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Lee H, Kim E. Repositioning medication for cardiovascular and cerebrovascular disease to delay the onset and prevent progression of Alzheimer's disease. Arch Pharm Res 2020; 43:932-960. [PMID: 32909178 DOI: 10.1007/s12272-020-01268-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/31/2020] [Indexed: 02/08/2023]
Abstract
Alzheimer's disease (AD) is a complex, progressive, neurodegenerative disorder. As with other common chronic diseases, multiple risk factors contribute to the onset and progression of AD. Many researchers have evaluated the epidemiologic and pathophysiological association between AD, cardiovascular diseases (CVDs), and cerebrovascular diseases (CBVDs), including commonly reported risk factors such as diabetes, hypertension, and dyslipidemia. Relevant therapies of CVDs/CBVDs for the attenuation of AD have also been empirically investigated. Considering the challenges of new drug development, in terms of cost and time, multifactorial approaches such as therapeutic repositioning of CVD/CBVD medication should be explored to delay the onset and progression of AD. Thus, in this review, we discuss our current understanding of the association between cardiovascular risk factors and AD, as revealed by clinical and non-clinical studies, as well as the therapeutic implications of CVD/CBVD medication that may attenuate AD. Furthermore, we discuss future directions by evaluating ongoing trials in the field.
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Affiliation(s)
- Heeyoung Lee
- Department of Clinical Medicinal Sciences, Konyang University, 121 Daehakro, Nonsan, 32992, Republic of Korea
| | - EunYoung Kim
- Evidence-Based Research Laboratory, Division of Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, 156-756, Republic of Korea.
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Bengel FM, Hermanns N, Thackeray JT. Radionuclide Imaging of the Molecular Mechanisms Linking Heart and Brain in Ischemic Syndromes. Circ Cardiovasc Imaging 2020; 13:e011303. [DOI: 10.1161/circimaging.120.011303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
For the heart and the brain, clinical observations suggest that an acute ischemic event experienced by one organ is associated with an increased risk for future acute events and chronic dysfunction of the reciprocal organ. Beyond atherosclerosis as a common systemic disease, various molecular mechanisms are thought to be involved in this interaction. Molecular-targeted nuclear imaging may identify the contribution of factors, such as the neurohumoral, circulatory, or especially the immune system, by combining specific radiotracers with whole-body acquisition and global as well as regional multiorgan analysis. This may be integrated with complementary functional imaging markers and systemic biomarkers for comprehensive network interrogation. Such systems-based strategies go beyond the traditional organ-centered approach and provide novel mechanistic insights, information about temporal dynamics, and a foundation for future interventions aiming at optimal preservation of function of both organs.
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Affiliation(s)
- Frank M. Bengel
- Department of Nuclear Medicine, Hannover Medical School, Germany
| | - Nele Hermanns
- Department of Nuclear Medicine, Hannover Medical School, Germany
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Abstract
PURPOSE OF REVIEW This review summarizes the evidence for the established vascular/hypoperfusion model and explores the new hypothesis that configures the heart/brain axis as an organ system where similar pathogenic mechanisms exploit physiological and pathological changes. RECENT FINDINGS Although associated by common risk factors, similar epidemiological stratification and common triggers (including inflammation, oxidative stress, and hypoxia), heart failure and Alzheimer's disease have been, for long time, viewed as pathogenically separate illnesses. The silos began to be broken down with the awareness that vascular dysfunction, and loss of cardiac perfusion pump power, trigger biochemical changes, contributing to the typical hallmark of Alzheimer's disease (AD)-the accumulation of Aβ plaques and hyperphosphorylated Tau tangles. Compromised blood flow to the brain becomes the paradigm for the "heart-to-head" connection. Compelling evidence of common genetic variants, biochemical characteristics, and the accumulation of Aβ outside the brain suggests a common pathogenesis for heart failure (HF) and AD. These new findings represent just the beginning of the understanding the complex connection between AD and HF requiring further studies and interdisciplinary approaches. Altogether, the current evidence briefly summarized in this review, highlight a closer and complex relationship between heart failure and Alzheimer's that goes beyond the vascular/perfusion hypothesis. Genetic and biochemical evidence begin to suggest common pathogenic mechanisms between the two diseases involving a systemic defect in the folding of protein or a seeding at distance of the misfolded proteins from one organ to the other.
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Dynamic Effects of Aortic Arch Stiffening on Pulsatile Energy Transmission to Cerebral Vasculature as A Determinant of Brain-Heart Coupling. Sci Rep 2020; 10:8784. [PMID: 32472027 PMCID: PMC7260194 DOI: 10.1038/s41598-020-65616-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
Aortic stiffness increases with age and is a robust predictor of brain pathology including Alzheimer’s and other dementias. Aging causes disproportionate stiffening of the aorta compared with the carotid arteries, reducing protective impedance mismatches at their interface and affecting transmission of destructive pulsatile energy to the cerebral circulation. Recent clinical studies have measured regional stiffness within the aortic arch using pulse wave velocity (PWV) and have found a stronger association with cerebrovascular events than global stiffness measures. However, effects of aortic arch PWV on the transmission of harmful excessive pulsatile energy to the brain is not well-understood. In this study, we use an energy-based analysis of hemodynamic waves to quantify the effect of aortic arch stiffening on transmitted pulsatility to cerebral vasculature, employing a computational approach using a one-dimensional model of the human vascular network. Results show there exists an optimum wave condition—occurring near normal human heart rates—that minimizes pulsatile energy transmission to the brain. This indicates the important role of aortic arch biomechanics on heart-brain coupling. Our results also suggest that energy-based indices of pulsatility combining pressure and flow data are more sensitive to increased stiffness than using flow or pressure pulsatility indices in isolation.
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Suryadevara V, Klüppel M, Monte FD, Willis MS. The Unraveling: Cardiac and Musculoskeletal Defects and Their Role in Common Alzheimer Disease Morbidity and Mortality. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1609-1621. [PMID: 32407731 DOI: 10.1016/j.ajpath.2020.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/02/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022]
Abstract
Alzheimer disease (AD) is characterized by deterioration of cognitive capabilities with an estimated 44 million individuals worldwide living with it. Beyond memory deficits, the most common AD co-morbidities include swallowing defects (muscle), fractures (bone, muscle), and heart failure. The underlying causes of these co-morbidities and their role in AD pathophysiology are currently unknown. This review is the first to summarize the emerging picture of the cardiac and musculoskeletal deficits in human AD. We present the involvement of the heart, characterized by diastolic heart failure, the presence of amyloid deposits, and electrophysiological changes, compared with age-matched control subjects. The characteristic musculoskeletal defects in AD come from recent clinical studies and include potential underlying mechanisms (bone) in animal models. These studies detail a primary muscle weakness (without a loss of muscle mass) in patients with mild cognitive impairment, with progression of cognitive impairment to AD associating with ongoing muscle weakness and the onset of muscle atrophy. We conclude by reviewing the loss of bone density in patients with AD, paralleling the increase in fracture and fall risk in specific populations. These studies paint AD as a systemic disease in broad strokes, which may help elucidate AD pathophysiology and to allow for new ways of thinking about therapeutic interventions, diagnostic biomarkers, and the pathogenesis of this multidisciplinary disease.
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Affiliation(s)
- Vidyani Suryadevara
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael Klüppel
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Federica Del Monte
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Monte S Willis
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana; Section of Cardiology, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Yang M, Li C, Zhang Y, Ren J. Interrelationship between Alzheimer's disease and cardiac dysfunction: the brain-heart continuum? Acta Biochim Biophys Sin (Shanghai) 2020; 52:1-8. [PMID: 31897470 DOI: 10.1093/abbs/gmz115] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023] Open
Abstract
Dementia, a devastating neurological disorder commonly found in the elderly, is characterized by severe cognitive and memory impairment. Ample clinical and epidemiological evidence has depicted a close association between dementia and heart failure. While cerebral blood under perfusion and neurohormonal activation due to the dampened cardiac pump function contribute to the loss of nutrient supply and neuronal injury, Alzheimer's disease (AD), the most common type of dementia, also provokes cardiovascular function impairment, in particular impairment of diastolic function. Aggregation of amyloid-β proteins and mutations of Presenilin (PSEN) genes are believed to participate in the pathological changes in the heart although it is still debatable with regards to the pathological cue of cardiac anomalies in AD process. In consequence, reduced cerebral blood flow triggered by cardiac dysfunction further deteriorates vascular dementia and AD pathology. Patients with atrial fibrillation, heart failure, and other cardiac anomalies are at a higher risk for cognitive decline and dementia. Conclusion: Due to the increased incidence of dementia and cardiovascular diseases, the coexistence of the two will cause more threat to public health, warranting much more attention. Here, we will update recent reports on dementia, AD, and cardiovascular diseases and discuss the causal relationship between dementia and heart dysfunction.
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Affiliation(s)
- Mingjie Yang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 210032, China
| | - Congye Li
- Department of Cardiology, Xijing Hospital, the Air Force Military Medical University, Xi’an 710032, China
| | - Yingmei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 210032, China
| | - Jun Ren
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 210032, China
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Abstract
BACKGROUND There are differences among the outcomes regarding cognitive impairment in heart failure (HF) because the evidence is fragmented and sample size is small. Therefore we aimed to systematically review and analyze the available evidence about the association between HF and dementia. METHODS In the present study, we searched for articles published until August 2019 in the following databases: PubMed, Web of Science, EMBASE, Medline and Google Scholar. The pooled multivariate odds ratio (OR) or relative risk (RR) and 95% confidence intervals (CI) were obtained by the use of STATA 12.0 software. RESULTS The meta-analysis showed a positive association between HF and risk of all-cause dementia (OR/RR = 1.28, 95% CI 1.15 to 1.43, I = 70.0%, P < 0.001). Additionally, the study showed no significant association between HF and risk of Alzheimer's disease (AD) (OR/RR = 1.38, 95% CI 0.90 to 2.13, I = 74.8%, P = 0.008). CONCLUSION In conclusion, HF was associated with an increased risk of developing dementia. In addition, large scale prospective studies are essential to explore the associations between HF and risk of AD.
