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Chan E, Bonifacio GB, Harrison C, Banerjee G, Best JG, Sacks B, Harding N, Del Rocio Hidalgo Mas M, Jäger HR, Cipolotti L, Werring DJ. Domain-specific neuropsychological investigation of CAA with and without intracerebral haemorrhage. J Neurol 2023; 270:6124-6132. [PMID: 37672105 PMCID: PMC10632296 DOI: 10.1007/s00415-023-11977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is associated with cognitive impairment, but the contributions of lobar intracerebral haemorrhage (ICH), underlying diffuse vasculopathy, and neurodegeneration, remain uncertain. We investigated the domain-specific neuropsychological profile of CAA with and without ICH, and their associations with structural neuroimaging features. METHODS Data were collected from patients with possible or probable CAA attending a specialist outpatient clinic. Patients completed standardised neuropsychological assessment covering seven domains. MRI scans were scored for markers of cerebral small vessel disease and neurodegeneration. Patients were grouped into those with and without a macro-haemorrhage (CAA-ICH and CAA-non-ICH). RESULTS We included 77 participants (mean age 72, 65% male). 26/32 (81%) CAA-non-ICH patients and 41/45 (91%) CAA-ICH patients were impaired in at least one cognitive domain. Verbal IQ and non-verbal IQ were the most frequently impaired, followed by executive functions and processing speed. We found no significant differences in the frequency of impairment across domains between the two groups. Medial temporal atrophy was the imaging feature most consistently associated with cognitive impairment (both overall and in individual domains) in both univariable and multivariable analyses. DISCUSSION Cognitive impairment is common in CAA, even in the absence of ICH, suggesting a key role for diffuse processes related to small vessel disease and/or neurodegeneration. Our findings indicate that neurodegeneration, possibly due to co-existing Alzheimer's disease pathology, may be the most important contributor. The observation that general intelligence is the most frequently affected domain suggests that CAA has a generalised rather than focal cognitive impact.
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Affiliation(s)
- Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK.
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.
| | - Guendalina B Bonifacio
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Corin Harrison
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Gargi Banerjee
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan G Best
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Benjamin Sacks
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Nicola Harding
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Maria Del Rocio Hidalgo Mas
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - H Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David J Werring
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
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Machado MF, Muela HCS, Costa-Hong VA, Panerai RB, Yassuda MS, Moraes NC, Memória CM, Bor-Seng-Shu E, Nitrini R, Bortolotto LA, Nogueira RDC. Measurement of resistance-area product by transcranial Doppler: An alternative tool for cognitive screening in hypertensive on drug treatment? CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100191. [PMID: 38046105 PMCID: PMC10692755 DOI: 10.1016/j.cccb.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/02/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
Introduction Arterial hypertrophy and remodeling are adaptive responses present in systemic arterial hypertension that can result in silent ischemia and neurodegeneration, compromising brain connections and cognitive performance (CP). However, CP is affected differently over time, so traditional screening methods may become less sensitive in assessing certain cognitive domains. The study aimed to evaluate whether cerebrovascular hemodynamic parameters can serve as a tool for cognitive screening in hypertensive without clinically manifest cognitive decline. Methods Participants were allocated into groups: non-hypertensive (n = 30) [group 1], hypertensive with systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg (n = 54) [group 2] and hypertensive with SBP ≥ 140 or DBP ≥ 90 (n = 31) [group 3]. Measurements of blood pressure and middle cerebral artery blood flow velocity were obtained from digital plethysmography and transcranial Doppler. For the cognitive assessment, the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and a broad neuropsychological battery were applied. Results Patients in groups 2 and 3 show no significant differences in most of the clinical-epidemiological variables or pulsatility index (p = 0.361), however compared to group 1 and 2, patients in group 3 had greater resistance-area product [RAP] (1.7 [±0.7] vs. 1.2 [±0.2], p < 0.001). There was a negative correlation between RAP, episodic memory (r = -0.277, p = 0.004) and cognitive processing speed (r = -0.319, p = 0.001). Conclusion RAP reflects the real cerebrovascular resistance, regardless of the direct action of antihypertensive on the microcirculation, and seems to be a potential alternative tool for cognitive screening in hypertensive.
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Affiliation(s)
- Michel Ferreira Machado
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | | | | | | | - Monica S. Yassuda
- Gerontology, School of Arts, Sciences and Humanities, University of São Paulo Medical School, Brazil
| | - Natalia Cristina Moraes
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | - Claudia Maia Memória
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | - Edson Bor-Seng-Shu
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil
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Sokolovič L, Hofmann MJ, Mohammad N, Kukolja J. Neuropsychological differential diagnosis of Alzheimer's disease and vascular dementia: a systematic review with meta-regressions. Front Aging Neurosci 2023; 15:1267434. [PMID: 38020767 PMCID: PMC10657839 DOI: 10.3389/fnagi.2023.1267434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Diagnostic classification systems and guidelines posit distinguishing patterns of impairment in Alzheimer's (AD) and vascular dementia (VaD). In our study, we aim to identify which diagnostic instruments distinguish them. Methods We searched PubMed and PsychInfo for empirical studies published until December 2020, which investigated differences in cognitive, behavioral, psychiatric, and functional measures in patients older than 64 years and reported information on VaD subtype, age, education, dementia severity, and proportion of women. We systematically reviewed these studies and conducted Bayesian hierarchical meta-regressions to quantify the evidence for differences using the Bayes factor (BF). The risk of bias was assessed using the Newcastle-Ottawa-Scale and funnel plots. Results We identified 122 studies with 17,850 AD and 5,247 VaD patients. Methodological limitations of the included studies are low comparability of patient groups and an untransparent patient selection process. In the digit span backward task, AD patients were nine times more probable (BF = 9.38) to outperform VaD patients (β g = 0.33, 95% ETI = 0.12, 0.52). In the phonemic fluency task, AD patients outperformed subcortical VaD (sVaD) patients (β g = 0.51, 95% ETI = 0.22, 0.77, BF = 42.36). VaD patients, in contrast, outperformed AD patients in verbal (β g = -0.61, 95% ETI = -0.97, -0.26, BF = 22.71) and visual (β g = -0.85, 95% ETI = -1.29, -0.32, BF = 13.67) delayed recall. We found the greatest difference in verbal memory, showing that sVaD patients outperform AD patients (β g = -0.64, 95% ETI = -0.88, -0.36, BF = 72.97). Finally, AD patients performed worse than sVaD patients in recognition memory tasks (β g = -0.76, 95% ETI = -1.26, -0.26, BF = 11.50). Conclusion Our findings show inferior performance of AD in episodic memory and superior performance in working memory. We found little support for other differences proposed by diagnostic systems and diagnostic guidelines. The utility of cognitive, behavioral, psychiatric, and functional measures in differential diagnosis is limited and should be complemented by other information. Finally, we identify research areas and avenues, which could significantly improve the diagnostic value of cognitive measures.
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Affiliation(s)
- Leo Sokolovič
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Markus J. Hofmann
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Nadia Mohammad
- Department of General and Biological Psychology, University of Wuppertal, Wuppertal, Germany
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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Zhang N, Xie B, Feng Y, Li Q, Li X. Effects of asymptomatic cerebral artery stenosis of anterior circulation and establishment of collateral circulation on cognition. Clin Neurol Neurosurg 2023; 233:107889. [PMID: 37515853 DOI: 10.1016/j.clineuro.2023.107889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate how cognition is affected by asymptomatic cerebral artery stenosis (CAS) of the anterior circulation and its related collateral circulation. METHODS 102 patients with CAS of the anterior circulation and 52 controls were enrolled from January 1, 2019 to June 30, 2022. Patients with CAS of anterior circulation were further divided into different subgroups according to the degree of stenosis, cerebral perfusion, and collateral circulation. A series of neuropsychological scales were used to evaluate the participant's cognitive function, activities of daily living, and neuropsychiatric symptoms (such as memory, execution, psychomotor speed, etc.). The data were analyzed using T-test, F-test, chi-square test, rank sum test, and other statistical methods, moreover, the quantitative data were further examined for trends. The relationship between the degree of CAS, cerebral perfusion, collateral circulation, and the outcome of the cognitive test was investigated using Spearman correlation analysis. RESULTS Compared to controls, there were severe impairments of global cognition, psychomotor speed/execution, memory, attention, activities of daily living, and more neuropsychiatric symptoms in patients with anterior circulation CAS (p < 0.05), and these impairments got worsened with the aggravation of CAS (p < 0.05). The global cognition, psychomotor speed / executive function, memory function, and daily living ability were impaired both in the cerebral perfusion-compensated group and decompensated group(p < 0.05), while there was no statistically significant difference between the two groups (p > 0.05). With the aggravation of CAS, the proportion of poor collateral formation increased, and this difference was statistically significant (P < 0.01). The degree of stenosis, cerebral perfusion, and collateral circulation establishment of anterior circulation CAS was correlated with global cognition, memory, psychomotor speed, execution, attention, activities of daily living, and neuropsychiatric symptoms (all p < 0.01). CONCLUSION Cognitive impairment and the percentage of inadequate collateral circulation development rise as stenosis progresses in patients with anterior circulation CAS. The decline in global cognitive function was accompanied by impairments in psychomotor speed / executive function, memory function, attention, and daily living skills, as well as the aggravation of neuropsychiatric symptoms, especially in patients with impaired cerebral perfusion and poor collateral circulation formation.
