark LR, Fields TN, Berman SE, Zuelsdorff M, Okonkwo OC, Bendlin BB, Hermann BP, Morris MC, Johnson SC. P2‐482: SELF‐REPORTED HEALTH BEHAVIORS ARE ASSOCIATED WITH LONGITUDINAL COGNITIVE PERFORMANCE: RESULTS FROM THE WISCONSIN REGISTRY FOR ALZHEIMER'S PREVENTION (WRAP). Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mora Pinzon MC, Krainer J, Pophal H, Houston S, O'Toole Smith K, Green-Harris G, Norris N, Kowalski K, Clark LR, Gleason CE, Hermann BP, Johnson SC, Mahoney J, Carlsson CM. P3‐502: MEMORY CLINIC NETWORK: CHALLENGES AND OPPORTUNITIES FOR RESEARCH. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Darst BF, Lu Q, Koscik RL, Jonaitis E, Clark LR, Hogan KJ, Johnson SC, Engelman CD. O3‐03‐05: INTEGRATIVE NETWORK ANALYSIS IDENTIFIES RELATIONSHIPS BETWEEN METABOLOMICS, GENOMICS, AND RISK FACTORS FOR AD. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Van Hulle CA, Lazar KK, Ma Y, Johnson SC, Clark LR, Zetterberg H, Blennow K, Bendlin BB, Okonkwo OC, Gleason CE, Chappell RJ, Jacobson LH, Blazel H, Cole A, Asthana S, Carlsson CM. P1‐248: LATENT PROFILES DERIVED FROM ATN RELATED CSF BIOMARKERS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Russek NS, Gepner AD, Korcarz CE, Berman SE, Lazar KK, Ma Y, Hoffman CA, Rivera LA, Austin B, Chappell RJ, Clark LR, Oh JM, Illingworth C, Jacobson L, Blazel H, Gleason CE, Bendlin BB, Asthana S, Turski P, Johnson SC, Stein JH, Wieben O, Carlsson CM. P4‐304: RELATIONSHIP BETWEEN AORTIC AUGMENTATION INDEX BY RADIAL ARTERY TONOMETRY AND CEREBRAL PULSATILITY INDEX IN INDIVIDUALS AT RISK FOR ALZHEIMER'S DISEASE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ma Y, Chappell RJ, Clark LR, Wahoske ML, Johnson SC, Carlsson CM, Chin NA, Asthana S, Gleason CE. P2‐480: LATENT FACTOR STRUCTURE AND MEASUREMENT INVARIANCE OF THE NIH TOOLBOX COGNITION BATTERY IN A SAMPLE FROM THE WISCONSIN ALZHEIMER'S DISEASE RESEARCH CENTER. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Johnson SC, Betthauser TJ, Clark LR, Cody KA, Zammit MD, DiFilippo AH, Murali D, Converse AK, Barnhart TE, Stone CK, Poetter J, Sanson L, Oh JM, Chin NA, Carlsson CM, Asthana S, Rowley HA, Christian BT. O3‐04‐06: TAU IMAGING WITH [F‐18]MK6240 ACROSS THE AD SPECTRUM: ASSOCIATIONS WITH AMYLOID AND COGNITIVE STATUS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cole A, Van Hulle CA, Chin NA, Blazel H, Clark LR, Lazar KK, Johnson SC, Bendlin BB, Okonkwo OC, Gleason CE, Edwards DF, Wahoske ML, Blazel M, Asthana S, Carlsson CM. P3‐271: LUMBAR PUNCTURE SIDE EFFECT RATES IN A RESEARCH SETTING. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clark LR, Johnson HM, Berman SE, Norton DL, Carter FP, Harris BL, Benton SF, Zuelsdorff M, Nystrom NC, Wyman MF, Bendlin BB, Carlsson CM, Wieben O, Turski P, Rowley HA, Asthana S, Johnson SC, Gleason CE. P1‐456: ASSOCIATION OF CARDIOVASCULAR RISK FACTORS WITH MICRO‐ AND MACROVASCULAR CEREBRAL FUNCTION IN WHITES AND AFRICAN AMERICANS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Darst BF, Koscik RL, Jonaitis E, Clark LR, Hogan KJ, Johnson SC, Engelman CD. THE LONGITUDINAL METABOLOMICS OF SEX, AGING, AND COGNITION. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allison SL, Jonaitis E, Koscik RL, Berman SE, Clark LR, Mueller KD, Carlsson CM, Zetterberg H, Blennow K, Rowley HA, Asthana S, Bendlin BB, Johnson SC. P3‐387: NEURODEGENERATION, AMYLOID, AND LONGITUDINAL VERBAL LEARNING AND MEMORY PERFORMANCE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Berman SE, Clark LR, Rivera-Rivera LA, Norton D, Racine AM, Rowley HA, Bendlin BB, Blennow K, Zetterberg H, Carlsson CM, Asthana S, Turski P, Wieben O, Johnson SC. Intracranial Arterial 4D Flow in Individuals with Mild Cognitive Impairment is Associated with Cognitive Performance and Amyloid Positivity. J Alzheimers Dis 2018; 60:243-252. [PMID: 28826187 DOI: 10.3233/jad-170402] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
It is becoming increasingly recognized that cerebrovascular disease is a contributing factor in the pathogenesis of Alzheimer's disease (AD). A unique 4D-Flow magnetic resonance imaging (MRI) technique, phase contrast vastly undersampled isotropic projection imaging (PC VIPR), enables examination of angiographic and quantitative metrics of blood flow in the arteries of the Circle of Willis within a single MRI acquisition. Thirty-eight participants with mild cognitive impairment (MCI) underwent a comprehensive neuroimaging protocol (including 4D-Flow imaging) and a standard neuropsychological battery. A subset of participants (n = 22) also underwent lumbar puncture and had cerebrospinal fluid (CSF) assayed for AD biomarkers. Cut-offs for biomarker positivity in CSF resulting from a receiver operating characteristic curve analysis of AD cases and controls from the larger Wisconsin Alzheimer's Disease Research Center cohort were used to classify MCI participants as biomarker positive or negative on amyloid-β (Aβ42), total-tau and total-tau/Aβ42 ratio. Internal carotid artery (ICA) and middle cerebral artery (MCA) mean flow were associated with executive functioning performance, with lower mean flow corresponding to worse performance. MCI participants who were biomarker positive for Aβ42 had lower ICA mean flow than did those who were Aβ42 negative. In sum, mean ICA and MCA arterial flow was associated with cognitive performance in participants with MCI and lower flow in the ICA was associated with amyloid positivity. This provides further evidence for vascular health as a contributing factor in the etiopathogenesis of AD, and could represent a point to intervene in the disease process.