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Waragai M, Ho G, Takamatsu Y, Wada R, Sugama S, Takenouchi T, Masliah E, Hashimoto M. Adiponectin Paradox in Alzheimer's Disease; Relevance to Amyloidogenic Evolvability? Front Endocrinol (Lausanne) 2020; 11:108. [PMID: 32194507 PMCID: PMC7065259 DOI: 10.3389/fendo.2020.00108] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
Adiponectin (APN) is a multi-functional adipokine which sensitizes the insulin signals, stimulates mitochondria biogenesis, and suppresses inflammation. By virtue of these beneficial properties, APN may protect against metabolic syndrome, including obesity and type II diabetes mellitus. Since these diseases are associated with hypoadiponectinemia, it is suggested that loss of function of APN might be involved. In contrast, despite beneficial properties for cardiovascular cells, APN is detrimental in circulatory diseases, including chronic heart failure (CHF) and chronic kidney disease (CKD). Notably, such an APN paradox might also be applicable to neurodegeneration. Although APN is neuroprotective in various experimental systems, APN was shown to be associated with the severity of amyloid accumulation and cognitive decline in a recent prospective cohort study in elderly. Furthermore, Alzheimer's disease (AD) was associated with hyperadiponectinemia in many studies. Moreover, APN was sequestered by phospho-tau into the neurofibrillary tangle in the postmortem AD brains. These results collectively indicate that APN might increase the risk of AD. In this context, the objective of the present study is to elucidate the mechanism of the APN paradox in AD. Hypothetically, APN might be involved in the stimulation of the amyloidogenic evolvability in reproductive stage, which may later manifest as AD by the antagonistic pleiotropy mechanism during aging. Given the accumulating evidence that AD and CHF are mechanistically overlapped, it is further proposed that the APN paradox of AD might be converged with those of other diseases, such as CHF and CKD.
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Affiliation(s)
- Masaaki Waragai
- Laboratory for Parkinson's Disease, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Gilbert Ho
- Department of Neurodegenerative Diseases, PCND Neuroscience Research Institute, Poway, CA, United States
| | - Yoshiki Takamatsu
- Laboratory for Parkinson's Disease, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ryoko Wada
- Laboratory for Parkinson's Disease, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shuei Sugama
- Department of Physiology, Nippon Medical School, Tokyo, Japan
| | - Takato Takenouchi
- Institute of Agrobiological Sciences, National Agriculture and Food Research Organization, Tsukuba, Japan
| | - Eliezer Masliah
- Division of Neurosciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Makoto Hashimoto
- Laboratory for Parkinson's Disease, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- *Correspondence: Makoto Hashimoto
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Mene-Afejuku TO, Pernia M, Ibebuogu UN, Chaudhari S, Mushiyev S, Visco F, Pekler G. Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations. Curr Cardiol Rev 2019; 15:291-303. [PMID: 31456512 PMCID: PMC8142355 DOI: 10.2174/1573403x15666190313112841] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.
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Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Monica Pernia
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee TN, United States
| | - Shobhana Chaudhari
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Savi Mushiyev
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Ferdinand Visco
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Gerald Pekler
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
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Nagata T, Ohara T, Hata J, Sakata S, Furuta Y, Yoshida D, Honda T, Hirakawa Y, Ide T, Kanba S, Kitazono T, Tsutsui H, Ninomiya T. NT-proBNP and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study. J Am Heart Assoc 2019; 8:e011652. [PMID: 31446828 PMCID: PMC6755853 DOI: 10.1161/jaha.118.011652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Abstract
Background Epidemiological evidence implies a link between heart disease and dementia. However, few prospective studies have assessed the association between serum NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels and dementia. Methods and Results A total of 1635 community-dwelling Japanese elderly aged ≥60 years without dementia (57% women, mean age±SD 70.8±7.7 years) were followed up for 10 years. Serum NT-proBNP levels were divided into 4 categories (≤54, 55-124, 125-299, and ≥300 pg/mL). The hazard ratios were estimated using a Cox proportional hazards model. During the follow-up period, 377 subjects developed all-cause dementia, 247 Alzheimer disease, and 102 vascular dementia. The age- and sex-adjusted incidence of all-cause dementia was 31.5 per 1000 person-years and increased significantly with higher serum NT-proBNP levels, being 16.4, 32.0, 35.7, and 45.5, respectively (P for trend <0.01). Subjects with serum NT-proBNP levels of ≥300 pg/mL had a significantly higher risk of all-cause dementia (hazard ratio=2.46, 95% CI 1.63-3.71) than those with serum NT-proBNP levels of ≤54 pg/mL after adjusting for confounders. Similar risks were observed for Alzheimer disease and vascular dementia. Incorporation of the serum NT-proBNP level into a model with known risk factors for dementia significantly improved the predictive ability for incident dementia (c-statistics 0.780-0.787, P=0.02; net reclassification improvement 0.189, P=0.001; integrated discrimination improvement 0.011, P=0.003). Conclusions Higher serum NT-proBNP levels were significantly associated with an increased risk of dementia. Serum NT-proBNP could be a novel biomarker for predicting future risk of dementia in the general elderly population.
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Affiliation(s)
- Takuya Nagata
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Tomoyuki Ohara
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of NeuropsychiatryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Jun Hata
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Satoko Sakata
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yoshihiko Furuta
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Daigo Yoshida
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Takanori Honda
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Tomomi Ide
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shigenobu Kanba
- Department of NeuropsychiatryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Takanari Kitazono
- Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Wang J, Gu BJ, Masters CL, Wang YJ. A systemic view of Alzheimer disease - insights from amyloid-β metabolism beyond the brain. Nat Rev Neurol 2019; 13:612-623. [PMID: 28960209 DOI: 10.1038/nrneurol.2017.111] [Citation(s) in RCA: 473] [Impact Index Per Article: 94.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer disease (AD) is the most common type of dementia, and is currently incurable; existing treatments for AD produce only a modest amelioration of symptoms. Research into this disease has conventionally focused on the CNS. However, several peripheral and systemic abnormalities are now understood to be linked to AD, and our understanding of how these alterations contribute to AD is becoming more clearly defined. This Review focuses on amyloid-β (Aβ), a major hallmark of AD. We review emerging findings of associations between systemic abnormalities and Aβ metabolism, and describe how these associations might interact with or reflect on the central pathways of Aβ production and clearance. On the basis of these findings, we propose that these abnormal systemic changes might not only develop secondary to brain dysfunction but might also affect AD progression, suggesting that the interactions between the brain and the periphery have a crucial role in the development and progression of AD. Such a systemic view of the molecular pathogenesis of AD could provide a novel perspective for understanding this disease and present new opportunities for its early diagnosis and treatment.
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Affiliation(s)
- Jun Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, 10 Changjiang branch road, Daping, Chongqing, 400042, China
| | - Ben J Gu
- The Florey Institute, The University of Melbourne, 30 Royal Parade, Parkville, Victoria 3052, Australia
| | - Colin L Masters
- The Florey Institute, The University of Melbourne, 30 Royal Parade, Parkville, Victoria 3052, Australia
| | - Yan-Jiang Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, 10 Changjiang branch road, Daping, Chongqing, 400042, China
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Myocardial Inflammation Predicts Remodeling and Neuroinflammation After Myocardial Infarction. J Am Coll Cardiol 2019; 71:263-275. [PMID: 29348018 DOI: 10.1016/j.jacc.2017.11.024] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The local inflammatory tissue response after acute myocardial infarction (MI) determines subsequent healing. Systemic interaction may induce neuroinflammation as a precursor to neurodegeneration. OBJECTIVES This study sought to assess the influence of MI on cardiac and brain inflammation using noninvasive positron emission tomography (PET) of the heart-brain axis. METHODS After coronary artery ligation or sham surgery, mice (n = 49) underwent serial whole-body PET imaging of the mitochondrial translocator protein (TSPO) as a marker of activated macrophages and microglia. Patients after acute MI (n = 3) were also compared to healthy controls (n = 9). RESULTS Infarct mice exhibited elevated myocardial TSPO signal at 1 week versus sham (percent injected dose per gram: 8.0 ± 1.6 vs. 4.8 ± 0.9; p < 0.001), localized to activated CD68+ inflammatory cells in the infarct. Early TSPO signal predicted subsequent left ventricular remodeling at 8 weeks (rpartial = -0.687; p = 0.001). In parallel, brain TSPO signal was elevated at 1 week (1.7 ± 0.2 vs. 1.4 ± 0.2 for sham; p = 0.017), localized to activated microglia. After interval decline at 4 weeks, progressive heart failure precipitated a second wave of neuroinflammation (1.8 ± 0.2; p = 0.005). TSPO was concurrently up-regulated in remote cardiomyocytes at 8 weeks (8.8 ± 1.7, p < 0.001) without inflammatory cell infiltration, suggesting mitochondrial impairment. Angiotensin-converting enzyme inhibitor treatment lowered acute inflammation in the heart (p = 0.003) and brain (p = 0.06) and improved late cardiac function (p = 0.05). Patients also demonstrated elevation of cardiac TSPO signal in the infarct territory, paralleled by neuroinflammation versus controls. CONCLUSIONS The brain is susceptible to acute MI and chronic heart failure. Immune activation may interconnect heart and brain dysfunction, a finding that provides a foundation for strategies to improve heart and brain outcomes.
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Hammond CA, Blades NJ, Chaudhry SI, Dodson JA, Longstreth WT, Heckbert SR, Psaty BM, Arnold AM, Dublin S, Sitlani CM, Gardin JM, Thielke SM, Nanna MG, Gottesman RF, Newman AB, Thacker EL. Long-Term Cognitive Decline After Newly Diagnosed Heart Failure: Longitudinal Analysis in the CHS (Cardiovascular Health Study). Circ Heart Fail 2019. [PMID: 29523517 DOI: 10.1161/circheartfailure.117.004476] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction. METHODS AND RESULTS Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (P=0.084), and did not vary significantly by reduced versus preserved ejection fraction (P=0.734). CONCLUSIONS Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.