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Affiliation(s)
- Nan Zhang
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Binbin Xie
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Yuxue Feng
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Qin Li
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofeng Li
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China.
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Silva AR, Santos I, Fernandes C, Silva C, Pereira D, Galego O, Queiroz H, Almeida MDR, Baldeiras I, Santo G. The relevance of the socio-emotional deficits in cerebral small vessels disease (CSVD): An exploratory study with sporadic CSVD and CADASIL patients. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100186. [PMID: 38162294 PMCID: PMC10757198 DOI: 10.1016/j.cccb.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/03/2023] [Accepted: 09/25/2023] [Indexed: 01/03/2024]
Abstract
Background Cerebral Small Vessels Disease (CSVD) is categorized in different forms, the most common being the sporadic form and a genetic variant - Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Amongst the most frequent clinical manifestations are the neuropsychological changes of cognitive, behavioral, and emotional nature, whose features are still under debate. Objective This exploratory study aimed to compare the neuropsychological profile of a sporadic CSVD sample and a CADASIL sample with an age, education, and gender matched control group, between the ages of 30-65 YO (total sample mean age=51.16; SD=4.31). Methods 20 patients with sporadic CSVD, 20 patients with CADASIL and 20 matched controls completed a neuropsychological assessment battery. Global cognitive state, processing speed, working memory, attention, executive dysfunction, episodic memory, social cognition, impulsivity, apathy, alexithymia, depression, and anxiety were measured. White matter hyperintensities (WMH) volume were quantified and measured as lesion burden. Results The cognitive differences found between the clinical groups combined (after confirming no differences between the two clinical groups) and matched controls were restricted to speed processing scores (d = 0.32 95 % CI [.12-.47]). The socio-emotional and behavioral profile revealed significantly higher levels of depression (d = 0.21, 95 % CI [.16-.33]). and anxiety (d = 0.25 95 % CI [.19-.32]) in CADASIL and sporadic CSVD groups, and the same for the alexithymia score (d = 0.533 95 % CI [.32-.65]) were the clinical groups revealed impoverished emotional processing compared to controls. WMH only significantly correlated with the cognitive changes and age. Conclusions In our study, CADASIL and sporadic cSVD patients combined, present multiple emotional-behavioral symptoms - alexithymia, anxiety, depression, and in a lower extent apathy and impulsivity - suggesting for the presence of emotion dysregulation behaviors, present independently of age and of the presence of cognitive deficits. Despite of the small sample size that could underpower some findings, this exploratory research supported that these symptoms may have a significant impact in disease monitoring, progression, and prognosis, requiring further investigation regarding their neurophysiological substrates.
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Affiliation(s)
- Ana Rita Silva
- CINEICC – Center for Research in Neuropsychology and Cognitive Behavioral Interventions of the University of Coimbra, Colegio Novo Street, N/A, Coimbra 3000-115, Portugal
| | - Irina Santos
- Neurology Department, Academic and Clinical Centre – Coimbra University Hospitals, Coimbra, Portugal
| | - Carolina Fernandes
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
| | - Cristiana Silva
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
| | - Daniela Pereira
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | - Orlando Galego
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | - Henrique Queiroz
- Neurorradiology Functional Unit, Coimbra University Hospitals, Coimbra, Portugal
| | | | - Inês Baldeiras
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Gustavo Santo
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, CNC-CIBB, Coimbra, Portugal
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Wei Z, Yue J, Li X, Zhao W, Cao D, Li A, Yang G, Zhang Q. A mini-review on functional magnetic resonance imaging on brain structure of vascular cognitive impairment. Front Neurol 2023; 14:1249147. [PMID: 37808504 PMCID: PMC10552639 DOI: 10.3389/fneur.2023.1249147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Vascular cognitive impairment (VCI) is the initial stage of vascular dementia (VaD). Early diagnosis and treatment of VCI are crucial to prevent the progression of VaD. In order to gain a better understanding of VCI, this study aimed to investigate the use of advanced imaging techniques such as structural magnetic resonance imaging (sMRI) and resting-state functional magnetic resonance imaging (rs-fMRI). These techniques allow researchers to observe the structural and functional changes in the brain that are associated with VCI. Functional magnetic resonance imaging (fMRI) and sMRI techniques have been widely used in studies focusing on gray matter, brain networks, and functional abnormalities during rest. By searching and summarizing recent literature, this study has provided valuable evidence on the use of advanced imaging techniques in understanding and treating VCI. The findings from this study can aid in the development of early intervention strategies for patients with VCI, potentially slowing down or even halting the progression of VCI to full-blown VaD.
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Affiliation(s)
- Zeyi Wei
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jinhuan Yue
- Shenzhen Frontiers in Chinese Medicine Research Co., Ltd., Shenzhen, China
- Department of Acupuncture and Moxibustion, Vitality University, Hayward, CA, United States
| | - Xiaoling Li
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | | | - Danna Cao
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Ang Li
- Servier (Beijing) Pharmaceutical Research & Development CO. Ltd., Beijing, China
| | - Guanhu Yang
- Department of Specialty Medicine, Ohio University, Athens, OH, United States
| | - Qinhong Zhang
- Shenzhen Frontiers in Chinese Medicine Research Co., Ltd., Shenzhen, China
- Department of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, China
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Hartwigsen G, Lim JS, Bae HJ, Yu KH, Kuijf HJ, Weaver NA, Biesbroek JM, Kopal J, Bzdok D. Bayesian modeling disentangles language versus executive control disruption in stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.06.552147. [PMID: 37609325 PMCID: PMC10441359 DOI: 10.1101/2023.08.06.552147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Stroke is the leading cause of long-term disability worldwide. Incurred brain damage disrupts cognition, often with persisting deficits in language and executive capacities. Despite their clinical relevance, the commonalities, and differences of language versus executive control impairments remain under-specified. We tailored a Bayesian hierarchical modeling solution in a largest-of-its-kind cohort (1080 stroke patients) to deconvolve language and executive control in the brain substrates of stroke insults. Four cognitive factors distinguished left- and right-hemispheric contributions to ischemic tissue lesion. One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized control and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two factors: executive speech functions and verbal memory. Impairments on both were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.
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Namirembe GE, Baker S, Albanese M, Mueller A, Qu JZ, Mekonnen J, Wiredu K, Westover MB, Houle TT, Akeju O. Association Between Postoperative Delirium and Long-Term Subjective Cognitive Decline in Older Patients Undergoing Cardiac Surgery: A Secondary Analysis of the Minimizing Intensive Care Unit Neurological Dysfunction with Dexmedetomidine-Induced Sleep Trial. J Cardiothorac Vasc Anesth 2023; 37:1700-1706. [PMID: 37217424 PMCID: PMC10524446 DOI: 10.1053/j.jvca.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/09/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES This study aimed to evaluate whether a measure of subjective cognitive decline (SCD), the Patient-Reported Outcomes Measurement Information System (PROMIS) Applied Cognition-Abilities questionnaire, was associated with postoperative delirium. It was hypothesized that delirium during the surgical hospitalization would be associated with a decrease in subjective cognition up to 6 months after cardiac surgery. DESIGN This was a secondary analysis of data from the Minimizing Intensive Care Unit Neurological Dysfunction with Dexmedetomidine-induced Sleep randomized, placebo-controlled, parallel-arm superiority trial. SETTING Data from patients recruited between March 2017 and February 2022 at a tertiary medical center in Boston, Massachusetts were analyzed in February 2023. PARTICIPANTS Data from 337 patients aged 60 years or older who underwent cardiac surgery with cardiopulmonary bypass were included. INTERVENTIONS Patients were assessed preoperatively and postoperatively at 30, 90, and 180 days using the subjective PROMIS Applied Cognition-Abilities and telephonic Montreal Cognitive Assessment. MEASUREMENT AND MAIN RESULTS Postoperative delirium occurred within 3 days in 39 participants (11.6%). After adjusting for baseline function, participants who developed postoperative delirium self-reported worse cognitive function (mean difference [MD] -2.64 [95% CI -5.25, -0.04]; p = 0.047) up to 180 days after surgery, as compared with nondelirious patients. This finding was consistent with those obtained from objective t-MoCA assessments (MD -0.77 [95% CI -1.49, -0.04]; p = 0.04). CONCLUSIONS In this cohort of older patients undergoing cardiac surgery, in-hospital delirium was associated with SCD up to 180 days after surgery. This finding suggested that measures of SCD may enable population-level insights into the burden of cognitive decline associated with postoperative delirium.