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Clark LR, Berman SE, Norton D, Koscik RL, Jonaitis E, Blennow K, Bendlin BB, Asthana S, Johnson SC, Zetterberg H, Carlsson CM. Age-accelerated cognitive decline in asymptomatic adults with CSF β-amyloid. Neurology 2018. [PMID: 29523644 DOI: 10.1212/wnl.0000000000005291] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Compare cognitive and hippocampal volume trajectories in asymptomatic middle-aged and older adults with positive CSF markers of β-amyloid (Aβ) or tau to adults without an Alzheimer disease (AD)-associated biomarker profile. METHODS Three hundred ninety-two adults enrolled in a longitudinal cohort study (Wisconsin Registry for Alzheimer's Prevention or Wisconsin Alzheimer's Disease Research Center) completed a lumbar puncture and at least 2 biennial or annual neuropsychological evaluations. Cutoffs for Aβ42, total tau, and phosphorylated tau were developed via receiver operating characteristic curve analyses on a sample of 78 participants (38 dementia, 40 controls). These cutoffs were applied to a separate sample of 314 cognitively healthy adults (mean age at CSF collection = 61.5 years), and mixed-effects regression analyses tested linear and quadratic interactions of biomarker group × age at each visit on cognitive and hippocampal volume outcomes. RESULTS Two hundred fifteen participants (69%) were biomarker negative (preclinical AD stage 0), 46 (15%) were Aβ+ only (preclinical AD stage 1), 25 (8%) were Aβ+ and tau+ (preclinical AD stage 2), and 28 (9%) were tau+ only. Both stage 1 and stage 2 groups exhibited greater rates of linear decline on story memory and processing speed measures, and nonlinear decline on list-learning and set-shifting measures compared to stage 0. The tau+ only group did not significantly differ from stage 0 in rates of cognitive decline. CONCLUSION In an asymptomatic at-risk cohort, elevated CSF Aβ (with or without elevated tau) was associated with greater rates of cognitive decline, with the specific pattern of decline varying across cognitive measures.
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Jurick SM, Weissberger GH, Clark LR, Wierenga CE, Chang YL, Schiehser DM, Han SD, Jak AJ, Dev SI, Bondi MW. Faulty Adaptation to Repeated Face-Name Associative Pairs in Mild Cognitive Impairment is Predictive of Cognitive Decline. Arch Clin Neuropsychol 2018; 33:168-183. [PMID: 28655152 PMCID: PMC6093342 DOI: 10.1093/arclin/acx056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/24/2017] [Accepted: 06/09/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We examined BOLD (Blood-Oxygen-Level Dependent) activity reduction upon stimuli repetition of face-name pairs in older adults with amnestic (aMCI) and non-amnestic (naMCI) mild cognitive impairment diagnosed using a comprehensive actuarial method, and relationships between activity reduction and behavioral indices. METHOD Twenty-nine cognitively healthy older adults (CHs) and 20 with MCI (n = 12 aMCI; n = 8 naMCI) underwent functional MRI event-related imaging, a comprehensive neuropsychological battery, and 1-year follow-up exam. During scanning, participants were shown face-name pairs 1-3 times and administered a post-scan recognition task. RESULTS The MCI group demonstrated less activity reduction upon repetition of face-name pairs within the MTL and other regions compared to CHs. Less activity reduction was associated with poorer Time 1 neuropsychological performance for the CH group and poorer post-scan recognition performance for the MCI group. Less activity reduction was related to poorer neuropsychological performance at Time 2 in the MCI group. Within MCIs, those with aMCI demonstrated less activity reduction upon repetition of face-name pairs than those with naMCI. CONCLUSIONS Distinct patterns of brain activity were identified in the MCI group compared to CHs, and aMCI compared to naMCI. Activated regions were not restricted to traditional memory circuitry, implicating a wider network of regions involved in the encoding of associative tasks. Findings add support to the hypothesis that lack of reduced BOLD activity reflects "faulty adaptation" to repeated stimuli and that reduction in activity represents successful encoding processes. They also provide further support for use of the face-name paradigm as a marker of prodromal Alzheimer's disease, and method to distinguish between MCI subtypes.