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Affiliation(s)
- Christa A Hammond
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Natalie J Blades
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Sarwat I Chaudhry
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - John A Dodson
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - W T Longstreth
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Susan R Heckbert
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Bruce M Psaty
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Alice M Arnold
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Sascha Dublin
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Colleen M Sitlani
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Julius M Gardin
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Stephen M Thielke
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Michael G Nanna
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Rebecca F Gottesman
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Anne B Newman
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA
| | - Evan L Thacker
- From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA.
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Toledo C, Andrade DC, Díaz HS, Inestrosa NC, Del Rio R. Neurocognitive Disorders in Heart Failure: Novel Pathophysiological Mechanisms Underpinning Memory Loss and Learning Impairment. Mol Neurobiol 2019; 56:8035-8051. [PMID: 31165973 DOI: 10.1007/s12035-019-01655-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
Heart failure (HF) is a major public health issue affecting more than 26 million people worldwide. HF is the most common cardiovascular disease in elder population; and it is associated with neurocognitive function decline, which represent underlying brain pathology diminishing learning and memory faculties. Both HF and neurocognitive impairment are associated with recurrent hospitalization episodes and increased mortality rate in older people, but particularly when they occur simultaneously. Overall, the published studies seem to confirm that HF patients display functional impairments relating to attention, memory, concentration, learning, and executive functioning compared with age-matched controls. However, little is known about the molecular mechanisms underpinning neurocognitive decline in HF. The present review round step recent evidence related to the possible molecular mechanism involved in the establishment of neurocognitive disorders during HF. We will make a special focus on cerebral ischemia, neuroinflammation and oxidative stress, Wnt signaling, and mitochondrial DNA alterations as possible mechanisms associated with cognitive decline in HF. Also, we provide an integrative mechanism linking pathophysiological hallmarks of altered cardiorespiratory control and the development of cognitive dysfunction in HF patients. Graphical Abstract Main molecular mechanisms involved in the establishment of cognitive impairment during heart failure. Heart failure is characterized by chronic activation of brain areas responsible for increasing cardiac sympathetic load. In addition, HF patients also show neurocognitive impairment, suggesting that the overall mechanisms that underpin cardiac sympathoexcitation may be related to the development of cognitive disorders in HF. In low cardiac output, HF cerebral infarction due to cardiac mural emboli and cerebral ischemia due to chronic or intermittent cerebral hypoperfusion has been described as a major mechanism related to the development of CI. In addition, while acute norepinephrine (NE) release may be relevant to induce neural plasticity in the hippocampus, chronic or tonic release of NE may exert the opposite effects due to desensitization of the adrenergic signaling pathway due to receptor internalization. Enhanced chemoreflex drive is a major source of sympathoexcitation in HF, and this phenomenon elevates brain ROS levels and induces neuroinflammation through breathing instability. Importantly, both oxidative stress and neuroinflammation can induce mitochondrial dysfunction and vice versa. Then, this ROS inflammatory pathway may propagate within the brain and potentially contribute to the development of cognitive impairment in HF through the activation/inhibition of key molecular pathways involved in neurocognitive decline such as the Wnt signaling pathway.
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Affiliation(s)
- C Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de investigación en fisiología del ejercicio, Universidad Mayor, Santiago, Chile
| | - H S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - N C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - R Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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Hayashi K, Hasegawa Y, Takemoto Y, Cao C, Takeya H, Komohara Y, Mukasa A, Kim-Mitsuyama S. Continuous intracerebroventricular injection of Porphyromonas gingivalis lipopolysaccharide induces systemic organ dysfunction in a mouse model of Alzheimer's disease. Exp Gerontol 2019; 120:1-5. [DOI: 10.1016/j.exger.2019.02.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/27/2018] [Accepted: 02/08/2019] [Indexed: 01/23/2023]
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Amin A, Garcia Reeves AB, Li X, Dhamane A, Luo X, Di Fusco M, Nadkarni A, Friend K, Rosenblatt L, Mardekian J, Pan X, Yuce H, Keshishian A. Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure. PLoS One 2019; 14:e0213614. [PMID: 30908512 PMCID: PMC6433218 DOI: 10.1371/journal.pone.0213614] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/25/2019] [Indexed: 12/28/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are at least as efficacious and safe as warfarin among non-valvular atrial fibrillation (NVAF) patients; limited evidence is available regarding NVAF patients with heart failure (HF). US Medicare enrollees with NVAF and HF initiating DOACs (apixaban, rivaroxaban, dabigatran) or warfarin were selected. Propensity score matching and Cox models were used to estimate the risk of stroke/systemic embolism (SE), major bleeding (MB), and major adverse cardiac events (MACE) comparing DOACs versus warfarin and DOACs versus DOACs. We identified 10,570 apixaban-warfarin, 4,297 dabigatran-warfarin, 15,712 rivaroxaban-warfarin, 4,263 apixaban-dabigatran, 10,477 apixaban-rivaroxaban, and 4,297 dabigatran-rivaroxaban matched pairs. Compared to warfarin, apixaban had lower rates of stroke/SE (hazard ratio = 0.64, 95% confidence interval = 0.48-0.85), MB (hazard ratio = 0.66, 0.58-0.76), and MACE (hazard ratio = 0.73,0.67-0.79); dabigatran and rivaroxaban had lower rates of MACE (hazard ratio = 0.87,0.77-0.99; hazard ratio = 0.84, 0.79-0.89, respectively). Rivaroxaban had a lower stroke/SE rate (hazard ratio = 0.65, 0.52-0.81) and higher MB rate (hazard ratio = 1.18, 1.08-1.30) versus warfarin. Compared to dabigatran and rivaroxaban, apixaban had lower MB (hazard ratio = 0.71, 0.57-0.89; hazard ratio = 0.55, 0.49-0.63) and MACE rates (hazard ratio = 0.80, 0.69-0.93; hazard ratio = 0.86, 0.79-0.94), respectively. All DOACs had lower MACE rates versus warfarin; differences were observed in stroke/SE and MB. Our findings provide insights about OAC therapy among NVAF patients with HF.
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Affiliation(s)
- Alpesh Amin
- University of California, Irvine, California, United States of America
| | - Alessandra B. Garcia Reeves
- University of North Carolina, Chapel Hill, North Carolina, United States of America
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - Xiaoyan Li
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - Amol Dhamane
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - Xuemei Luo
- Pfizer, Inc., Groton, Connecticut, United States of America
| | | | - Anagha Nadkarni
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - Keith Friend
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - Lisa Rosenblatt
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - Jack Mardekian
- Pfizer Inc., New York, New York, United States of America
| | - Xianying Pan
- Bristol-Myers Squibb Company, Wallingford, Connecticut, United States of America
| | - Huseyin Yuce
- New York City College of Technology, City University of New York, New York, New York, United States of America
| | - Allison Keshishian
- New York City College of Technology, City University of New York, New York, New York, United States of America
- SIMR, Inc, Ann Arbor, Michigan, United States of America
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69
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Colín-Castelán D, Zaina S. Associations between atherosclerosis and neurological diseases, beyond ischemia-induced cerebral damage. Rev Endocr Metab Disord 2019; 20:15-25. [PMID: 30891682 DOI: 10.1007/s11154-019-09486-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neurodegeneration is traditionally viewed as a consequence of peptide accumulation in the brain, stroke and/or cerebral ischemia. Nonetheless, a number of scattered observations suggest that neurological disease and atherosclerosis may be linked by more complex mechanisms. Understanding the intricate link between atherosclerosis and neurological conditions may have a significant impact on the quality of life of the growing ageing population and of high cardiovascular risk groups in general. Epidemiological data support the notion that neurological dysfunction and atherosclerosis coexist long before any evident clinical complications of cardiovascular disease appear and may be causally linked. Baffling, often overlooked, molecular data suggest that nervous tissue-specific gene expression is relaxed specifically in the atheromatous vascular wall, and/or that a systemic dysregulation of genes involved in nervous system biology dictates a concomitant progression of neurological disease and atherosclerosis. Further epidemiological and experimental work is needed to clarify the details and clinical relevance of those complex links.
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Affiliation(s)
- Dannia Colín-Castelán
- Department of Medical Sciences, Division of Health Sciences, Campus León, University of Guanajuato, León, Guanajuato, Mexico.
| | - Silvio Zaina
- Department of Medical Sciences, Division of Health Sciences, Campus León, University of Guanajuato, León, Guanajuato, Mexico
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Hay M, Polt R, Heien ML, Vanderah TW, Largent-Milnes TM, Rodgers K, Falk T, Bartlett MJ, Doyle KP, Konhilas JP. A Novel Angiotensin-(1-7) Glycosylated Mas Receptor Agonist for Treating Vascular Cognitive Impairment and Inflammation-Related Memory Dysfunction. J Pharmacol Exp Ther 2019; 369:9-25. [PMID: 30709867 DOI: 10.1124/jpet.118.254854] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
Increasing evidence indicates that decreased brain blood flow, increased reactive oxygen species (ROS) production, and proinflammatory mechanisms accelerate neurodegenerative disease progression such as that seen in vascular contributions to cognitive impairment and dementia (VCID) and Alzheimer's disease and related dementias. There is a critical clinical need for safe and effective therapies for the treatment and prevention of cognitive impairment known to occur in patients with VCID and chronic inflammatory diseases such as heart failure (HF), hypertension, and diabetes. This study used our mouse model of VCID/HF to test our novel glycosylated angiotensin-(1-7) peptide Ang-1-6-O-Ser-Glc-NH2 (PNA5) as a therapy to treat VCID and to investigate circulating inflammatory biomarkers that may be involved. We demonstrate that PNA5 has greater brain penetration compared with the native angiotensin-(1-7) peptide. Moreover, after treatment with 1.0/mg/kg, s.c., for 21 days, PNA5 exhibits up to 10 days of sustained cognitive protective effects in our VCID/HF mice that last beyond the peptide half-life. PNA5 reversed object recognition impairment in VCID/HF mice and rescued spatial memory impairment. PNA5 activation of the Mas receptor results in a dose-dependent inhibition of ROS in human endothelial cells. Last, PNA5 treatment decreased VCID/HF-induced activation of brain microglia/macrophages and inhibited circulating tumor necrosis factor α, interleukin (IL)-7, and granulocyte cell-stimulating factor serum levels while increasing that of the anti-inflammatory cytokine IL-10. These results suggest that PNA5 is an excellent candidate and "first-in-class" therapy for treating VCID and other inflammation-related brain diseases.