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Affiliation(s)
- Grace E Namirembe
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sarah Baker
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marissa Albanese
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jason Z Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jennifer Mekonnen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kwame Wiredu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - M Brandon Westover
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Sequeiros JM, Rodriguez-Calienes A, Chavez-Malpartida SS, Morán-Mariños C, Alvarado-Gamarra G, Malaga M, Quincho-Lopez A, Hernadez-Fernandez W, Pacheco-Barrios K, Ortega-Gutierrez S, Hoit D, Arthur AS, Alexandrov AV, Alva-Diaz C, Elijovich L. Stroke imaging modality for endovascular therapy in the extended window: systematic review and meta-analysis. J Neurointerv Surg 2023; 15:e46-e53. [PMID: 35725306 DOI: 10.1136/neurintsurg-2022-018896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND In anterior circulation large vessel occlusion (LVO) in the extended time window, the guidelines recommend advanced imaging (ADVI) to select patients for endovascular therapy (EVT). However, questions remain regarding its availability and applicability in the real world. It is unclear whether an approach to the extended window EVT that does not use ADVI would be equivalent. METHODS In April 2022, a literature search was performed to identified randomized controlled trials (RCT) and observational studies describing 90-day outcomes. We performed a meta-analysis of the proportion of aggregate using a random effect to estimate rates of functional independence, defined as modified Rankin Scale (mRS) score ≤2 at 90 days, mean mRS, mortality and symptomatic intracranial hemorrhage (sICH) stratified by imaging modality. RESULTS Four RCTs and 28 observational studies were included. The pooled proportion of functional independence among patients selected by ADVI was 44% (95% CI 39% to 48%; I2=80%) and 48% (95% CI 41% to 55%; I2=75%) with non-contrast CT/CT angiography (NCCT/CTA) (p=0.36). Mean mRS with ADVI was 2.88 (95% CI 2.36 to 3.41; I2=0.0%) and 2.79 (95% CI 2.31 to 3.27; I2=0.0%) with NCCT (p=0.79). Mortality in patients selected by ADVI was 13% (95% CI 10% to 17%; I2=81%) and 16% (95% CI 12% to 22%; I2=69%) with NCCT (p=0.29). sICH with ADVI was 4% (95% CI 3% to 7%; I2=73%) and 6% with NCCT/CTA (95% CI 4% to 8%; I2=6%, p=0.27). CONCLUSIONS Our study suggests that, in anterior circulation LVO, the rates of functional independence may be similar when patients are selected using ADVI or NCCT for EVT in the extended time window. A simplified triage protocol does not seem to increase mortality or sICH. PROTOCOL REGISTRATION NUMBER: (PROSPERO ID: CRD42021236092).
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Affiliation(s)
- Joel M Sequeiros
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aaron Rodriguez-Calienes
- Grupo de Investigacion Neurociencia, Efectividad Clinica y Salud Publica, Universidad Científica del Sur, Lima, Peru
| | - Sandra S Chavez-Malpartida
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Servicio de Neurologia, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigacion, Hospital Daniel Alcides Carrion, Callao, Peru
| | - Cristian Morán-Mariños
- Unidad de Investigacion en Bibliometria, Universidad San Ignacio de Loyola, Lima, Peru
- Servicio de Neumologia, Hospital Nacional Dos de Mayo, Lima, Peru
| | - Giancarlo Alvarado-Gamarra
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Departamento de Pediatria, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Departamento de Pediatria, Instituto de Investigación Nutricional, Lima, Peru
| | - Marco Malaga
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
| | - Alvaro Quincho-Lopez
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Wendy Hernadez-Fernandez
- Servicio de Neurologia, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigacion, Hospital Daniel Alcides Carrion, Callao, Peru
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Vicerrectorado de Investigacion, Unidad de Investigacion para la Generacion y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel Hoit
- Department of Neurosurgery, University of Tennessee Health Science Center - Semmens Murphy Clinic, Memphis, TN, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center - Semmens Murphy Clinic, Memphis, TN, USA
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Carlos Alva-Diaz
- Grupo de Investigacion Neurociencia, Efectividad Clinica y Salud Publica, Universidad Científica del Sur, Lima, Peru
- Servicio de Neurologia, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigacion, Hospital Daniel Alcides Carrion, Callao, Peru
| | - Lucas Elijovich
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center - Semmens Murphy Clinic, Memphis, TN, USA
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Sarfo FS, Boateng R, Opare-Addo PA, Gyamfi RA, Nguah SB, Ovbiagele B. Prevalence and predictors of low folate levels among stroke survivors in a country without mandatory folate food fortification: Analysis of a Ghanaian sample. J Stroke Cerebrovasc Dis 2023; 32:107239. [PMID: 37480805 PMCID: PMC10529575 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND While additional folic acid (FA) treatment has a neutral effect on lowering overall vascular risk in countries that mandate FA fortification of food, meta-analytic data suggest that folate supplementation reduces stroke risk in certain patient subgroups, and among people living in countries without mandatory folate food fortification. However, the burden of folate deficiency among adults with stroke in the world's poorest continent is unknown. PURPOSE To assess the prevalence and predictors of folate deficiency among recent ischemic stroke survivors. METHODS We analyzed data among consecutively encountered ischemic stroke patients aged ≥18 years at a tertiary medical center in Kumasi, Ghana between 10/2020 - 08/2021. We identified a modest sample of stroke free adults to serve as a comparator group. Fasting serum folate was measured using a radioimmunoassay and a cut-off of 4ng/mL used to define folate deficiency. Factors associated with serum folate concentration were assessed using a multilinear regression model. RESULTS Comparing stroke cases (n = 116) with stroke-free comparators (n = 20), mean folate concentration was lower among stroke cases (7 ng/ml vs. 10.2 ng/ml, p = 0.004). Frequency of folate deficiency was higher among stroke cases vs. stroke-free controls (31% vs 5%, p = 0.02). Male sex (beta coefficient of -2.6 (95% CI: -4.2, -0.9) and LDL (β: -0.76; -1.4, -0.07) were significantly associated with serum folate concentration. CONCLUSION Almost one in three ischemic stroke survivors have folate deficiency potentially accentuating their risk for further adverse atherosclerotic events in a setting without folate fortification. A clinical trial of folate supplementation among stroke survivors is warranted.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | | | | | - Samuel Blay Nguah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
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Manso-Calderón R, Cacabelos-Pérez P, Sevillano-García MD, Herrero-Prieto ME, González-Sarmiento R. Analysis of endothelial gene polymorphisms in Spanish patients with vascular dementia and Alzheimer´s disease. Sci Rep 2023; 13:13441. [PMID: 37596325 PMCID: PMC10439194 DOI: 10.1038/s41598-023-39576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/14/2020] [Indexed: 08/20/2023] Open
Abstract
There is increasing evidence for the involvement of blood-brain barrier (BBB) in vascular dementia (VaD) and Alzheimer´s disease (AD) pathogenesis. However, the role of endothelial function-related genes in these disorders remains unclear. We evaluated the association of four single-nucleotide polymorphisms (VEGF, VEGFR2 and NOS3) with diagnosis and rate of cognitive decline in AD and VaD in a Spanish case-control cohort (150 VaD, 147 AD and 150 controls). Participants carrying -604AA genotype in VEGFR2 (rs2071559) were less susceptible to VaD after multiple testing. Further analysis for VaD subtype revealed a significant difference between small-vessel VaD patients and controls, but not for large-vessel VaD patients. In addition, -2578A and -460C alleles in VEGF (rs699947 and rs833061) showed to decrease the risk of AD, whereas NOS3 (rs1799983) influenced disease progression. Our study supports previous findings of a deleterious effect of VEGFR2 reduced expression on small-vessel disease, but not on large-vessel disease; as well as a detrimental effect of down-regulating VEGF and eNOS in AD, affecting vascular permeability and neuronal survival. These data highlight the relevance of endothelial function and, therefore, BBB in both VaD and AD.
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Affiliation(s)
- Raquel Manso-Calderón
- Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, 37007, Salamanca, Spain.
- Division of Neurology, Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain.
- Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.
| | - Purificación Cacabelos-Pérez
- Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, 37007, Salamanca, Spain
- Department of Neurology, Hospital Clínico Universitario de Santiago (CHUS), A Coruña, Spain
| | - M Dolores Sevillano-García
- Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - M Elisa Herrero-Prieto
- Division of Neurology, Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain
- Division of Neurology, Department of Internal Medicine, Hospital El Bierzo de Ponferrada, León, Spain
| | - Rogelio González-Sarmiento
- Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
- Molecular Medicine Unit, Department of Medicine, University of Salamanca, Salamanca, Spain
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Hinman JD, Elahi F, Chong D, Radabaugh H, Ferguson A, Maillard P, Thompson JF, Rosenberg GA, Sagare A, Moghekar A, Lu H, Lee T, Wilcock D, Satizabal CL, Tracy R, Seshadri S, Schwab K, Helmer K, Singh H, Kivisäkk P, Greenberg S, DeCarli C, Kramer J. Placental growth factor as a sensitive biomarker for vascular cognitive impairment. Alzheimers Dement 2023; 19:3519-3527. [PMID: 36815663 PMCID: PMC10440207 DOI: 10.1002/alz.12974] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/14/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023]
Abstract
INTRODUCTION High-performing biomarkers measuring the vascular contributions to cognitive impairment and dementia are lacking. METHODS Using a multi-site observational cohort study design, we examined the diagnostic accuracy of plasma placental growth factor (PlGF) within the MarkVCID Consortium (n = 335; CDR 0-1). Subjects underwent clinical evaluation, cognitive testing, MRI, and blood sampling as defined by Consortium protocols. RESULTS In the prospective population of 335 subjects (72.2 ± 7.8 years of age, 49.3% female), plasma PlGF (pg/mL) shows an ordinal odds ratio (OR) of 1.16 (1.07-1.25; P = .0003) for increasing Fazekas score and ordinal OR of 1.22 (1.14-1.32; P < .0001) for functional cognitive impairment measured by the Clinical Dementia Rating scale. We achieved the primary study outcome of a site-independent association of plasma PlGF (pg/mL) with white matter injury and cognitive impairment in two of three study cohorts. Secondary outcomes using the full MarkVCID cohort demonstrated that plasma PlGF can significantly discriminate individuals with Fazekas ≥ 2 and CDR = 0.5 (area under the curve [AUC] = 0.74) and CDR = 1 (AUC = 0.89) from individuals with CDR = 0. DISCUSSION Plasma PlGF measured by standardized immunoassay functions as a stable, reliable, diagnostic biomarker for cognitive impairment associated with substantial white matter burden.
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Affiliation(s)
- Jason D. Hinman
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles
- Department of Neurology, West Los Angeles Veterans Association Medical Center, Department of Veterans Affairs
| | - Fanny Elahi
- Memory and Aging Center, Weill Institute for Neuroscience, University of California San Francisco
- Department of Neurology, San Francisco Veterans Association Medical Center, Department of Veterans Affairs
| | - Davis Chong
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles
| | - Hannah Radabaugh
- Department of Neurological Surgery, Weill Institute for Neuroscience, University of California San Francisco
| | - Adam Ferguson
- Department of Neurology, San Francisco Veterans Association Medical Center, Department of Veterans Affairs
- Department of Neurological Surgery, Weill Institute for Neuroscience, University of California San Francisco
| | | | | | | | - Abhay Sagare
- Zilkha Neurogenetic Institute, University of Southern California
| | | | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University
| | - Tiffany Lee
- Sanders-Brown Center on Aging, Department of Physiology, University of Kentucky
| | - Donna Wilcock
- Sanders-Brown Center on Aging, Department of Physiology, University of Kentucky
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, UT Health San Antonio
| | - Russell Tracy
- Department of Pathology & Laboratory Medicine, Larner College of Medicine, University of Vermont
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, UT Health San Antonio
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard University
| | - Karl Helmer
- Department of Neurology, Massachusetts General Hospital, Harvard University
| | - Herpreet Singh
- Department of Neurology, Massachusetts General Hospital, Harvard University
| | - Pia Kivisäkk
- Department of Neurology, Massachusetts General Hospital, Harvard University
| | - Steve Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard University
| | | | - Joel Kramer
- Memory and Aging Center, Weill Institute for Neuroscience, University of California San Francisco
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Tap L, Vernooij MW, Wolters F, van den Berg E, Mattace-Raso FUS. New horizons in cognitive and functional impairment as a consequence of cerebral small vessel disease. Age Ageing 2023; 52:afad148. [PMID: 37585592 PMCID: PMC10431695 DOI: 10.1093/ageing/afad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/06/2023] [Indexed: 08/18/2023] Open
Abstract
Cerebral small vessel disease (cSVD) is a frequent finding in imaging of the brain in older adults, especially in the concomitance of cardiovascular disease risk factors. Despite the well-established link between cSVD and (vascular) cognitive impairment (VCI), it remains uncertain how and when these vascular alterations lead to cognitive decline. The extent of acknowledged markers of cSVD is at best modestly associated with the severity of clinical symptoms, but technological advances increasingly allow to identify and quantify the extent and perhaps also the functional impact of cSVD more accurately. This will facilitate a more accurate diagnosis of VCI, against the backdrop of concomitant other neurodegenerative pathology, and help to identify persons with the greatest risk of cognitive and functional deterioration. In this study, we discuss how better assessment of cSVD using refined neuropsychological and comprehensive geriatric assessment as well as modern image analysis techniques may improve diagnosis and possibly the prognosis of VCI. Finally, we discuss new avenues in the treatment of cSVD and outline how these contemporary insights into cSVD can contribute to optimise screening and treatment strategies in older adults with cognitive impairment and multimorbidity.
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Affiliation(s)
- Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank Wolters
- Department of Epidemiology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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McLeod A, Bernabe BP, Xia Y, Sanchez-Flack J, Lamar M, Schiffer L, Hemphill NON, Fantuzzi G, Maki P, Fitzgibbon M, Tussing-Humphreys L. Exploring the Effects of a Mediterranean Diet and Weight Loss on the Gut Microbiome and Cognitive Performance in Older, African American Obese Adults: A Post Hoc Analysis. Nutrients 2023; 15:3332. [PMID: 37571270 PMCID: PMC10420801 DOI: 10.3390/nu15153332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
African American adults have a higher prevalence of Alzheimer's dementia (AD) than non-Hispanic Whites. The impact of a Mediterranean Diet (Med Diet) and intentional weight loss (IWL) on the gut microbiome may alter AD risk. A post hoc analysis of the Building Research in Diet and Cognition (BRIDGE) trial was performed to determine whether participation in an 8-month Med Diet lifestyle intervention with (n = 35) or without IWL (n = 31) was associated with changes in gut microbiota structure, abundance, and function and whether these changes were related to changes in cognitive performance. The results showed that family and genus alpha diversity increased significantly in both groups combined (p = 0.0075 and p = 0.024, respectively). However, there were no other significant microbially related within- or between-group changes over time. Also, an increase in Med Diet adherence was significantly associated with a decrease in alpha diversity at the phylum level only (p = 0.049). Increasing alpha diversity was associated with decreasing cognitive performance, but this association was attenuated after controlling for Med Diet adherence. In sum, an 8-month Med Diet lifestyle intervention with or without IWL did not appreciably alter the gut microbiome.
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Affiliation(s)
- Andrew McLeod
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA; (G.F.); (L.T.-H.)
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
| | | | - Yinglin Xia
- Department of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.X.); (M.L.)
| | - Jennifer Sanchez-Flack
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL 60612, USA
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Melissa Lamar
- Department of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.X.); (M.L.)
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL 60612, USA
| | - Linda Schiffer
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
| | | | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA; (G.F.); (L.T.-H.)
| | - Pauline Maki
- Departments of Psychology and Psychiatry, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Marian Fitzgibbon
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL 60612, USA
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA; (G.F.); (L.T.-H.)
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA; (J.S.-F.); (L.S.); (M.F.)
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA
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Yang R, Li J, Qin Y, Zhao L, Liu R, Yang F, Jiang G. A bibliometric analysis of cerebral microbleeds and cognitive impairment. Brain Cogn 2023; 169:105999. [PMID: 37262941 DOI: 10.1016/j.bandc.2023.105999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Cerebral microbleeds (CMBs) are imaging markers for small cerebral vascular diseases, which can accumulate and impact the corresponding brain networks. CMBs can affect cognitive function, including executive function, information processing speed, and visuospatial memory. Bibliometrics is a scientific and innovative method that can analyze and visualize the scientific field quantitatively. In this study, we aimed to use bibliometric analysis to demonstrate the relationship and mechanisms between CMBs and cognitive impairment. Furthermore, we reviewed the relationship between CMBs and different cognitive disorders. The use of bibliometrics can help further clarify this relationship. METHODS We retrieved articles on CMBs and cognitive impairment from the Web of Science Core Collection. The keywords (such as stroke, dementia, and cerebral amyloid angiopathy), authors, countries, institutions and journals, in the field were visually analyzed using VOSviewer software and bibliometric websites. RESULTS This bibliometric analysis reveals the related trends of CMBs in the field of cognitive impairment. CMBs, along with other small vascular lesions, constitute the basis of cognitive impairment, and studying CMBs is essential to understand the mechanisms underlying cognitive impairment. CONCLUSION This bibliometric analysis reveals a strong link between CMBs and cognitive impairment-related diseases and that specific brain networks were affected by CMBs. This provides further insights into the possible mechanisms and causes of CMBs and cognitive impairment. The direct and indirect damage (such as oxidative stress and neuroinflammation) to the brain caused by CMBs, destruction of the frontal-subcortical circuits, elevated Cystatin C levels, and iron deposition are involved in the occurrence and development of cognitive impairment. CMBs may be a potential marker for detecting, quantifying, and predicting cognitive impairment.