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Bratzke LC, Koscik RL, Schenning KJ, Clark LR, Sager MA, Johnson SC, Hermann BP, Hogan KJ. Cognitive decline in the middle-aged after surgery and anaesthesia: results from the Wisconsin Registry for Alzheimer's Prevention cohort. Anaesthesia 2018; 73:549-555. [PMID: 29468634 DOI: 10.1111/anae.14216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Abstract
Surgery and anaesthesia might affect cognition in middle-aged people without existing cognitive dysfunction. We measured memory and executive function in 964 participants, mean age 54 years, and again four years later, by when 312 participants had had surgery and 652 participants had not. Surgery between tests was associated with a decline in immediate memory by one point (out of a maximum of 30), p = 0.013: memory became abnormal in 77 out of 670 participants with initially normal memory, 21 out of 114 (18%) of whom had had surgery compared with 56 out of 556 (10%) of those who had not, p = 0.02. The number of operations was associated with a reduction in immediate memory on retesting, beta coefficient (SE) 0.08 (0.03), p = 0.012. Working memory decline was also associated with longer cumulative operations, beta coefficient (SE) -0.01 (0.00), p = 0.028. A reduction in cognitive speed and flexibility was associated with worse ASA physical status, beta coefficient (SE) 0.55 (0.22) and 0.37 (0.17) for ASA 1 and 2 vs. 3, p = 0.035. However, a decline in working memory was associated with better ASA physical status, beta coefficient (SE) -0.48 (0.21) for ASA 1 vs. 3, p = 0.01.
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Racine AM, Clark LR, Berman SE, Koscik RL, Mueller KD, Norton D, Nicholas CR, Blennow K, Zetterberg H, Jedynak B, Bilgel M, Carlsson CM, Christian BT, Asthana S, Johnson SC. Associations between Performance on an Abbreviated CogState Battery, Other Measures of Cognitive Function, and Biomarkers in People at Risk for Alzheimer's Disease. J Alzheimers Dis 2018; 54:1395-1408. [PMID: 27589532 DOI: 10.3233/jad-160528] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It is not known whether computerized cognitive assessments, like the CogState battery, are sensitive to preclinical cognitive changes or pathology in people at risk for Alzheimer's disease(AD). In 469 late middle-aged participants from the Wisconsin Registry for Alzheimer's Prevention(mean age 63.8±7 years at testing; 67% female; 39% APOE4+), we examined relationships between a CogState abbreviated battery(CAB) of seven tests and demographic characteristics, traditional paper-based neuropsychological tests as well as a composite cognitive impairment index, cognitive impairment status(determined by consensus review), and biomarkers for amyloid and tau(CSF phosphorylated-tau/Aβ42 and global PET-PiB burden) and neural injury(CSF neurofilament light protein). CSF and PET-PiB were collected in n = 71 and n = 91 participants, respectively, approximately four years prior to CAB testing. For comparison, we examined three traditional tests of delayed memory in parallel. Similar to studies in older samples, the CAB was less influenced by demographic factors than traditional tests. CAB tests were generally correlated with most paper-based cognitive tests examined and mapped onto the same cognitive domains. Greater composite cognitive impairment index was associated with worse performance on all CAB tests. Cognitively impaired participants performed significantly worse compared to normal controls on all but one CAB test. Poorer One Card Learning test performance was associated with higher levels of CSF phosphorylated-tau/Aβ42. These results support the use of the CogState battery as measures of early cognitive impairment in studies of people at risk for AD.