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Affiliation(s)
- Meredith Hay
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Robin Polt
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Michael L Heien
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Todd W Vanderah
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Tally M Largent-Milnes
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Kathleen Rodgers
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Torsten Falk
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Mitchell J Bartlett
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - Kristian P Doyle
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
| | - John P Konhilas
- Departments of Physiology (M.H., J.P.K.), Chemistry and Biochemistry (R.P., M.L.H.), Pharmacology (T.W.V., T.M.L.-M., K.R., T.F., M.J.B.), Neurology (T.F., M.J.B.), and Immunobiology (K.P.D.), Evelyn F. McKnight Brain Institute (M.H.), Sarver Heart Center (M.H., J.P.K.), and Center for Innovation in Brain Science (M.H., T.W.V., K.R.), University of Arizona, Tucson, Arizona
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71
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Abstract
In a somewhat narrow diagnostic lens, Alzheimer disease (AD) has been considered a brain-specific disease characterized by the presence of Aβ (β-amyloid) plaques and tau neural fibrillary tangles and neural inflammation; these pathologies lead to neuronal death and consequently clinical symptoms, such as memory loss, confusion, and impaired cognitive function. However, for decades, researchers have noticed a link between various cardiovascular abnormalities and AD-such as heart failure, coronary artery disease, atrial fibrillation, and vasculopathy. A considerable volume of work has pointed at this head to heart connection, focusing mainly on associations between cerebral hypoperfusion and neuronal degradation. However, new evidence of a possible systemic or metastatic profile to AD calls for further analysis of this connection. Aβ aggregations-biochemically and structurally akin to those found in the typical AD pathology-are now known to be present in the hearts of individuals with idiopathic dilated cardiomyopathy, as well as the hearts of patients with AD. These findings suggest a potential systemic profile of proteinopathies and a new hypothesis for the link between peripheral and central symptoms of heart failure and AD. Herein, we provide an overview of the cardiovascular links to Alzheimer disease.
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Affiliation(s)
- Joshua M Tublin
- From the College of Nursing (J.M.T., J.M.A., L.E.W.), The Ohio State University, Columbus
| | - Jeremy M Adelstein
- From the College of Nursing (J.M.T., J.M.A., L.E.W.), The Ohio State University, Columbus
| | | | - Colin K Combs
- Department of Biomedical Sciences, University of North Dakota, Grand Forks (C.K.C.)
| | - Loren E Wold
- From the College of Nursing (J.M.T., J.M.A., L.E.W.), The Ohio State University, Columbus
- Department of Physiology and Cell Biology, College of Medicine (L.E.W.), The Ohio State University, Columbus
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72
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Ozturk Tasar N, Kosger P, Uzuner N, Ucar B. Alterations in cerebral blood flow in children with congestive heart failure due to ventricular septal defect. CONGENIT HEART DIS 2018; 13:1038-1044. [PMID: 30280507 DOI: 10.1111/chd.12678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/03/2018] [Accepted: 08/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to investigate the effect of ventricular septal defect (VSD) and heart failure on cerebral blood flow (CBF) in children, whether heart failure treatment improves CBF, and if there is any relationship between CBF and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level. METHOD Forty children with VSD (13 with heart failure) aged between 1 and 36 months were studied. The control group comprised 25 healthy children in the same age group. Maximum, minimum, and mean blood flow velocities and pulsatility indices of the right and left middle cerebral arteries were assessed using transcranial Doppler ultrasonography. Measurements of CBF and serum NT-proBNP levels were repeated in patients with heart failure a month post-heart failure treatment initiation. The groups were also compared in terms of defect diameters, cardiac structural changes, left ventricular systolic function, and findings related to pulmonary hypertension determined by echocardiography. Correlations between echocardiographic measurements and CBF parameters were analyzed. RESULTS Although no significant difference was found between patient and control groups for CBF, right and left maximum CBF velocities significantly increased posttreatment in patients with heart failure (P = .04 and P = .01, respectively). Serum NT-proBNP levels in children with VSD associated with heart failure were significantly higher than those in children with VSD alone (P = .04) or in healthy children (P < .001). NT-proBNP levels were negatively correlated with right and left maximum CBF velocities (r = -0.39, P = .013 and r = -0.32, P = .043, respectively). CONCLUSION Although no significant difference was found in CBF velocity among the study groups, increase in the CBF velocity post heart failure treatment and negative correlations between CBF velocity and both the VSD diameter and NT-proBNP levels indicate that the hemodynamic status due to VSD associated with heart failure has an effect on CBF.
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Affiliation(s)
- Nurdan Ozturk Tasar
- Clinic of Pediatrics, Afyonkarahisar Sinanpasa State Hospital, Afyonkarahisar, Turkey
| | - Pelin Kosger
- Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Nevzat Uzuner
- Department of Neurology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Birsen Ucar
- Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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73
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Cermakova P, Formanek T, Kagstrom A, Winkler P. Socioeconomic position in childhood and cognitive aging in Europe. Neurology 2018; 91:e1602-e1610. [PMID: 30258021 DOI: 10.1212/wnl.0000000000006390] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We aimed to investigate whether socioeconomic position (SEP) in childhood has an effect on the level of cognitive performance and the rate of cognitive decline in older adults. METHODS We performed a prospective cohort study of individuals enrolled in a multicenter population-based study, SHARE (Survey of Health, Ageing and Retirement in Europe). Interviews were conducted in 6 waves at approximately 2-year intervals and included examinations of cognitive performance (memory, verbal fluency, delayed recall) and measurements of childhood SEP (participants' household characteristics at the age of 10 years). We estimated the associations of SEP with the level of cognitive performance using linear regression and the relation to the rate of cognitive decline with mixed-effects models. RESULTS This study included 20,244 participants from 16 European countries (median age at baseline 71 years, 54% women). Adverse childhood SEP was associated with a lower level of baseline cognitive performance. This association was attenuated after adjustment for clinical and social risk factors but remained statistically significant. Childhood SEP was not related to the rate of cognitive decline. CONCLUSIONS Variation in childhood SEP helps to explain differences in cognitive performance between older people, but not the rate of decline from their previous level of cognition. Strategies to protect cognitive aging should be applied early in life.
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Affiliation(s)
- Pavla Cermakova
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Tomas Formanek
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anna Kagstrom
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Petr Winkler
- From the National Institute of Mental Health (P.C., T.F., A.K., P.W.), Klecany, Czech Republic; and Health Service and Population Research Department (P.W.), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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74
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Cerebral blood flow alteration following acute myocardial infarction in mice. Biosci Rep 2018; 38:BSR20180382. [PMID: 30061176 PMCID: PMC6123068 DOI: 10.1042/bsr20180382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/13/2018] [Accepted: 07/26/2018] [Indexed: 01/05/2023] Open
Abstract
Heart failure is associated with low cardiac output (CO) and low brain perfusion that imposes a significant risk for accelerated brain ageing and Alzheimer’s disease (AD) development. Although clinical heart failure can emerge several years following acute myocardial infarction (AMI), the impact of AMI on cerebral blood flow (CBF) at early stages and up to 30 days following MI is unknown. Sixteen months old male mice underwent left anterior descending (LAD) coronary artery ligation. Hemodynamics analyses were performed at baseline and at days 1, 7, and 30 post-MI. Left ventricular (LV) ejection fraction (EF), LV volumes, CO, and right common carotid artery (RCCA) diameter were recorded by echocardiography. RCCA flow (RCCA FL) was measured by Doppler echocardiography. LV volumes consistently increased (P<0.0012) and LV systolic function progressively deteriorated (P<0.0001) post-MI. CO and RCCA FL showed a moderate but significant decrease over the course of MI with similar fluctuation pattern such that both variables were decreased at day 1, increased at day 7, and decreased at 30 days post-MI. Correlation and regression analyses between CO and RCCA FL showed a strong correlation with significance at baseline and day 30 post-MI (R = 0.71, P=0.03, and R = 0.72, P=0.03, respectively). Days 1 and 7 analyses between CO and RCCA FL showed moderate correlation with non-significance post-MI (R = 0.51, P=0.2, and R = 0.56, P=0.12, respectively). In summary, CBF significantly decreased following AMI and remained significantly decreased for up to 30 days, suggesting a potential risk for brain damage that could contribute to cognitive dysfunction later in life.