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Affiliation(s)
- Rui Yang
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jia Li
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yaya Qin
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Zhao
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Rong Liu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Fanhui Yang
- Department of Nuclear Medicine, Affiliated Hospital of North Sichuan Medical College North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
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Anita NZ, Kwan F, Ryoo SW, Major-Orfao C, Lin WZ, Noor S, Lanctôt KL, Herrmann N, Oh PI, Shah BR, Gilbert J, Assal A, Halperin IJ, Taha AY, Swardfager W. Cytochrome P450-soluble epoxide hydrolase derived linoleic acid oxylipins and cognitive performance in type 2 diabetes. J Lipid Res 2023; 64:100395. [PMID: 37245563 PMCID: PMC10394387 DOI: 10.1016/j.jlr.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) increases the risk of cognitive decline and dementia. Disruptions in the cytochrome P450-soluble epoxide hydrolase (CYP450-sEH) pathway have been reported in T2DM, obesity and cognitive impairment. We examine linoleic acid (LA)-derived CYP450-sEH oxylipins and cognition in T2DM and explore potential differences between obese and nonobese individuals. The study included 51 obese and 57 nonobese participants (mean age 63.0 ± 9.9, 49% women) with T2DM. Executive function was assessed using the Stroop Color-Word Interference Test, FAS-Verbal Fluency Test, Digit Symbol Substitution Test, and Trails Making Test-Part B. Verbal memory was assessed using the California Verbal Learning Test, second Edition. Four LA-derived oxylipins were analyzed by ultra-high-pressure-LC/MS, and the 12,13-dihydroxyoctadecamonoenoic acid (12,13-DiHOME) considered the main species of interest. Models controlled for age, sex, BMI, glycosylated hemoglobin A1c, diabetes duration, depression, hypertension, and education. The sEH-derived 12,13-DiHOME was associated with poorer executive function scores (F1,98 = 7.513, P = 0.007). The CYP450-derived 12(13)-epoxyoctadecamonoenoic acid (12(13)-EpOME) was associated with poorer executive function and verbal memory scores (F1,98 = 7.222, P = 0.008 and F1,98 = 4.621, P = 0.034, respectively). There were interactions between obesity and the 12,13-DiHOME/12(13)-EpOME ratio (F1,97 = 5.498, P = 0.021) and between obesity and 9(10)-epoxyoctadecamonoenoic acid (9(10)-EpOME) concentrations (F1,97 = 4.126, P = 0.045), predicting executive function such that relationships were stronger in obese individuals. These findings suggest that the CYP450-sEH pathway as a potential therapeutic target for cognitive decline in T2DM. For some markers, relationships may be obesity dependent.
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Affiliation(s)
- Natasha Z Anita
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Felicia Kwan
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Si Won Ryoo
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Chelsi Major-Orfao
- Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - William Z Lin
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Shiropa Noor
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Paul I Oh
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Baiju R Shah
- Sunnybrook Research Institute, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Angela Assal
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Ameer Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA; West Coast Metabolomics Center, Genome Center, University of California, Davis, Davis, CA, USA; Center for Neuroscience, University of California, Davis, Davis, CA, USA
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
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Salvadori E, Pantoni L. Teleneuropsychology for vascular cognitive impairment: Which tools do we have? CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100173. [PMID: 37457663 PMCID: PMC10299844 DOI: 10.1016/j.cccb.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
The halt of clinical activities imposed during the COVID-19 pandemic forced clinicians to find alternative strategies to provide continuity of care and services, and led to a renewed interest in use of teleneuropsychology (TNP) to remotely assess patients. Recent TNP guidelines recommend maximizing the reproduction of standard in-person assessment, particularly through videoconferences. However, consistency of the adaptations of usual cognitive tests to videoconference needs further elucidation. This review aims at critical reviewing which cognitive tests could be recommended for a remote evaluation of patients with vascular cognitive impairment (VCI) among those widely recognized as reference standards. Current evidence supports the use of global cognitive efficiency (MMSE and MoCA), verbal memory (Revised Hopkins Verbal Learning Test), and language tests (phonemic and semantic verbal fluencies, Boston Naming Test), while there is a lack of strong validity support for measures of visuospatial functions (Rey-Osterreith Complex Figure), and executive functioning and processing speed (Trail making Test, and Digit symbol or Symbol digit tests). This represents a major limitation in the evaluation of VCI because its cognitive profile in often characterized by attention and executive deficits. At present, a videoconference TNP visit appears useful for a brief evaluation of global cognitive efficiency, and to 'triage' patients towards a second level in person evaluation. In future, hybrid models of TNP based on data collected across multiple modalities, incorporating both adaptation of usual cognitive tools and new computerized tools in the supervised videoconference setting, are likely to become the best option for a comprehensive remote cognitive assessment.
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Affiliation(s)
- Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Leonardo Pantoni
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Ozzoude M, Varriano B, Beaton D, Ramirez J, Adamo S, Holmes MF, Scott CJM, Gao F, Sunderland KM, McLaughlin P, Goubran M, Kwan D, Roberts A, Bartha R, Symons S, Tan B, Swartz RH, Abrahao A, Saposnik G, Masellis M, Lang AE, Marras C, Zinman L, Shoesmith C, Borrie M, Fischer CE, Frank A, Freedman M, Montero-Odasso M, Kumar S, Pasternak S, Strother SC, Pollock BG, Rajji TK, Seitz D, Tang-Wai DF, Turnbull J, Dowlatshahi D, Hassan A, Casaubon L, Mandzia J, Sahlas D, Breen DP, Grimes D, Jog M, Steeves TDL, Arnott SR, Black SE, Finger E, Rabin J, Tartaglia MC. White matter hyperintensities and smaller cortical thickness are associated with neuropsychiatric symptoms in neurodegenerative and cerebrovascular diseases. Alzheimers Res Ther 2023; 15:114. [PMID: 37340319 PMCID: PMC10280981 DOI: 10.1186/s13195-023-01257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are a core feature of most neurodegenerative and cerebrovascular diseases. White matter hyperintensities and brain atrophy have been implicated in NPS. We aimed to investigate the relative contribution of white matter hyperintensities and cortical thickness to NPS in participants across neurodegenerative and cerebrovascular diseases. METHODS Five hundred thirteen participants with one of these conditions, i.e. Alzheimer's Disease/Mild Cognitive Impairment, Amyotrophic Lateral Sclerosis, Frontotemporal Dementia, Parkinson's Disease, or Cerebrovascular Disease, were included in the study. NPS were assessed using the Neuropsychiatric Inventory - Questionnaire and grouped into hyperactivity, psychotic, affective, and apathy subsyndromes. White matter hyperintensities were quantified using a semi-automatic segmentation technique and FreeSurfer cortical thickness was used to measure regional grey matter loss. RESULTS Although NPS were frequent across the five disease groups, participants with frontotemporal dementia had the highest frequency of hyperactivity, apathy, and affective subsyndromes compared to other groups, whilst psychotic subsyndrome was high in both frontotemporal dementia and Parkinson's disease. Results from univariate and multivariate results showed that various predictors were associated with neuropsychiatric subsyndromes, especially cortical thickness in the inferior frontal, cingulate, and insula regions, sex(female), global cognition, and basal ganglia-thalamus white matter hyperintensities. CONCLUSIONS In participants with neurodegenerative and cerebrovascular diseases, our results suggest that smaller cortical thickness and white matter hyperintensity burden in several cortical-subcortical structures may contribute to the development of NPS. Further studies investigating the mechanisms that determine the progression of NPS in various neurodegenerative and cerebrovascular diseases are needed.
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Affiliation(s)
- Miracle Ozzoude
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Brenda Varriano
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Derek Beaton
- Data Science & Advanced Analytic, St. Michael's Hospital, Toronto, ON, Canada
| | - Joel Ramirez
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Sabrina Adamo
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, ON, Canada
| | - Melissa F Holmes
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher J M Scott
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Fuqiang Gao
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Maged Goubran
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Donna Kwan
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Queen's University, Kingston, ON, Canada
| | - Angela Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Robert Bartha
- Robarts Research Institute, Western University, London, ON, Canada
| | - Sean Symons
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Richard H Swartz
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mario Masellis
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Anthony E Lang
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Connie Marras
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Lorne Zinman
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Christen Shoesmith
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Michael Borrie
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Corinne E Fischer
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Andrew Frank
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Morris Freedman
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Manuel Montero-Odasso
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Lawsone Health Research Institute, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, London, ON, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephen Pasternak
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stephen C Strother
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Dallas Seitz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David F Tang-Wai
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - John Turnbull
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Leanne Casaubon
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Healthcare Centre, London, ON, Canada
| | - Demetrios Sahlas
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - David Grimes
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Thomas D L Steeves
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stephen R Arnott
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Rabin
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada.