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Mueller KD, Koscik RL, Turkstra LS, Riedeman SK, LaRue A, Clark LR, Hermann B, Sager MA, Johnson SC. Connected Language in Late Middle-Aged Adults at Risk for Alzheimer's Disease. J Alzheimers Dis 2018; 54:1539-1550. [PMID: 27636838 DOI: 10.3233/jad-160252] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Connected language is often impaired among people with Alzheimer's disease (AD), yet little is known about when language difficulties first emerge on the path to a clinical diagnosis. The objective of this study was to determine whether individuals with psychometric (preclinical) evidence of amnestic mild cognitive impairment (pMCI) showed deficits in connected language measures. Participants were 39 pMCI and 39 cognitively healthy (CH) adults drawn from the Wisconsin Registry for Alzheimer's Prevention, who were matched for age, literacy, and sex. Participants completed a connected language task in which they described the Cookie Theft picture from the Boston Diagnostic Aphasia Examination. Language samples were analyzed across three language domains: content, syntactic complexity, and speech fluency. Paired t-tests were used to compare CH and pMCI groups on all variables, and Cohen's d effect sizes were calculated for each comparison. The CH and pMCI groups differed significantly on measures of content (e.g., CH group produced more semantic units, more unique words and had larger idea density, on average, than the pMCI group). The picture description findings are consistent with previous retrospective studies showing semantic language differences in adults with autopsy-confirmed AD. Given that these comparisons are between cognitively healthy and pMCI individuals (before a clinical MCI diagnosis), these findings may represent subtle language difficulty in spontaneous speech, and may be predictive of larger language changes over time.
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Johnson SC, Koscik RL, Jonaitis EM, Clark LR, Mueller KD, Berman SE, Bendlin BB, Engelman CD, Okonkwo OC, Hogan KJ, Asthana S, Carlsson CM, Hermann BP, Sager MA. The Wisconsin Registry for Alzheimer's Prevention: A review of findings and current directions. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2017; 10:130-142. [PMID: 29322089 PMCID: PMC5755749 DOI: 10.1016/j.dadm.2017.11.007] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The Wisconsin Registry for Alzheimer's Prevention is a longitudinal observational cohort study enriched with persons with a parental history (PH) of probable Alzheimer's disease (AD) dementia. Since late 2001, Wisconsin Registry for Alzheimer's Prevention has enrolled 1561 people at a mean baseline age of 54 years. Participants return for a second visit 4 years after baseline, and subsequent visits occur every 2 years. Eighty-one percent (1270) of participants remain active in the study at a current mean age of 64 and 9 years of follow-up. Serially assessed cognition, self-reported medical and lifestyle histories (e.g., diet, physical and cognitive activity, sleep, and mood), laboratory tests, genetics, and linked studies comprising molecular imaging, structural imaging, and cerebrospinal fluid data have yielded many important findings. In this cohort, PH of probable AD is associated with 46% apolipoprotein E (APOE) ε4 positivity, more than twice the rate of 22% among persons without PH. Subclinical or worse cognitive decline relative to internal normative data has been observed in 17.6% of the cohort. Twenty-eight percent exhibit amyloid and/or tau positivity. Biomarker elevations, but not APOE or PH status, are associated with cognitive decline. Salutary health and lifestyle factors are associated with better cognition and brain structure and lower AD pathophysiologic burden. Of paramount importance is establishing the amyloid and tau AD endophenotypes to which cognitive outcomes can be linked. Such data will provide new knowledge on the early temporal course of AD pathophysiology and inform the design of secondary prevention clinical trials.
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Koscik RL, Johnson SC, Norton DL, Clark LR, Green‐Harris G, Hermann BP, Asthana S, Edwards DF, Carlsson CM, Gleason CE. [P4–286]: A COMPARISON OF METHODS TO MEASURE INTRA‐INDIVIDUAL COGNITIVE VARIABILITY IN NON‐HISPANIC WHITES AND AFRICAN AMERICANS IN THE WISCONSIN REGISTRY FOR ALZHEIMER'S PREVENTION (WRAP). Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koscik RL, Clark LR, Mueller KD, Hermann BP, Chappell RJ, Gleason CE, Johnson SC. [P2–471]: LONGITUDINAL NORMS FOR MID‐LIFE COGNITIVE PERFORMANCE: IDENTIFYING ABNORMAL WITHIN‐PERSON CHANGES IN WRAP. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Clark LR, Koscik RL, Berman SE, Carlsson CM, Norton DL, Bendlin BB, Asthana S, Johnson SC. [P1–503]: MODIFIABLE RISK FACTORS MODERATE THE RELATIONSHIP BETWEEN BETA‐AMYLOID AND LONGITUDINAL COGNITIVE TRAJECTORIES IN THE WISCONSIN REGISTRY FOR ALZHEIMER's PREVENTION STUDY. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berman SE, Clark LR, Rivera LA, Carlsson CM, Turski P, Rowley HA, Asthana S, Wieben O, Johnson SC. [P3–331]: 4D‐FLOW IN THE CEREBRAL ARTERIES PROVIDES UNIQUE INFORMATION ABOUT CEREBROVASCULAR HEALTH BEYOND ISCHEMIC LESION BURDEN AND SIGNIFICANTLY PREDICTS COGNITIVE OUTCOMES. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Carlsson CM, Johnson SC, Bendlin BB, Berman SE, Clark LR, Zetterberg H, Blennow K, Lazar KK, Okonkwo OC, Gleason CE, Asthana S. [O3–10–02]: LONGITUDINAL CSF BIOMARKER CHANGES IN MIDDLE‐AGED ADULTS AT RISK FOR AD: THE WISCONSIN REGISTRY FOR ALZHEIMER's PREVENTION (WRAP) AND WISCONSIN ADRC COHORTS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nicholas CR, Hoscheidt SM, Clark LR, Racine AM, Berman SE, Koscik RL, Maritza Dowling N, Asthana S, Christian BT, Sager MA, Johnson SC. Positive affect predicts cerebral glucose metabolism in late middle-aged adults. Soc Cogn Affect Neurosci 2017; 12:993-1000. [PMID: 28402542 PMCID: PMC5472120 DOI: 10.1093/scan/nsx027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/01/2017] [Indexed: 11/13/2022] Open