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75
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Lumsden AL, Rogers JT, Majd S, Newman M, Sutherland GT, Verdile G, Lardelli M. Dysregulation of Neuronal Iron Homeostasis as an Alternative Unifying Effect of Mutations Causing Familial Alzheimer's Disease. Front Neurosci 2018; 12:533. [PMID: 30150923 PMCID: PMC6099262 DOI: 10.3389/fnins.2018.00533] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/16/2018] [Indexed: 12/12/2022] Open
Abstract
The overwhelming majority of dominant mutations causing early onset familial Alzheimer’s disease (EOfAD) occur in only three genes, PSEN1, PSEN2, and APP. An effect-in-common of these mutations is alteration of production of the APP-derived peptide, amyloid β (Aβ). It is this key fact that underlies the authority of the Amyloid Hypothesis that has informed Alzheimer’s disease research for over two decades. Any challenge to this authority must offer an alternative explanation for the relationship between the PSEN genes and APP. In this paper, we explore one possible alternative relationship – the dysregulation of cellular iron homeostasis as a common effect of EOfAD mutations in these genes. This idea is attractive since it provides clear connections between EOfAD mutations and major characteristics of Alzheimer’s disease such as dysfunctional mitochondria, vascular risk factors/hypoxia, energy metabolism, and inflammation. We combine our ideas with observations by others to describe a “Stress Threshold Change of State” model of Alzheimer’s disease that may begin to explain the existence of both EOfAD and late onset sporadic (LOsAD) forms of the disease. Directing research to investigate the role of dysregulation of iron homeostasis in EOfAD may be a profitable way forward in our struggle to understand this form of dementia.
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Affiliation(s)
- Amanda L Lumsden
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jack T Rogers
- Neurochemistry Laboratory, Department of Psychiatry-Neuroscience, Massachusetts General Hospital (East), Harvard Medical School, Harvard University, Charlestown, MA, United States
| | - Shohreh Majd
- Neuronal Injury and Repair Laboratory, Centre for Neuroscience, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Morgan Newman
- Centre for Molecular Pathology, School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Greg T Sutherland
- Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Giuseppe Verdile
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Michael Lardelli
- Centre for Molecular Pathology, School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
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76
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Mebius MJ, Roofthooft MTR, Bos AF. Editorial based on: "Risk of dementia in adults with congenital heart disease: population-based cohort study". J Thorac Dis 2018; 10:S2048-S2051. [PMID: 30023115 PMCID: PMC6036039 DOI: 10.21037/jtd.2018.05.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 05/22/2018] [Indexed: 09/28/2023]
Affiliation(s)
- Mirthe J. Mebius
- Division of Neonatology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcus T. R. Roofthooft
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- Division of Neonatology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Rodríguez-Mañero M, López-Pardo E, Cordero A, Kreidieh O, Novo Platas J, Valdés L, Cid-Menendez A, García-Seara J, Pereira-Vázquez M, Martínez-Sande JL, Ruano A, Peña-Gil C, Mazón P, García-Acuña J, González-Juanatey J. Relevance of Dementia in Atrial Fibrillation Patients within a Specific European Health Care Area. Neuroepidemiology 2018; 51:11-18. [DOI: 10.1159/000487887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/20/2018] [Indexed: 12/18/2022] Open
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Londono-Hoyos F, Zamani P, Beraun M, Vasim I, Segers P, Chirinos JA. Effect of organic and inorganic nitrates on cerebrovascular pulsatile power transmission in patients with heart failure and preserved ejection fraction. Physiol Meas 2018; 39:044001. [PMID: 29488900 DOI: 10.1088/1361-6579/aab2ef] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Increased penetration of pulsatile power to the brain has been implicated in the pathogenesis of age-related cognitive dysfunction and dementia, a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). However, there is a lack of knowledge on the effects of organic and inorganic nitrates administration in this population on the power carried by pressure and flow waves traveling through the proximal aorta and penetrating the carotid artery into the brain microvasculature. APPROACH We assessed aortic and carotid hemodynamics non-invasively in two sub-studies: (1) at baseline and after administration of 0.4 mg of sublingual nitroglycerine (an organic nitrate; n = 26); and (2) in a randomized controlled trial of placebo (PB) versus inorganic nitrate administration (beetroot-juice (BR), 12.9 mmol NO3; n = 16). MAIN RESULTS Wave and hydraulic power analysis demonstrated that NTG increased total hydraulic power (from 5.68% at baseline to 8.62%, P = 0.001) and energy penetration (from 8.69% to 11.63%; P = 0.01) from the aorta to the carotid, while inorganic nitrate administration did not induce significant changes in aortic and carotid wave power (power: 5.49%PB versus 6.25%BR, P = 0.49; energy: 8.89%PB versus 10.65%BR, P = 0.27). SIGNIFICANCE Organic nitrates, but not inorganic nitrates, increase the amount of hydraulic energy transmitted into the carotid artery in subjects with HFpEF. These findings may have implications for the adverse effect profiles of these agents (such as the differential incidence of headaches) and for the pulsatile hemodynamic stress of the brain microvasculature in this patient population.
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Affiliation(s)
- Francisco Londono-Hoyos
- University of Pennsylvania Perelman School of Medicine Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America. Institute Biomedical Technology (IBiTech)-bioMMeda Research Group-Ghent University, Ghent, Belgium. FLH and PZ contributed equally to this manuscript
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79
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Adamski MG, Sternak M, Mohaissen T, Kaczor D, Wierońska JM, Malinowska M, Czaban I, Byk K, Lyngsø KS, Przyborowski K, Hansen PBL, Wilczyński G, Chlopicki S. Vascular Cognitive Impairment Linked to Brain Endothelium Inflammation in Early Stages of Heart Failure in Mice. J Am Heart Assoc 2018; 7:e007694. [PMID: 29581224 PMCID: PMC5907583 DOI: 10.1161/jaha.117.007694] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although advanced heart failure (HF) is a clinically documented risk factor for vascular cognitive impairment, the occurrence and pathomechanisms of vascular cognitive impairment in early stages of HF are equivocal. Here, we characterize vascular cognitive impairment in the early stages of HF development and assess whether cerebral hypoperfusion or prothrombotic conditions are involved. METHODS AND RESULTS Tgαq*44 mice with slowly developing isolated HF triggered by cardiomyocyte-specific overexpression of G-αq*44 protein were studied before the end-stage HF, at the ages of 3, 6, and 10 months: before left ventricle dysfunction; at the stage of early left ventricle diastolic dysfunction (with preserved ejection fraction); and left ventricle diastolic/systolic dysfunction, respectively. In 6- to 10-month-old but not in 3-month-old Tgαq*44 mice, behavioral and cognitive impairment was identified with compromised blood-brain barrier permeability, most significantly in brain cortex, that was associated with myelin sheet loss and changes in astrocytes and microglia. Brain endothelial cells displayed increased E-selectin immunoreactivity, which was accompanied by increased amyloid-β1-42 accumulation in piriform cortex and increased cortical oxidative stress (8-OHdG immunoreactivity). Resting cerebral blood flow measured by magnetic resonance imaging in vivo was preserved, but ex vivo NO-dependent cortical arteriole flow regulation was impaired. Platelet hyperreactivity was present in 3- to 10-month-old Tgαq*44 mice, but it was not associated with increased platelet-dependent thrombogenicity. CONCLUSIONS We report for the first time that vascular cognitive impairment is already present in the early stage of HF development, even before left ventricle systolic dysfunction. The underlying pathomechanism, independent of brain hypoperfusion, involves preceding platelet hyperreactivity and brain endothelium inflammatory activation.
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MESH Headings
- Amyloid beta-Peptides/metabolism
- Animals
- Behavior, Animal
- Blood Platelets/metabolism
- Blood-Brain Barrier/metabolism
- Blood-Brain Barrier/physiopathology
- Brain/blood supply
- Capillary Permeability
- Cerebral Arteries/metabolism
- Cerebral Arteries/physiopathology
- Cerebrovascular Circulation
- Cognition
- Cognition Disorders/etiology
- Cognition Disorders/metabolism
- Cognition Disorders/physiopathology
- Cognition Disorders/psychology
- Dementia, Vascular/etiology
- Dementia, Vascular/metabolism
- Dementia, Vascular/physiopathology
- Dementia, Vascular/psychology
- Disease Models, Animal
- Disease Progression
- Encephalitis/etiology
- Encephalitis/metabolism
- Encephalitis/pathology
- Encephalitis/physiopathology
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Female
- GTP-Binding Protein alpha Subunits, Gq-G11/genetics
- Genetic Predisposition to Disease
- Heart Failure/complications
- Heart Failure/genetics
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Mice, Transgenic
- Myocytes, Cardiac/metabolism
- Peptide Fragments/metabolism
- Phenotype
- Time Factors
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Mateusz G Adamski
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Magdalena Sternak
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Tasnim Mohaissen
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Dawid Kaczor
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | | | - Monika Malinowska
- Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Iwona Czaban
- Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Katarzyna Byk
- Institute of Nuclear Physics, Polish Academy of Sciences, Warsaw, Poland
| | | | - Kamil Przyborowski
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
| | - Pernille B L Hansen
- University of Southern Denmark, Odense, Denmark
- Cardiovascular and Metabolic Disease, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Grzegorz Wilczyński
- Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw, Poland
| | - Stefan Chlopicki
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Kraków, Poland
- Chair of Pharmacology, Jagiellonian University, Medical College, Kraków, Poland
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81
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Kaushik V, Smith ST, Mikobi E, Raji MA. Acetylcholinesterase Inhibitors: Beneficial Effects on Comorbidities in Patients With Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2018; 33:73-85. [PMID: 28974110 PMCID: PMC10852526 DOI: 10.1177/1533317517734352] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Elderly patients with Alzheimer's disease (AD) and other dementias are at high risk of polypharmacy and excessive polypharmacy for common coexisting medical conditions. Polypharmacy increases the risk of drug-drug and drug-disease interactions in these patients who may not be able to communicate early symptoms of adverse drug events. Three acetylcholinesterase inhibitors (ACHEIs) have been approved for AD: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They are also used off-label for other causes of dementia such as Lewy body and vascular dementia. We here report evidence from the literature that ACHEI treatment, prescribed for cognitive impairment, can reduce the load of medications in patients with AD by also addressing cardiovascular, gastrointestinal, and other comorbidities. Using one drug to address multiple symptoms can reduce costs and improve medication compliance.