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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Rajeev V, Chai YL, Poh L, Selvaraji S, Fann DY, Jo DG, De Silva TM, Drummond GR, Sobey CG, Arumugam TV, Chen CP, Lai MKP. Chronic cerebral hypoperfusion: a critical feature in unravelling the etiology of vascular cognitive impairment. Acta Neuropathol Commun 2023; 11:93. [PMID: 37309012 DOI: 10.1186/s40478-023-01590-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
Vascular cognitive impairment (VCI) describes a wide spectrum of cognitive deficits related to cerebrovascular diseases. Although the loss of blood flow to cortical regions critically involved in cognitive processes must feature as the main driver of VCI, the underlying mechanisms and interactions with related disease processes remain to be fully elucidated. Recent clinical studies of cerebral blood flow measurements have supported the role of chronic cerebral hypoperfusion (CCH) as a major driver of the vascular pathology and clinical manifestations of VCI. Here we review the pathophysiological mechanisms as well as neuropathological changes of CCH. Potential interventional strategies for VCI are also reviewed. A deeper understanding of how CCH can lead to accumulation of VCI-associated pathology could potentially pave the way for early detection and development of disease-modifying therapies, thus allowing preventive interventions instead of symptomatic treatments.
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Affiliation(s)
- Vismitha Rajeev
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
| | - Yuek Ling Chai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
| | - Luting Poh
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
| | - Sharmelee Selvaraji
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore, Singapore
| | - David Y Fann
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dong-Gyu Jo
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - T Michael De Silva
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Christopher G Sobey
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Thiruma V Arumugam
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Christopher P Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- NUS Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mitchell K P Lai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.
- NUS Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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70
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Yang X, Chen C, Wang A, Li C, Cheng G. Imaging, Genetic, and Pathological Features of Vascular Dementia. Eur Neurol 2023; 86:277-284. [PMID: 37271126 DOI: 10.1159/000531088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/14/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Over the past decades, marked progress has been made in detecting vascular dementia (VD) both through maturation of diagnostic concepts and advances in brain imaging, especially MRI. We summarized the imaging, genetic, and pathological features of VD in this review. SUMMARY It is a challenge for the diagnosis and treatment of VD, particularly in patients where there is no evident temporal relation between cerebrovascular events and cognitive dysfunction. In patients with cognitive dysfunction with poststroke onset, the etiological classification is still complicated. KEY MESSAGES In this review, we summarized the clinical, imaging, and genetic as well as pathological features of VD. We hope to offer a framework to translate diagnostic criteria to daily practice, address treatment, and highlight some future perspectives.
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Affiliation(s)
- Xiaoni Yang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chao Chen
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Aishuai Wang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Changsheng Li
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guangqing Cheng
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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71
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Broatch JR, Zarekookandeh N, Glarin R, Strik M, Johnston LA, Moffat BA, Bird LJ, Gunningham K, Churilov L, Johns HT, Askew CD, Levinger I, O'Riordan SF, Bishop DJ, Brodtmann A. Train Smart Study: protocol for a randomised trial investigating the role of exercise training dose on markers of brain health in sedentary middle-aged adults. BMJ Open 2023; 13:e069413. [PMID: 37225276 DOI: 10.1136/bmjopen-2022-069413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Regular aerobic exercise is associated with improved cognitive function, implicating it as a strategy to reduce dementia risk. This is reinforced by the association between greater cardiorespiratory fitness and larger brain volume, superior cognitive performance and lower dementia risk. However, the optimal aerobic exercise dose, namely the intensity and mode of delivery, to improve brain health and lower dementia risk has received less attention. We aim to determine the effect of different doses of aerobic exercise training on markers of brain health in sedentary middle-aged adults, hypothesising that high-intensity interval training (HIIT) will be more beneficial than moderate-intensity continuous training (MICT). METHODS AND ANALYSIS In this two-group parallel, open-label blinded endpoint randomised trial, 70 sedentary middle-aged (45-65 years) adults will be randomly allocated to one of two 12-week aerobic exercise training interventions matched for total exercise training volume: (1) MICT (n=35) or HIIT (n=35). Participants will perform ~50 min exercise training sessions, 3 days per week, for 12 weeks. The primary outcome will be measured as between-group difference in cardiorespiratory fitness (peak oxygen uptake) change from baseline to the end of training. Secondary outcomes include between-group differences in cognitive function and ultra-high field MRI (7T) measured markers of brain health (brain blood flow, cerebrovascular function, brain volume, white matter microstructural integrity and resting state functional brain activity) changes from baseline to the end of training. ETHICS AND DISSEMINATION The Victoria University Human Research Ethics Committee (VUHREC) has approved this study (HRE20178), and all protocol modifications will be communicated to the relevant parties (eg, VUHREC, trial registry). Findings from this study will be disseminated via peer-review publications, conference presentations, clinical communications and both mainstream and social media. TRIAL REGISTRATION NUMBER ANZCTR12621000144819.
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Affiliation(s)
- James R Broatch
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Navabeh Zarekookandeh
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Rebecca Glarin
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Myrte Strik
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leigh A Johnston
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bradford A Moffat
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Bird
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Kate Gunningham
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hannah T Johns
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Stroke Alliance, Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christopher D Askew
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
- School of Health, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Itamar Levinger
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- The Australian Institute of Musculoskeletal Sciences, Melbourne, Victoria, Australia
| | - Shane F O'Riordan
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - David J Bishop
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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72
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Smith PJ, Sherwood A, Avorgbedor F, Ingle KK, Kraus WE, Hinderliter AE, Blumenthal JA. Sleep Quality, Metabolic Function, Physical Activity, and Neurocognition Among Individuals with Resistant Hypertension. J Alzheimers Dis 2023:JAD230029. [PMID: 37212110 DOI: 10.3233/jad-230029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Resistant hypertension (RH) is a major risk factor for stroke, cognitive decline, and dementia. Sleep quality is increasingly suggested to play an important role linking RH to cognitive outcomes, although the mechanisms linking sleep quality to poor cognitive function have yet to be fully delineated. OBJECTIVE To delineate biobehavioral mechanisms linking sleep quality, metabolic function, and cognitive function among 140 overweight/obese adults with RH in the TRIUMPH clinical trial. METHODS Sleep quality was indexed using actigraphy measures of sleep quality and sleep fragmentation, as well as self-reported sleep quality from the Pittsburgh Sleep Quality Index (PSQI). Cognitive function was assessed using a 45-minute battery assessing executive function, processing speed, and memory. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA) for 4 months. RESULTS Better sleep quality at baseline was associated with better executive function (B = 0.18 p = 0.027), as well as greater fitness (B = 0.27, p = 0.007) and lower HBA1c (B = -0.25, p = 0.010). Cross-sectional analyses revealed that the sleep quality executive function association was mediated by HBA1c (B = 0.71 [0.05, 2.05]). C-LIFE improved sleep quality (-1.1 [-1.5, -0.6] versus+-0.1 [-0.8, 0.7]) and actigraphy steps (+922 [529, 1316] versus+56 [-548, 661]), with actigraphy mediating improvements in executive function (B = 0.40 [0.02, 1.07]). CONCLUSION Better metabolic function and improved physical activity patterns levels play important roles linking sleep quality and executive function in RH.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Forgive Avorgbedor
- Department of Nursing, University of North Carolina at Greensboro, NC, USA
| | - Krista K Ingle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - William E Kraus
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan E Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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73
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Levine DA, Chen B, Galecki AT, Gross AL, Briceño EM, Whitney RT, Ploutz-Snyder RJ, Giordani BJ, Sussman JB, Burke JF, Lazar RM, Howard VJ, Aparicio HJ, Beiser AS, Elkind MSV, Gottesman RF, Koton S, Pendlebury ST, Sharma A, Springer MV, Seshadri S, Romero JR, Hayward RA. Associations Between Vascular Risk Factor Levels and Cognitive Decline Among Stroke Survivors. JAMA Netw Open 2023; 6:e2313879. [PMID: 37195662 PMCID: PMC10193182 DOI: 10.1001/jamanetworkopen.2023.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/30/2023] [Indexed: 05/18/2023] Open
Abstract
Importance Incident stroke is associated with accelerated cognitive decline. Whether poststroke vascular risk factor levels are associated with faster cognitive decline is uncertain. Objective To evaluate associations of poststroke systolic blood pressure (SBP), glucose, and low-density lipoprotein (LDL) cholesterol levels with cognitive decline. Design, Setting, and Participants Individual participant data meta-analysis of 4 US cohort studies (conducted 1971-2019). Linear mixed-effects models estimated changes in cognition after incident stroke. Median (IQR) follow-up was 4.7 (2.6-7.9) years. Analysis began August 2021 and was completed March 2023. Exposures Time-dependent cumulative mean poststroke SBP, glucose, and LDL cholesterol levels. Main Outcomes and Measures The primary outcome was change in global cognition. Secondary outcomes were change in executive function and memory. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition. Results A total of 1120 eligible dementia-free individuals with incident stroke were identified; 982 (87.7%) had available covariate data and 138 (12.3%) were excluded for missing covariate data. Of the 982, 480 (48.9%) were female individuals, and 289 (29.4%) were Black individuals. The median age at incident stroke was 74.6 (IQR, 69.1-79.8; range, 44.1-96.4) years. Cumulative mean poststroke SBP and LDL cholesterol levels were not associated with any cognitive outcome. However, after accounting for cumulative mean poststroke SBP and LDL cholesterol levels, higher cumulative mean poststroke glucose level was associated with faster decline in global cognition (-0.04 points/y faster per each 10-mg/dL increase [95% CI, -0.08 to -0.001 points/y]; P = .046) but not executive function or memory. After restricting to 798 participants with apolipoprotein E4 (APOE4) data and controlling for APOE4 and APOE4 × time, higher cumulative mean poststroke glucose level was associated with a faster decline in global cognition in models without and with adjustment for cumulative mean poststroke SBP and LDL cholesterol levels (-0.05 points/y faster per 10-mg/dL increase [95% CI, -0.09 to -0.01 points/y]; P = .01; -0.07 points/y faster per 10-mg/dL increase [95% CI, -0.11 to -0.03 points/y]; P = .002) but not executive function or memory declines. Conclusions and Relevance In this cohort study, higher poststroke glucose levels were associated with faster global cognitive decline. We found no evidence that poststroke LDL cholesterol and SBP levels were associated with cognitive decline.