Abstract
Positive affect is associated with a number of health benefits; however, few studies have examined the relationship between positive affect and cerebral glucose metabolism, a key energy source for neuronal function and a possible index of brain health. We sought to determine if positive affect was associated with cerebral glucose metabolism in late middle-aged adults (n = 133). Participants completed the positive affect subscale of the Center for Epidemiological Studies Depression Scale at two time points over a two-year period and underwent 18F-fluorodeoxyglucose-positron emission tomography scanning. After controlling for age, sex, perceived health status, depressive symptoms, anti-depressant use, family history of Alzheimer’s disease, APOE ε4 status and interval between visits, positive affect was associated with greater cerebral glucose metabolism across para-/limbic, frontal, temporal and parietal regions. Our findings provide evidence that positive affect in late midlife is associated with greater brain health in regions involved in affective processing and also known to be susceptible to early neuropathological processes. The current findings may have implications for interventions aimed at increasing positive affect to attenuate early neuropathological changes in at-risk individuals.
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Gross AL, Hassenstab JJ, Johnson SC, Clark LR, Resnick SM, Kitner-Triolo M, Masters CL, Maruff P, Morris JC, Soldan A, Pettigrew C, Albert MS. A classification algorithm for predicting progression from normal cognition to mild cognitive impairment across five cohorts: The preclinical AD consortium. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 8:147-155. [PMID: 28653035 PMCID: PMC5476965 DOI: 10.1016/j.dadm.2017.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION We established a method for diagnostic harmonization across multiple studies of preclinical Alzheimer's disease and validated the method by examining its relationship with clinical status and cognition. METHODS Cognitive and clinical data were used from five studies (N = 1746). Consensus diagnoses established in each study used criteria to identify progressors from normal cognition to mild cognitive impairment. Correspondence was evaluated between these consensus diagnoses and three algorithmic classifications based on (1) objective cognitive impairment in 2+ tests only; (2) a Clinical Dementia Rating (CDR) of ≥0.5 only; and (3) both. Associations between baseline cognitive performance and cognitive change were each tested in relation to progression to algorithm-based classifications. RESULTS In each study, an algorithmic classification based on both cognitive testing cutoff scores and a CDR ≥0.5 provided optimal balance of sensitivity and specificity (areas under the curve: 0.85-0.95). Over an average 6.6 years of follow-up (up to 28 years), N = 186 initially cognitively normal participants aged on average 64 years at baseline progressed (incidence rate: 15.3 people/1000 person-years). Baseline cognitive scores and cognitive change were associated with future diagnostic status using this algorithmic classification. DISCUSSION Both cognitive tests and CDR ratings can be combined across multiple studies to obtain a reliable algorithmic classification with high specificity and sensitivity. This approach may be applicable to large cohort studies and to clinical trials focused on preclinical Alzheimer's disease because it provides an alternative to implementation of a time-consuming adjudication panel.
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Boots EA, Schultz SA, Clark LR, Racine AM, Darst BF, Koscik RL, Carlsson CM, Gallagher CL, Hogan KJ, Bendlin BB, Asthana S, Sager MA, Hermann BP, Christian BT, Dubal DB, Engelman CD, Johnson SC, Okonkwo OC. BDNF Val66Met predicts cognitive decline in the Wisconsin Registry for Alzheimer's Prevention. Neurology 2017; 88:2098-2106. [PMID: 28468845 DOI: 10.1212/wnl.0000000000003980] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the influence of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on longitudinal cognitive trajectories in a large, cognitively healthy cohort enriched for Alzheimer disease (AD) risk and to understand whether β-amyloid (Aβ) burden plays a moderating role in this relationship. METHODS One thousand twenty-three adults (baseline age 54.94 ± 6.41 years) enrolled in the Wisconsin Registry for Alzheimer's Prevention underwent BDNF genotyping and cognitive assessment at up to 5 time points (average follow-up 6.92 ± 3.22 years). A subset (n = 140) underwent 11C-Pittsburgh compound B (PiB) scanning. Covariate-adjusted mixed-effects regression models were used to elucidate the effect of BDNF on cognitive trajectories in 4 cognitive domains, including verbal learning and memory, speed and flexibility, working memory, and immediate memory. Secondary mixed-effects regression models were conducted to examine whether Aβ burden, indexed by composite PiB load, modified any observed BDNF-related cognitive trajectories. RESULTS Compared to BDNF Val/Val homozygotes, Met carriers showed steeper decline in verbal learning and memory (p = 0.002) and speed and flexibility (p = 0.017). In addition, Aβ burden moderated the relationship between BDNF and verbal learning and memory such that Met carriers with greater Aβ burden showed even steeper cognitive decline (p = 0.033). CONCLUSIONS In a middle-aged cohort with AD risk, carriage of the BDNF Met allele was associated with steeper decline in episodic memory and executive function. This decline was exacerbated by greater Aβ burden. These results suggest that the BDNF Val66Met polymorphism may play an important role in cognitive decline and could be considered as a target for novel AD therapeutics.