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Affiliation(s)
- Vinod Kaushik
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah Toombs Smith
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Emmanuel Mikobi
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila A. Raji
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
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82
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Bagge CN, Henderson VW, Laursen HB, Adelborg K, Olsen M, Madsen NL. Risk of Dementia in Adults With Congenital Heart Disease: Population-Based Cohort Study. Circulation 2018; 137:1912-1920. [PMID: 29440121 DOI: 10.1161/circulationaha.117.029686] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/12/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND More children with congenital heart disease (CHD) are surviving to adulthood, and CHD is associated with risk factors for dementia. We compared the risk of dementia in CHD adults to that of the general population. METHODS In this cohort study, we used medical registries and a medical record review covering all Danish hospitals to identify adults with CHD diagnosed between 1963 and 2012. These individuals with CHD were followed from January 1, 1981, 30 years of age, or date of first CHD registration (index date for matched members of the general population cohort) until hospital diagnosis of dementia, death, emigration, or end of study (December 31, 2012). For each individual with CHD, we identified 10 members of the general population utilizing the Danish Civil Registration System matched on sex and birth year. We computed cumulative incidences and hazard ratios (HRs) of dementia, adjusting for sex and birth year. RESULTS The cumulative incidence of dementia was 4% by 80 years of age in 10 632 adults with CHD (46% male). The overall HR comparing adults with CHD with the general population cohort was 1.6 (95% confidence interval [CI], 1.3-2.0). The HR among individuals with CHD without extracardiac defects was 1.4 (95% CI, 1.1-1.8). Adults with mild-to-moderate CHD had an HR of 1.5 (95% CI, 1.1-2.0), whereas the HR was 2.0 (95% CI, 1.2-3.3) for severe CHD, including univentricular hearts. The HR for early onset dementia (<65 years of age) was 2.6 (95% CI, 1.8-3.8), whereas the late-onset HR was 1.3 (95% CI, 1.0-1.8). CONCLUSIONS CHD was associated with an increased risk of dementia compared with the general population, in particular for early onset dementia. Further understanding of dementia risk in the population with CHD is a potential target for future investigation.
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Affiliation(s)
- Carina N Bagge
- Departments of Clinical Epidemiology (C.N.B., V.W.H., H.B.L., K.A., M.O., N.L.M.)
| | - Victor W Henderson
- Departments of Clinical Epidemiology (C.N.B., V.W.H., H.B.L., K.A., M.O., N.L.M.).,Aarhus University Hospital, Denmark. Departments of Health Research and Policy (Epidemiology) and Neurology and Neurological Sciences, Stanford University, CA (V.W.H.)
| | - Henning B Laursen
- Departments of Clinical Epidemiology (C.N.B., V.W.H., H.B.L., K.A., M.O., N.L.M.)
| | - Kasper Adelborg
- Departments of Clinical Epidemiology (C.N.B., V.W.H., H.B.L., K.A., M.O., N.L.M.).,Cardiology (K.A.)
| | - Morten Olsen
- Departments of Clinical Epidemiology (C.N.B., V.W.H., H.B.L., K.A., M.O., N.L.M.).,Cardiology (K.A.)
| | - Nicolas L Madsen
- Departments of Clinical Epidemiology (C.N.B., V.W.H., H.B.L., K.A., M.O., N.L.M.).,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (N.L.M.)
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83
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Ong WY, Wu YJ, Farooqui T, Farooqui AA. Qi Fu Yin-a Ming Dynasty Prescription for the Treatment of Dementia. Mol Neurobiol 2018; 55:7389-7400. [PMID: 29417476 PMCID: PMC6096952 DOI: 10.1007/s12035-018-0908-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/11/2018] [Indexed: 12/19/2022]
Abstract
The Traditional Chinese Medicine (TCM) theory that “kidneys give rise to marrow, and the brain is the sea of marrow” has been a guide for the clinical application of kidney, qi and blood tonics for prevention and treatment of dementia and improvement in memory. As low resistance end-organs, both the brain and the kidneys are subjected to blood flow of high volumes throughout the cardiac cycle. Alzheimer’s disease and vascular dementia are two common causes of dementia, and it is increasingly recognized that many older adults with dementia have both AD and vascular pathologies. The underlying molecular mechanisms are incompletely understood, but may involve atherosclerosis, vascular dysfunction, hypertension, type 2 diabetes, history of cardiac disease and possibly, kidney dysfuntion, leading to reduced erythropoietin production, anemia, brain energy deficit and slow excitotoxicity. During the Ming Dynasty, Zhang Jing-Yue used Qi Fu Yin (seven blessings decoction), comprising Panax ginseng, Rehmannia glutinosa, Angelica polymorpha, Atractylodes macrocephala, Glycyrrhiza uralensis, Ziziphus jujube, and Polygala tenuifolia to boost qi and blood circulation, strengthen the heart, and calm the spirit—skillfully linking heart, spleen, kidney, qi, blood and brain as a whole to treat age-related dementia. The purpose of this review is to outline TCM concepts for the treatment of dementia and illustrated with a historical prescription for the treatment of the condition, with the hope that this description may lead to advances in its management.
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Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore. .,Neurobiology and Ageing Research Programme, National University of Singapore, Singapore, 119260, Singapore.
| | - Ya-Jun Wu
- Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore
| | - Tahira Farooqui
- Department of Molecular and Cellular Biochemistry, The Ohio State University, Columbus, OH, 43220, USA
| | - Akhlaq A Farooqui
- Department of Molecular and Cellular Biochemistry, The Ohio State University, Columbus, OH, 43220, USA
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84
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Kumfu S, Charununtakorn ST, Jaiwongkam T, Chattipakorn N, Chattipakorn SC. Humanin Exerts Neuroprotection During Cardiac Ischemia-Reperfusion Injury. J Alzheimers Dis 2018; 61:1343-1353. [DOI: 10.3233/jad-170708] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sirinart Kumfu
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Physiology, Cardiac Electrophysiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Savitree T. Charununtakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Physiology, Cardiac Electrophysiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Thidarat Jaiwongkam
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Physiology, Cardiac Electrophysiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Physiology, Cardiac Electrophysiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C. Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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85
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Cermakova P, Muller M, Armstrong AC, Religa D, Bryan RN, Lima JAC, Launer LJ. Subclinical Cardiac Dysfunction and Brain Health in Midlife: CARDIA (Coronary Artery Risk Development in Young Adults) Brain Magnetic Resonance Imaging Substudy. J Am Heart Assoc 2017; 6:JAHA.117.006750. [PMID: 29246962 PMCID: PMC5779005 DOI: 10.1161/jaha.117.006750] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background We investigated whether cardiac parameters in young adulthood are associated with indicators of brain health in midlife. Methods and Results This study includes 648 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study (52% women, 38% black). We studied associations of cardiac parameters assessed by echocardiography (left ventricular ejection fraction, left atrial volume, and left ventricular mass) in young adulthood (mean age: 30 years) with brain measures obtained by magnetic resonance imaging (total brain, gray and white matter volume, white matter integrity, abnormal white matter) in midlife (mean age: 50 years). In 406 individuals with complete measurements, higher left atrial volume was associated with lower white matter fractional anisotropy, independent of traditional cardiovascular risk factors (β=−0.002; P <0.02). The association was strongest in black participants and in men. Conclusions Higher left atrial volume in early adulthood is associated with impairment of white matter integrity in midlife. Interventions to improve cardiac function in young adults may benefit brain health and should be targeted in particular at black men.
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Affiliation(s)
- Pavla Cermakova
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,National Institute of Mental Health, Klecany, Czech Republic
| | - Majon Muller
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD.,Department of Internal Medicine-Section Geriatric Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Anderson C Armstrong
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.,University of Sao Francisco Valley, Petrolina, Brasil
| | - Dorota Religa
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - João A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD
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86
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87
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Bayes-Genis A, Barallat J, de Antonio M, Domingo M, Zamora E, Vila J, Subirana I, Gastelurrutia P, Pastor MC, Januzzi JL, Lupón J. Bloodstream Amyloid-beta (1-40) Peptide, Cognition, and Outcomes in Heart Failure. ACTA ACUST UNITED AC 2017; 70:924-932. [DOI: 10.1016/j.rec.2017.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
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88
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Wennberg AMV, Wu MN, Rosenberg PB, Spira AP. Sleep Disturbance, Cognitive Decline, and Dementia: A Review. Semin Neurol 2017; 37:395-406. [PMID: 28837986 DOI: 10.1055/s-0037-1604351] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractApproximately half of older people report sleep disturbances, which are associated with various health conditions, including neurodegenerative disease and dementia. Indeed, 60 to 70% of people with cognitive impairment or dementia have sleep disturbances, which are linked to poorer disease prognosis. Sleep disturbances in people with dementia have long been recognized and studied; however, in the past 10 years, researchers have begun to study disturbed sleep, including sleep fragmentation, abnormal sleep duration, and sleep disorders, as risk factors for dementia. In this review the authors summarize evidence linking sleep disturbance and dementia. They describe how specific aspects of sleep (e.g., quality, duration) and the prevalence of clinical sleep disorders (e.g., sleep-disordered breathing, rapid eye movement sleep behavior disorder) change with age; how sleep parameters and sleep disorders are associated with the risk of dementia; how sleep can be disturbed in dementia; and how disturbed sleep affects dementia prognosis. These findings highlight the potential importance of identifying and treating sleep problems and disorders in middle-aged and older adults as a strategy to prevent cognitive decline and dementia. The authors also review recent evidence linking sleep disturbances to the pathophysiology underlying dementing conditions, and briefly summarize available treatments for sleep disorders in people with dementia.