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Affiliation(s)
- Deborah A. Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Bingxin Chen
- Department of Nursing, University of Michigan, Ann Arbor
| | - Andrzej T. Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, Maryland
| | - Emily M. Briceño
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Rachael T. Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | | | - Bruno J. Giordani
- Department of Psychiatry and Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor
| | - Jeremy B. Sussman
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - James F. Burke
- Department of Neurology, Ohio State University College of Medicine, Columbus
| | - Ronald M. Lazar
- Department of Neurology and Evelyn F. McKnight Brain Institute, Heersink School of Medicine, University of Alabama at Birmingham
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health
| | - Hugo J. Aparicio
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
| | - Alexa S. Beiser
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, Maryland
- Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Sarah T. Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Departments of Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Anu Sharma
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | - Mellanie V. Springer
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Sudha Seshadri
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
- Department of Neurology and Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, Joe R. and Teresa Lozano Long School of Medicine, University of Texas San Antonio
| | - Jose R. Romero
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
| | - Rodney A. Hayward
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Kaddumukasa MN, Kaddumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda. BMC Neurol 2023; 23:166. [PMID: 37098461 PMCID: PMC10127321 DOI: 10.1186/s12883-023-03212-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/15/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Little is known about the characteristics and determinants of post-stroke cognitive impairment in residents of low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. METHODS 131 patients were enrolled a minimum of 3-months after hospital admission for stroke. A questionnaire, clinical examination findings, and laboratory test results were used to collect demographic information and data on vascular risk factors and clinical characteristics. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. RESULTS The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. CONCLUSIONS Our findings highlight the high burden and need for awareness of cognitive impairment in post stroke populations in the sub-Saharan region and serve to emphasize the importance of detailed cognitive assessment as part of routine clinical evaluation of patients who have had a stroke.
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Affiliation(s)
- Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lillian D Namujju
- Department of Electrical and Computer Engineering, College of Engineering, Design, Art and Technology, Makerere University, Kampala, Uganda
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75
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Yu S, Wang L, Jing X, Wang Y, An C. Features of gut microbiota and short-chain fatty acids in patients with first-episode depression and their relationship with the clinical symptoms. Front Psychol 2023; 14:1088268. [PMID: 37168424 PMCID: PMC10165121 DOI: 10.3389/fpsyg.2023.1088268] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/31/2023] [Indexed: 05/13/2023] Open
Abstract
Objective To compare the differences in gut microbiota and short-chain fatty acids (SCFAs; metabolites of gut microbiota) in the serum of patients with first-episode depression and the healthy population and to analyze the relationship between gut microbiota and metabolite SCFAs and the clinical symptoms of major depressive disorder (MDD). Methods A total of 45 patients with first-episode depression and 22 healthy volunteers were chosen to complete relevant scale evaluations, and feces samples and venous blood samples were collected. The 16S RNA method was used to analyze the intestinal microflora and the characteristics of serum SCFAs detection by ELISA kit, as well as the intestinal flora, SCFAs content and their correlation with MDD clinical indicators. Results The abundance of Akkermansia, Megamonas, Prevotellaceae NK3B31 group, and butyrate-producing bacteria, Lachnospira, Subdoligranulum, Blautia, and Dialister, and acetate-producing bacteria, Streptococcus, in the gut microbiota of the MDD group was lower than that in the control (C) group. The abundance of Parasutterella in the MDD group was higher than that in the C group. Dialister negatively correlated with all measured clinical symptoms (r < 0, P < 0.05). The serum SCFA content in the MDD group was higher than that in the C group, and the content positively correlated with the Hamilton anxiety scale scores (r = 0.584, P < 0.05). Conclusion The results demonstrated that the MDD group differed from the C group in terms of gut microbiota and SCFAs in the serum and that the change in certain intestinal bacteria might participate in the pathogenic mechanism of MDD.
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Affiliation(s)
| | | | | | | | - Cuixia An
- Mental Health Center, The First Hospital of Hebei Medical University, Hebei Clinical Research Center for Mental Disorders and Institute of Mental Health, Hebei Technical Innovation Center for Mental Health Assessment and Intervention, Shijiazhuang, China
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76
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Otoki Y, Yu D, Shen Q, Sahlas DJ, Ramirez J, Gao F, Masellis M, Swartz RH, Chan PC, Pettersen JA, Kato S, Nakagawa K, Black SE, Swardfager W, Taha AY. Quantitative Lipidomic Analysis of Serum Phospholipids Reveals Dissociable Markers of Alzheimer's Disease and Subcortical Cerebrovascular Disease. J Alzheimers Dis 2023; 93:665-682. [PMID: 37092220 DOI: 10.3233/jad-220795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Circulating phospholipid species have been shown to predict Alzheimer's disease (AD) prognosis but the link between phospholipid disturbances and subcortical small vessel cerebrovascular disease (CeVD) common in AD patients is not known. OBJECTIVE This study used quantitative lipidomics to measure serum diacyl, alkenyl (ether), alkyl, and lyso phospholipid species in individuals with extensive CeVD (n = 29), AD with minimal CeVD (n = 16), and AD with extensive CeVD (n = 14), and compared them to age-matched controls (n = 27). Memory was assessed using the California Verbal Learning Test. 3.0T MRI was used to assess hippocampal volume, atrophy, and white matter hyperintensity (WMH) volumes as manifestations of CeVD. RESULTS AD was associated with significantly higher concentrations of choline plasmalogen 18:0_18:1 and alkyl-phosphocholine 18:1. CeVD was associated with significantly lower lysophospholipids containing 16:0. Phospholipids containing arachidonic acid (AA) were associated with poorer memory in controls, whereas docosahexaenoic acid (DHA)-containing phospholipids were associated with better memory in individuals with AD+CeVD. In controls, DHA-containing phospholipids were associated with more atrophy and phospholipids containing linoleic acid and AA were associated with less atrophy. Lysophospholipids containing 16:0, 18:0, and 18:1 were correlated with less atrophy in controls, and of these, alkyl-phosphocholine 18:1 was correlated with smaller WMH volumes. Conversely, 16:0_18:1 choline plasmalogen was correlated with greater WMH volumes in controls. CONCLUSION This study demonstrates discernable differences in circulating phospholipids in individuals with AD and CeVD, as well as new associations between phospholipid species with memory and brain structure that were specific to contexts of commonly comorbid vascular and neurodegenerative pathologies.