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Berman SE, Koscik RL, Clark LR, Mueller KD, Bluder L, Galvin JE, Johnson SC. Use of the Quick Dementia Rating System (QDRS) as an Initial Screening Measure in a Longitudinal Cohort at Risk for Alzheimer's Disease. J Alzheimers Dis Rep 2017; 1:9-13. [PMID: 28819654 PMCID: PMC5557032 DOI: 10.3233/adr-170004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Quick Dementia Rating System (QDRS) and Clinical Dementia Rating Scale (CDR) assess global cognitive and functional decline. We evaluated whether the shorter QDRS was a valid screen for problems identified by the CDR in individuals with minimal clinical abnormalities. Agreement between QDRS-Global and CDR-Global was assessed for 54 participants from the Wisconsin Registry for Alzheimer’s Prevention. Resource-savings achieved by adopting an “administer CDR-only-if-QDRS-Global>0” approach were estimated based on 238 subsequent participants. Agreement statistics (concordance = 88.9%) supported use of the QDRS as an initial informant report and modifying center protocol to administer CDRs only when QDRS>0 reduced CDR assessments by 79.8%.
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Sheppard DP, Iudicello JE, Morgan EE, Kamat R, Clark LR, Avci G, Bondi MW, Woods SP. Accelerated and accentuated neurocognitive aging in HIV infection. J Neurovirol 2017; 23:492-500. [PMID: 28321696 DOI: 10.1007/s13365-017-0523-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/16/2017] [Accepted: 02/24/2017] [Indexed: 12/21/2022]
Abstract
There is debate as to whether the neurocognitive changes associated with HIV infection represent an acceleration of the typical aging process or more simply reflect a greater accentuated risk for age-related declines. We aimed to determine whether accelerated neurocognitive aging is observable in a sample of older HIV-infected individuals compared to age-matched seronegatives and older old (i.e., aged ≥65) seronegative adults. Participants in a cross-sectional design included 48 HIV-seronegative (O-) and 40 HIV-positive (O+) participants between the ages of 50-65 (mean ages = 55 and 56, respectively) and 40 HIV-seronegative participants aged ≥65 (OO-; mean age = 74) who were comparable for other demographics. All participants were administered a brief neurocognitive battery of attention, episodic memory, speeded executive functions, and confrontation naming (i.e., Boston Naming Test). The O+ group performed more poorly than the O- group (i.e., accentuated aging), but not differently from the OO- on digit span and initial recall of a supraspan word list, consistent with an accelerating aging profile. However, the O+ group's performance was comparable to the O- group on all other neurocognitive tests (ps > 0.05). These data partially support a model of accelerated neurocognitive aging in HIV infection, which was observed in the domain of auditory verbal attention, but not in the areas of memory, language, or speeded executive functions. Future studies should examine whether HIV-infected adults over 65 evidence accelerated aging in downstream neurocognitive domains and subsequent everyday functioning outcomes.