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Affiliation(s)
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Center on Aging and Health, Baltimore, Maryland
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89
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Patel N, Gluck J. Is Entresto good for the brain? World J Cardiol 2017; 9:594-599. [PMID: 28824789 PMCID: PMC5545143 DOI: 10.4330/wjc.v9.i7.594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023] Open
Abstract
The main stay pharmacotherapy for heart failure (HF) is targeted towards rennin-angiotensin-aldosterone (RAAS) and neprilysin pathways (NP). Both therapeutic strategies decreases morbidity and mortality but also carry considerable adverse effects. This review of the literature highlights the new generation of HF drug, sacubitril-valsartan (SV), trade name Entresto (researched as LCZ696, Novartis) which simultaneously blocks RAAS and NP. This dual action of angiotensin receptors blocker and neprilysin inhibitor (NPi) has improved HF prognosis and it is an evolution in the management of HF. Although the initial follow-up of patients treated with SV has yielded promising results, there are concerns regarding potential side effects especially an increase in the risk of Alzheimer’s disease (AD) and young onset of AD. NPi interferes with the breakdown and clearing of beta-amyloid peptides, the plaques seen in AD, raising concern for AD in SV patients. On the other hand, hypertension and cardiovascular diseases are established risk factors for AD which can be decreased by SV therapy. It is therefore essential that SV treated patients are followed up over an extended period of time to detect any adverse cognitive changes.
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90
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Kuller LH, Lopez OL, Gottdiener JS, Kitzman DW, Becker JT, Chang Y, Newman AB. Subclinical Atherosclerosis, Cardiac and Kidney Function, Heart Failure, and Dementia in the Very Elderly. J Am Heart Assoc 2017; 6:e005353. [PMID: 28735291 PMCID: PMC5586275 DOI: 10.1161/jaha.116.005353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Heart failure (HF) and dementia are major causes of disability and death among older individuals. Risk factors and biomarkers of HF may be determinants of dementia in the elderly. We evaluated the relationship between biomarkers of cardiovascular disease and HF and risk of dementia and death. Three hypotheses were tested: (1) higher levels of high-sensitivity cardiac troponin T, N-terminal of prohormone brain natriuretic peptide, and cystatin C predict risk of death, cardiovascular disease, HF, and dementia; (2) higher levels of cardiovascular disease biomarkers are associated with increased risk of HF and then secondary increased risk of dementia; and (3) risk of dementia is lower among participants with a combination of lower coronary artery calcium, atherosclerosis, and lower high-sensitivity cardiac troponin T (myocardial injury). METHODS AND RESULTS The Cardiovascular Health Study Cognition Study was a continuation of the Cardiovascular Health Study limited to the Pittsburgh, PA, center from 1998-1999 to 2014. In 1992-1994, 924 participants underwent magnetic resonance imaging of the brain. There were 199 deaths and 116 developed dementia before 1998-1999. Of the 609 participants eligible for the Pittsburgh Cardiovascular Health Study Cognition Study, 87.5% (n=532) were included in the study. There were 120 incident HF cases and 72% had dementia. In 80 of 87, dementia preceded HF. A combination of low coronary artery calcium score and low high-sensitivity cardiac troponin T was significantly associated with reduced risk of dementia and HF. CONCLUSIONS Most participants with HF had dementia but with onset before HF. Lower high-sensitivity cardiac troponin T and coronary artery calcium was associated with low risk of dementia based on a small number of events. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
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Affiliation(s)
- Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, PA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
| | - John S Gottdiener
- Division of Cardiovascular Medicine, School of Medicine, University of Maryland, Baltimore, MD
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - James T Becker
- Department of Neurology, School of Medicine, University of Pittsburgh, PA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, PA
| | - Yuefang Chang
- Department of Neurological Surgery, University of Pittsburgh, PA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
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91
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Meguro T, Meguro Y, Kunieda T. Atrophy of the parahippocampal gyrus is prominent in heart failure patients without dementia. ESC Heart Fail 2017; 4:632-640. [PMID: 28925598 PMCID: PMC5695180 DOI: 10.1002/ehf2.12192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 05/14/2017] [Accepted: 06/02/2017] [Indexed: 01/01/2023] Open
Abstract
Aims The exacerbation of heart failure (HF) induces brain damage and cognitive impairment (CI), which frequently attenuates the effects of treatment. However, it is not clear whether HF patients without clinical dementia demonstrate increased risk of CI. We examined whether local atrophy in the parahippocampal gyrus, a potential predictor of CI, is prominent in HF patients without clinical dementia. Methods and results Twenty stable HF patients with a history of admission due to decompensated HF or presentation of apparent pulmonary congestion following chest X‐ray and 17 controls were enrolled in this observational, analytical, cross‐sectional, case‐control study. Patients with dementia were excluded from this study based on the results of cognitive assessment. Three‐dimensional T1 weighted magnetic resonance image analysis was performed to evaluate the severity of local brain atrophy using software based on statistical parametric mapping. Z‐score values were calculated to evaluate the severity of atrophy in the total brain and parahippocampal gyrus. The severity of total brain atrophy was similar between HF patients (8.0 ± 2.9%) and controls (6.5 ± 3.1%). However, the Z‐score was significantly higher in the HF group (1.12 ± 0.49) in comparison with the control group (0.63 ± 0.36, P = 0.002). The Z‐score value did not correlate with age, ejection fraction, left atrial dimension, left ventricular dimensions, or brain natriuretic peptides in the HF group but did correlate with the Clinical Frailty Scale. Conclusions Local atrophy in the parahippocampal gyrus was prominent in HF patients without clinical dementia. This finding showed that HF patients without dementia feature a potential risk for developing CI.
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Affiliation(s)
- Tomomi Meguro
- Department of Cardiology, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan
| | | | - Takeyoshi Kunieda
- Department of Cardiology, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan
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92
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Troncone L, Luciani M, Coggins M, Wilker EH, Ho CY, Codispoti KE, Frosch MP, Kayed R, Del Monte F. Aβ Amyloid Pathology Affects the Hearts of Patients With Alzheimer's Disease: Mind the Heart. J Am Coll Cardiol 2017; 68:2395-2407. [PMID: 27908343 DOI: 10.1016/j.jacc.2016.08.073] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/08/2016] [Accepted: 08/31/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Individually, heart failure (HF) and Alzheimer's disease (AD) are severe threats to population health, and their potential coexistence is an alarming prospect. In addition to sharing analogous epidemiological and genetic profiles, biochemical characteristics, and common triggers, the authors recently recognized common molecular and pathological features between the 2 conditions. Whereas cognitive impairment has been linked to HF through perfusion defects, angiopathy, and inflammation, whether patients with AD present with myocardial dysfunction, and if the 2 conditions bear a common pathogenesis as neglected siblings are unknown. OBJECTIVES Here, the authors investigated whether amyloid beta (Aβ) protein aggregates are present in the hearts of patients with a primary diagnosis of AD, affecting myocardial function. METHODS The authors examined myocardial function in a retrospective cross-sectional study from a cohort of AD patients and age-matched controls. Imaging and proteomics approaches were used to identify and quantify Aβ deposits in AD heart and brain specimens compared with controls. Cell shortening and calcium transients were measured on isolated adult cardiomyocytes. RESULTS Echocardiographic measurements of myocardial function suggest that patients with AD present with an anticipated diastolic dysfunction. As in the brain, Aβ40 and Aβ42 are present in the heart, and their expression is increased in AD. CONCLUSIONS Here, the authors provide the first report of the presence of compromised myocardial function and intramyocardial deposits of Aβ in AD patients. The findings depict a novel biological framework in which AD may be viewed either as a systemic disease or as a metastatic disorder leading to heart, and possibly multiorgan failure. AD and HF are both debilitating and life-threatening conditions, affecting enormous patient populations. Our findings underline a previously dismissed problem of a magnitude that will require new diagnostic approaches and treatments for brain and heart disease, and their combination.
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Affiliation(s)
- Luca Troncone
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Marco Luciani
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew Coggins
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elissa H Wilker
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cheng-Ying Ho
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rakez Kayed
- Department of Neurology, University of Texas Medical Branch Health, Galveston, Texas
| | - Federica Del Monte
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Cardiology Massachusetts General Hospital, Boston, Massachusetts.
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93
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Jin WS, Bu XL, Wang YR, Li L, Li WW, Liu YH, Zhu C, Yao XQ, Chen Y, Gao CY, Zhang T, Zhou HD, Zeng F, Wang YJ. Reduced Cardiovascular Functions in Patients with Alzheimer’s Disease. J Alzheimers Dis 2017; 58:919-925. [DOI: 10.3233/jad-170088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Takane K, Hasegawa Y, Lin B, Koibuchi N, Cao C, Yokoo T, Kim-Mitsuyama S. Detrimental Effects of Centrally Administered Angiotensin II are Enhanced in a Mouse Model of Alzheimer Disease Independently of Blood Pressure. J Am Heart Assoc 2017; 6:JAHA.116.004897. [PMID: 28428194 PMCID: PMC5533006 DOI: 10.1161/jaha.116.004897] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The significance of brain angiotensin II in Alzheimer disease (AD) is unclear. Methods and Results To examine the role of brain angiotensin II in AD, intracerebroventricular angiotensin II infusion was performed on 5XFAD mice, a mouse model of AD, and wild‐type mice, and the detrimental effects of brain angiotensin II was compared between the 2 strains of mice. Intracerebroventricular angiotensin II infusion significantly impaired cognitive function in 5XFAD mice but not in wild‐type mice. This vulnerability of 5XFAD mice to brain angiotensin II was associated with enhancement of hippocampal inflammation and oxidative stress and with increased cerebrovascular amyloid β deposition. We also compared the effect of brain angiotensin II on the heart and skeletal muscle between the 2 strains because AD is associated with heart failure and sarcopenia. We found that cardiac compensatory response of 5XFAD mice to brain angiotensin II–induced hypertension was less than that of wild‐type mice. Brain angiotensin II caused skeletal muscle atrophy and injury in 5XFAD mice more than in wild‐type mice. Conclusions Brain angiotensin II seems to be involved in cognitive impairment and brain injury in AD, which is associated with oxidative stress, inflammation, and cerebral amyloid angiopathy. Further, brain angiotensin II may participate in cardiac disease and sarcopenia observed in AD.