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Gross AL, Johnson SC, Clark LR, Resnick SM, Moghekar A, Masters CL, Maruff P, Hassenstab J, Morris JC, Soldan A, Albert MS. P3‐205: Development and Validation of an Algorithm for Diagnosing Preclinical Alzheimer’s Disease Across Five Cohorts. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mueller KD, Koscik RL, Clark LR, Racine AM, Riedeman SK, Turkstra LS, Hermann BP, Johnson SC. P2‐301: Characteristics of Connected Language Subtypes in the Wisconsin Registry for Alzheimer's Prevention. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clark LR, Koscik RL, Berman SE, Racine AM, Mueller KD, Carlsson CM, Nicholas CR, Asthana S, Blennow K, Zetterberg H, Johnson SC. O3‐09‐01: Distinct Cognitive Trajectories in Late Middle‐Age and their Associations with Brain Structure and Alzheimer's Disease Biomarkers: Findings from the Wisconsin Registry for Alzheimer's Prevention. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Racine AM, Koscik RL, Berman SE, Nicholas CR, Clark LR, Okonkwo OC, Rowley HA, Asthana S, Bendlin BB, Blennow K, Zetterberg H, Gleason CE, Carlsson CM, Johnson SC. Biomarker clusters are differentially associated with longitudinal cognitive decline in late midlife. Brain 2016; 139:2261-74. [PMID: 27324877 DOI: 10.1093/brain/aww142] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/05/2016] [Indexed: 11/12/2022] Open
Abstract
The ability to detect preclinical Alzheimer's disease is of great importance, as this stage of the Alzheimer's continuum is believed to provide a key window for intervention and prevention. As Alzheimer's disease is characterized by multiple pathological changes, a biomarker panel reflecting co-occurring pathology will likely be most useful for early detection. Towards this end, 175 late middle-aged participants (mean age 55.9 ± 5.7 years at first cognitive assessment, 70% female) were recruited from two longitudinally followed cohorts to undergo magnetic resonance imaging and lumbar puncture. Cluster analysis was used to group individuals based on biomarkers of amyloid pathology (cerebrospinal fluid amyloid-β42/amyloid-β40 assay levels), magnetic resonance imaging-derived measures of neurodegeneration/atrophy (cerebrospinal fluid-to-brain volume ratio, and hippocampal volume), neurofibrillary tangles (cerebrospinal fluid phosphorylated tau181 assay levels), and a brain-based marker of vascular risk (total white matter hyperintensity lesion volume). Four biomarker clusters emerged consistent with preclinical features of (i) Alzheimer's disease; (ii) mixed Alzheimer's disease and vascular aetiology; (iii) suspected non-Alzheimer's disease aetiology; and (iv) healthy ageing. Cognitive decline was then analysed between clusters using longitudinal assessments of episodic memory, semantic memory, executive function, and global cognitive function with linear mixed effects modelling. Cluster 1 exhibited a higher intercept and greater rates of decline on tests of episodic memory. Cluster 2 had a lower intercept on a test of semantic memory and both Cluster 2 and Cluster 3 had steeper rates of decline on a test of global cognition. Additional analyses on Cluster 3, which had the smallest hippocampal volume, suggest that its biomarker profile is more likely due to hippocampal vulnerability and not to detectable specific volume loss exceeding the rate of normal ageing. Our results demonstrate that pathology, as indicated by biomarkers, in a preclinical timeframe is related to patterns of longitudinal cognitive decline. Such biomarker patterns may be useful for identifying at-risk populations to recruit for clinical trials.
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Clark LR, Koscik RL, Nicholas CR, Okonkwo OC, Engelman CD, Bratzke LC, Hogan KJ, Mueller KD, Bendlin BB, Carlsson CM, Asthana S, Sager MA, Hermann BP, Johnson SC. Mild Cognitive Impairment in Late Middle Age in the Wisconsin Registry for Alzheimer's Prevention Study: Prevalence and Characteristics Using Robust and Standard Neuropsychological Normative Data. Arch Clin Neuropsychol 2016; 31:675-688. [PMID: 27193363 DOI: 10.1093/arclin/acw024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Detecting cognitive decline in presymptomatic Alzheimer's disease (AD) and early mild cognitive impairment (MCI) is challenging, but important for treatments targeting AD-related neurodegeneration. The current study aimed to investigate the utility and performance of internally developed robust norms and standard norms in identifying cognitive impairment in late middle-age (baseline age range = 36-68; M = 54). METHOD Robust norms were developed for neuropsychological measures based on longitudinally confirmed cognitively normal (CN) participants (n= 476). Seven hundred and seventy-nine participants enriched for AD risk were classified as psychometric MCI (pMCI) or CN based on standard and robust norms and "single-test" versus "multi-test" criteria. RESULTS Prevalence of pMCI ranged from 3% to 49% depending on the classification scheme used. Those classified as pMCI using robust norms exhibited greater subjective cognitive complaints, diagnostic stability, and mild clinical symptoms at follow-up. CONCLUSIONS Results suggest that identifying early clinically relevant cognitive decline in late middle-age is feasible using robust norms and multi-test criteria.
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Clark LR, Racine AM, Koscik RL, Okonkwo OC, Engelman CD, Carlsson CM, Asthana S, Bendlin BB, Chappell R, Nicholas CR, Rowley HA, Oh JM, Hermann BP, Sager MA, Christian BT, Johnson SC. Beta-amyloid and cognitive decline in late middle age: Findings from the Wisconsin Registry for Alzheimer's Prevention study. Alzheimers Dement 2016; 12:805-14. [PMID: 26806386 DOI: 10.1016/j.jalz.2015.12.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/23/2015] [Accepted: 12/07/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The present study investigated the relationship between beta-amyloid (Aβ) and cognition in a late middle-aged cohort at risk for Alzheimer's disease (AD). METHODS One eighty-four participants (mean age = 60; 72% parental history of AD) completed a [C-11]Pittsburgh compound B positron emission tomography scan and serial cognitive evaluations. A global measure of Aβ burden was calculated, and composite scores assessing learning, delayed memory, and executive functioning were computed. RESULTS Higher Aβ was associated with classification of psychometric mild cognitive impairment (MCI) at follow-up (P < .01). Linear mixed effects regression results indicated higher Aβ was associated with greater rates of decline in delayed memory (P < .01) and executive functioning (P < .05). Apolipoprotein E (APOE) ε4 status moderated the relationship between Aβ and cognitive trajectories (P values <.01). DISCUSSION In individuals at risk for AD, greater Aβ in late middle age is associated with increased likelihood of MCI at follow-up and steeper rates of cognitive decline.
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Racine AM, Koscik RL, Nicholas CR, Clark LR, Okonkwo OC, Oh JM, Hillmer AT, Murali D, Barnhart TE, Betthauser TJ, Gallagher CL, Rowley HA, Dowling NM, Asthana S, Bendlin BB, Blennow K, Zetterberg H, Carlsson CM, Christian BT, Johnson SC. Cerebrospinal fluid ratios with Aβ42 predict preclinical brain β-amyloid accumulation. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2015; 2:27-38. [PMID: 26955655 PMCID: PMC4778249 DOI: 10.1016/j.dadm.2015.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Biomarkers are urgently needed for the critical yet understudied preclinical stage of Alzheimer's disease (AD). Methods Cerebrospinal fluid (CSF) collection, [C-11]Pittsburgh compound B (PiB) amyloid imaging, and magnetic resonance imaging were acquired in 104 cognitively healthy adults enriched with risk for sporadic AD. Image-derived cerebral β-amyloid (Aβ) burden, measured concurrently and longitudinally, was regressed on CSF measures of Aβ, neural injury, and inflammation, as well as ratios with Aβ42. Linear mixed-effects regression was used to model the effect of the CSF measures that predicted longitudinal brain amyloid accumulation on longitudinal cognitive decline, measured by memory test scores. Results At baseline, Aβ42/Aβ40 and all CSF ratios to Aβ42 were associated with PiB binding in AD-vulnerable regions. Longitudinally, Aβ42/Aβ40 and ratios of total tau (t-tau), phosphorylated-tau (p-tau), neurofilament light protein, and monocyte chemoattractant protein-1 to Aβ42 were associated with increased Aβ deposition over 2 years, predominantly in lateral parietal and temporal cortex. However, these CSF ratios were not significantly associated with cognitive decline, and the effect seems to be largely driven by Aβ42 in the denominator. Discussion These results corroborate previous findings that t-tau/Aβ42 and p-tau/Aβ42 are the strongest candidate biomarkers during the preclinical time frame. They support a framework in which neural injury and amyloid deposition are likely occurring simultaneously. It may be that neurodegenerative processes influence progressive amyloid accumulation, even in the preclinical time frame. CSF biomarkers for nonspecific axonal injury and inflammation may provide more information at more advanced stages of the preclinical time course.
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Berman SE, Rivera-Rivera LA, Clark LR, Racine AM, Keevil JG, Bratzke LC, Carlsson CM, Bendlin BB, Rowley HA, Blennow K, Zetterberg H, Asthana S, Turski P, Johnson SC, Wieben O. Intracranial Arterial 4D-Flow is Associated with Metrics of Brain Health and Alzheimer's Disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2015; 1:420-428. [PMID: 26693176 PMCID: PMC4674833 DOI: 10.1016/j.dadm.2015.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Although cerebrovascular disease has long been known to co-occur with Alzheimer's disease (AD), recent studies suggest an etiologic contribution to AD pathogenesis. We used four dimensional (4D)-flow magnetic resonance imaging (MRI) to evaluate blood flow and pulsatility indices in the circle of Willis. We hypothesized decreased mean blood flow and increased pulsatility, metrics indicative of poor vascular health, would be associated with cerebral atrophy and an AD cerebrospinal fluid (CSF) profile. Methods A total of 312 patients along the AD continuum (172 middle aged, 60 cognitively healthy older, 44 mild cognitive impairment, and 36 AD) underwent MRI, CSF, and medical examinations. Regression was used to predict CSF biomarkers and atrophy from 4D-flow and analysis of covariance to compare vascular health between groups. Results Decreased mean flow in the middle cerebral artery (MCA) and superior portion of the internal carotid artery (sICA) and increased pulsatility in the MCA were associated with greater brain atrophy. Decreased mean flow in the sICA was associated with lower amyloid beta 1–42 (Aβ42) in the CSF, a pathologic biomarker profile associated with AD. Interestingly, although metrics of flow and pulsatility differed markedly across the AD spectrum, there were no significant differences in cardiovascular risk score, mean arterial pressure, and pulse pressure across the three age-matched older cohorts. Discussion By measuring intracranial arterial health directly with 4D-flow MRI, these data suggest that intracranial arterial health is compromised in symptomatic AD. Even after accounting for disease stage, cerebral artery health is associated with atrophy and an AD Aβ42 profile, suggesting neurovascular health may contribute to the etiopathogenesis of AD.
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