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Affiliation(s)
- Koki Takane
- Departments of Pharmacology and Molecular Therapeutics, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.,Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yu Hasegawa
- Departments of Pharmacology and Molecular Therapeutics, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Bowen Lin
- Departments of Pharmacology and Molecular Therapeutics, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Nobutaka Koibuchi
- Departments of Pharmacology and Molecular Therapeutics, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Cheng Cao
- Departments of Pharmacology and Molecular Therapeutics, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Shokei Kim-Mitsuyama
- Departments of Pharmacology and Molecular Therapeutics, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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95
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Cannatà A, Marcon G, Cimmino G, Camparini L, Ciucci G, Sinagra G, Loffredo FS. Role of circulating factors in cardiac aging. J Thorac Dis 2017; 9:S17-S29. [PMID: 28446965 PMCID: PMC5383555 DOI: 10.21037/jtd.2017.03.95] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
Worldwide increase in life expectancy is a major contributor to the epidemic of chronic degenerative diseases. Aging, indeed, simultaneously affects multiple organ systems, and it has been hypothesized that systemic alterations in regulators of tissue physiology may regulate this process. Cardiac aging itself is a major risk factor for cardiovascular diseases and, because of the intimate relationship with the brain, may contribute to increase the risk of neurodegenerative disorders. Blood-borne factors may play a major role in this complex and still elusive process. A number of studies, mainly based on the revival of parabiosis, a surgical technique very popular during the 70s of the 20th century to study the effect of a shared circulation in two animals, have indeed shown the potential that humoral factors can control the aging process in different tissues. In this article we review the role of circulating factors in cardiovascular aging. A better understanding of these mechanisms may provide new insights in the aging process and provide novel therapeutic opportunities for chronic age-related disorders.
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Affiliation(s)
- Antonio Cannatà
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Gabriella Marcon
- DAMA- University of Udine, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Giovanni Cimmino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
| | - Luca Camparini
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Giulio Ciucci
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Francesco S. Loffredo
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
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96
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Greco S, Zaccagnini G, Fuschi P, Voellenkle C, Carrara M, Sadeghi I, Bearzi C, Maimone B, Castelvecchio S, Stellos K, Gaetano C, Menicanti L, Martelli F. Increased BACE1-AS long noncoding RNA and β-amyloid levels in heart failure. Cardiovasc Res 2017; 113:453-463. [DOI: 10.1093/cvr/cvx013] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 01/25/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Simona Greco
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
| | - Germana Zaccagnini
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
| | - Paola Fuschi
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
| | - Christine Voellenkle
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
| | - Matteo Carrara
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
| | - Iman Sadeghi
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
| | - Claudia Bearzi
- Institute of Cell Biology and Neurobiology (IBCN), National Research Council of Italy (CNR), Monterotondo Scalo, Rome, Italy
| | - Biagina Maimone
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
| | | | - Konstantinos Stellos
- Laboratory of RNA Metabolism and Vascular Inflammation, Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Carlo Gaetano
- Division of Cardiovascular Epigenetics, Department of Cardiology and Internal Medicine Clinic III, Department of Cardiology, Goethe University, Frankfurt/Main, Germany
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Fabio Martelli
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, Via Morandi, 30 20097 San Donato, Milanese, Milan, Italy
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97
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Adelborg K, Horváth-Puhó E, Ording A, Pedersen L, Sørensen HT, Henderson VW. Heart failure and risk of dementia: a Danish nationwide population-based cohort study. Eur J Heart Fail 2017; 19:253-260. [PMID: 27612177 PMCID: PMC5522185 DOI: 10.1002/ejhf.631] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 11/08/2022] Open
Abstract
AIMS The association between heart failure and dementia remains unclear. We assessed the risk of dementia among patients with heart failure and members of a general population comparison cohort. METHODS AND RESULTS Individual-level data from Danish medical registries were linked in this nationwide population-based cohort study comparing patients with a first-time hospitalization for heart failure between 1980 and 2012 and a year of birth-, sex-, and calendar year-matched comparison cohort from the general population. Stratified Cox regression analysis was used to compute 1-35-year hazard ratios (HRs) for the risk of all-cause dementia and, secondarily, Alzheimer's disease, vascular dementia, and other dementias. Analyses included 324 418 heart failure patients and 1 622 079 individuals from the general population (median age 77 years, 52% male). Compared with the general population cohort, risk of all-cause dementia was increased among heart failure patients [adjusted HR 1.21, 95% confidence interval (CI) 1.18-1.24]. The associations were stronger in men and in heart failure patients under age 70. Heart failure patients had higher risks of vascular dementia (adjusted HR 1.49, 95% CI 1.40-1.59) and other dementias (adjusted HR 1.30, 95% CI 1.26-1.34) than members of the general population cohort. Heart failure was not associated with Alzheimer's disease (adjusted HR 1.00, 95% CI 0.96-1.04). CONCLUSION Heart failure was associated with an increased risk of all-cause dementia. Heart failure may represent a risk factor for dementia, but not necessarily for Alzheimer's disease.
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Affiliation(s)
- Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Anne Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Victor W. Henderson
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
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98
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Zhang B, He P, Lu Y, Bian X, Yang X, Fu X, Wu Y, Li D. HSF1 Relieves Amyloid-β-Induced Cardiomyocytes Apoptosis. Cell Biochem Biophys 2017; 72:579-87. [PMID: 25631374 DOI: 10.1007/s12013-014-0505-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Accumulation of amyloid-β in organs results in a series of diseases. Heat shock transcription factor 1 (HSF1) is the master regulator of genes encoding molecular chaperones and attenuates apoptosis induced by multiple factors. However, the role of HSF1 on amyloid-β-induced apoptosis is still unknown. The present study was aimed to explore the function of HSF1 in amyloid-β-induced cardiomyocytes apoptosis. TUNEL assay and flow cytometry analysis were used to detect cell apoptosis. Phalloidin staining was used to detect cytoskeleton injury. Changes in expression levels of proteins involved in apoptosis and endoplasmic reticulum stress were measured by Western blot. In our study, amyloid-β was found to promote apoptosis, impair cytoskeleton, and induce endoplasmic reticulum stress in isolated cardiomyocytes. However, these damaging effects of amyloid-β can be relieved by over-expression of HSF1, and the protective role of HSF1 might be associated with the regulation of HSPs expressions. Results of our study suggest that over-expression of HSF1 might become a promising gene therapeutic for the treatment of heart diseases associated with amyloid-β accumulation.
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Affiliation(s)
- Beiru Zhang
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
| | - Ping He
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Yonghao Lu
- Department of Neurosurgery, Affiliated Central Hospital of Shenyang Medical College, Shenyang, 110024, Liaoning, China
| | - Xiaohui Bian
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Xu Yang
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Xiaoying Fu
- Department of Pathology, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Yan Wu
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Detian Li
- Department of Nephrology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China
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99
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Multiple beneficial effects of melanocortin MC 4 receptor agonists in experimental neurodegenerative disorders: Therapeutic perspectives. Prog Neurobiol 2016; 148:40-56. [PMID: 27916623 DOI: 10.1016/j.pneurobio.2016.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 12/13/2022]
Abstract
Melanocortin peptides induce neuroprotection in acute and chronic experimental neurodegenerative conditions. Melanocortins likewise counteract systemic responses to brain injuries. Furthermore, they promote neurogenesis by activating critical signaling pathways. Melanocortin-induced long-lasting improvement in synaptic activity and neurological performance, including learning and memory, sensory-motor orientation and coordinated limb use, has been consistently observed in experimental models of acute and chronic neurodegeneration. Evidence indicates that the neuroprotective and neurogenic effects of melanocortins, as well as the protection against systemic responses to a brain injury, are mediated by brain melanocortin 4 (MC4) receptors, through an involvement of the vagus nerve. Here we discuss the targets and mechanisms underlying the multiple beneficial effects recently observed in animal models of neurodegeneration. We comment on the potential clinical usefulness of melanocortin MC4 receptor agonists as neuroprotective and neuroregenerative agents in ischemic stroke, subarachnoid hemorrhage, traumatic brain injury, spinal cord injury, and Alzheimer's disease.
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100
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Dacks PA, Armstrong JJ, Brannan SK, Carman AJ, Green AM, Kirkman MS, Krakoff LR, Kuller LH, Launer LJ, Lovestone S, Merikle E, Neumann PJ, Rockwood K, Shineman DW, Stefanacci RG, Velentgas P, Viswanathan A, Whitmer RA, Williamson JD, Fillit HM. A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline. ALZHEIMERS RESEARCH & THERAPY 2016; 8:33. [PMID: 27543171 PMCID: PMC4992192 DOI: 10.1186/s13195-016-0200-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through mechanisms that are independent of their primary indication. While surgery, benzodiazepines, and anti-cholinergic drugs may accelerate decline or even raise the risk of dementia, other medications act directly on the brain to potentially slow the pathology that underlies Alzheimer’s and other dementia. In other words, the functional and cognitive decline in vulnerable patients may be influenced by the choice of treatments for other medical conditions. Despite the importance of these questions, very little research is available. The Alzheimer’s Drug Discovery Foundation convened an advisory panel to discuss the existing evidence and to recommend strategies to accelerate the development of comparative effectiveness research on how choices in the clinical care of common chronic diseases may protect from cognitive decline and dementia.
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Affiliation(s)
- Penny A Dacks
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA.
| | - Joshua J Armstrong
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Aaron J Carman
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA
| | | | - M Sue Kirkman
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD, USA
| | | | | | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,DGI Clinical, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Diana W Shineman
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA
| | - Richard G Stefanacci
- Thomas Jefferson College of Population Health, The Access Group, Philadelphia, PA, USA
| | - Priscilla Velentgas
- Scientific Affairs, Quintiles Real World Late Phase Research, Cambridge, MA, USA
| | - Anand Viswanathan
- Representative for the American Heart Association; Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Rachel A Whitmer
- Kaiser Permanente Division of Research, Population Science and Brain Aging, Oakland, CA, USA
| | | | - Howard M Fillit
- Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA
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