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Affiliation(s)
- Yurika Otoki
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
- Laboratory of Food Function Analysis, Graduate School of Agricultural Science, Tohoku University, Sendai, Miyagi, Japan
| | - Di Yu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- LC Campbell Cognitive Neurology Unit, Sunnybrook Research Institute, Toronto, Canada
| | - Qing Shen
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
| | - Demetrios J Sahlas
- Department of Medicine (Neurology Division), McMaster University, Hamilton, Canada
| | - Joel Ramirez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Medicine (Neurology Division) and the Northern Medical Program, University of British Columbia, Vancouver, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Pak Cheung Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jacqueline A Pettersen
- Department of Medicine (Neurology Division) and the Northern Medical Program, University of British Columbia, Vancouver, Canada
| | - Shunji Kato
- Laboratory of Food Function Analysis, Graduate School of Agricultural Science, Tohoku University, Sendai, Miyagi, Japan
| | - Kiyotaka Nakagawa
- Laboratory of Food Function Analysis, Graduate School of Agricultural Science, Tohoku University, Sendai, Miyagi, Japan
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- LC Campbell Cognitive Neurology Unit, Sunnybrook Research Institute, Toronto, Canada
- Department of Medicine (Neurology Division), University of Toronto, Toronto, Canada
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- LC Campbell Cognitive Neurology Unit, Sunnybrook Research Institute, Toronto, Canada
- University Health Network Toronto Rehabilitation Institute, Toronto, Canada
| | - Ameer Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
- West Coast Metabolomics Center, Genome Center, University of California - Davis, Davis, CA, USA
- Center for Neuroscience, University of California - Davis, Davis, CA, USA
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He A, Wang Z, Wu X, Sun W, Yang K, Feng W, Wang Y, Song H. Incidence of post-stroke cognitive impairment in patients with first-ever ischemic stroke: a multicenter cross-sectional study in China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100687. [PMID: 37181529 PMCID: PMC10166998 DOI: 10.1016/j.lanwpc.2023.100687] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/11/2022] [Accepted: 12/24/2022] [Indexed: 01/15/2023]
Abstract
Background Post-stroke cognitive impairment (PSCI) is a common sequela after stroke. China has a large population of stroke survivors, but a large-scale survey on the incidence and risk factors for PSCI has not been undertaken. We aimed to calculate the incidence and risk factors for vascular cognitive symptoms among first-ever stroke survivors in China through a multicenter cross-sectional study. Methods From May 1, 2019 to November 30, 2019, patients with a clinical diagnosis of first-ever ischemic stroke were recruited from 563 hospitalized-based stroke center networks in 30 provinces of China. Cognitive impairment was measured by 5-min National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) at 3-6 months after the indexed stroke. Stepwise multivariate regression and stratified analysis were performed to assess the association between PSCI and demographic variables. Findings A total of 24,055 first-ever ischemic stroke patients were enrolled, with an average age of 70.25 ± 9.88 years. The incidence of PSCI as per the 5-min NINDS-CSN was 78.7%. Age ≥75 years old (OR: 1.887, 95%CI: 1.391-2.559), western regional residence (OR: 1.620, 95%CI: 1.411-1.860) and lower education level were associated with increased PSCI risk. Hypertension might be related to non-PSCI (OR: 0.832, 95%CI: 0.779-0.888). For patients under 45 years old, unemployment was an independent risk factor for PSCI (OR: 6.097, 95%CI: 1.385-26.830). For patients who were residents of the southern region (OR: 1.490, 95%CI: 1.185-1.873) and non-manual workers (OR: 2.122, 95%CI: 1.188-3.792), diabetes was related to PSCI. Interpretation PSCI is common in Chinese patients with first-ever stroke, and many risk factors are related to the occurrence of PSCI. Funding The Beijing Hospitals Authority Youth Program (No. QMS20200801); Youth Program of the National Natural Science Foundation of China (No. 81801142); the Key Project of Science and Technology Development of China Railway Corporation (No. K2019Z005); The Capital Health Research and Development of Special (No. 2020-2-2014); Science and Technology Innovation 2030-Major Project (No. 2021ZD0201806).
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Affiliation(s)
- Aini He
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Zu Wang
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Xiao Wu
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Wei Sun
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Kun Yang
- The Office of National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, USA
| | - Yuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medicine University, Beijing, China
- Beijing Stroke Quality Control Center, Beijing, China
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Kernbach JM, Hartwigsen G, Lim JS, Bae HJ, Yu KH, Schlaug G, Bonkhoff A, Rost NS, Bzdok D. Bayesian stroke modeling details sex biases in the white matter substrates of aphasia. Commun Biol 2023; 6:354. [PMID: 37002267 PMCID: PMC10066402 DOI: 10.1038/s42003-023-04733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Ischemic cerebrovascular events often lead to aphasia. Previous work provided hints that such strokes may affect women and men in distinct ways. Women tend to suffer strokes with more disabling language impairment, even if the lesion size is comparable to men. In 1401 patients, we isolate data-led representations of anatomical lesion patterns and hand-tailor a Bayesian analytical solution to carefully model the degree of sex divergence in predicting language outcomes ~3 months after stroke. We locate lesion-outcome effects in the left-dominant language network that highlight the ventral pathway as a core lesion focus across different tests of language performance. We provide detailed evidence for sex-specific brain-behavior associations in the domain-general networks associated with cortico-subcortical pathways, with unique contributions of the fornix in women and cingular fiber bundles in men. Our collective findings suggest diverging white matter substrates in how stroke causes language deficits in women and men. Clinically acknowledging such sex disparities has the potential to improve personalized treatment for stroke patients worldwide.
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Affiliation(s)
- Julius M Kernbach
- Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), RWTH Aachen University Hospital, Aachen, Germany
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Research Group Cognition and Plasticity, Leipzig, Germany
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Gottfried Schlaug
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Anna Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, QC, Canada.
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada.
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79
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Gallagher R, Ouyang ML, Tofler G, Bauman A, Zhao E, Weddell J, Naismith SL. Sensitivity and specificity of 5 min cognitive screening tests in patients with acute coronary syndrome. Eur J Cardiovasc Nurs 2023; 22:166-174. [PMID: 35714164 DOI: 10.1093/eurjcn/zvac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022]
Abstract
AIMS This study aimed to determine the sensitivity and specificity of the National Institute of Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) brief (5 min) screen composed of three items of the Montreal Cognitive Assessment (MoCA), in acute coronary syndrome (ACS) patients during hospital admission, relative to the full MoCA and potential alternative combinations of other items. METHODS AND RESULTS Participants were consecutively recruited during ACS admission and administered the MoCA before discharge. The three NINDS-CSN screen items were extracted, collated and compared to the full MoCA. Receiver operator characteristic (ROC) curves were created to determine the sensitivity, specificity, and appropriate cut-off scores of the screens. The mean age of the sample (n = 81) was 63.49 [standard deviation (SD) 10.85] years and 49.4% screened positive for cognitive impairment. The NINDS-CSN mean score was 9.22 (SD 2.09 of the potential range 0-12). Area under the ROC (AUC) indicated high accuracy levels for screening for cognitive impairment (AUC = 0.89, P < 0.01, 95% confidence interval 0.82, 0.96) with none of the alternative combination screens performing better on both sensitivity and specificity. A cut-off score of ≤10 on the NINDS-CSN protocol provided 83% sensitivity and 80% specificity for classifying cognitive impairment. CONCLUSION The NINDS-CSN protocol presents an accurate, feasible screen for cognitive impairment in patients following ACS for use at the bedside and potentially also for telephone screens. Diagnostic accuracy should be confirmed using a neurocognitive battery.
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Affiliation(s)
- Robyn Gallagher
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Meng-Lu Ouyang
- Neurological Program, The George Institute for Global Health, City Road, Darlington, Sydney, NSW 2008, Australia
| | - Geoffrey Tofler
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Department of Cardiology, Royal North Shore Hospital, Reserve Road St Leonards, Sydney, NSW 2065, Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Emma Zhao
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Joseph Weddell
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Sharon L Naismith
- Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Faculty of Science, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Brain & Mind Centre, The University of Sydney, Mallet Street Campus, Sydney, NSW 2006, Australia
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80
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Hachinski V. We are preventing some dementias now-But how? The Potamkin lecture. Alzheimers Dement 2023; 19:1067-1072. [PMID: 36134730 DOI: 10.1002/alz.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/09/2022]
Abstract
Most dementias are untreatable and their prevalence is increasing around the world. However, the incidence of dementia is declining in some countries. We need to find out urgently why and how and apply the lessons promptly and widely. Given the multiplicity and variability of environmental, socioeconomic, and individual risk and protective factors, the approach needs to be comprehensive, customized to work in a particular setting, and cost effective, to justify the needed funding. Stroke, heart disease, and dementia share the same major preventable risk and protective factors and pose risks for each other. Preventing them together might result in efficiencies and economies of scale. Prevention can best occur in existing actionable population health units through established leaders in government, non-governmental organizations, and the community, around a positive message of promoting brain health as the key to health, productivity, and well-being.
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Affiliation(s)
- Vladimir Hachinski
- Department of Clinical Neurological Sciences, Robarts Research Institute and University of Western Ontario, London, Ontario, Canada
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81
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de Carvalho Rodrigues J, Fumagalli de Salles J, Ruschel Bandeira D. Evidence of validity based on the relation to other variables and inter-rater reliability of the Cognitive Screening (TRIACOG) for adults with cerebrovascular diseases. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:259-268. [PMID: 34078184 DOI: 10.1080/23279095.2021.1931219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study presents evidence of validity and reliability of the results obtained with the Cognitive Screening (TRIACOG) to evaluate post-stroke adults. The TRIACOG assesses orientation memory, language, arithmetic, praxis, information processing speed, and executive functions. A total of 126 post-stroke adults (M = 63.50; SD = 13.28 years old) and 126 neurologically healthy adults (M = 61.97; SD = 11.48 years old) participated in the study. Performance on the TRIACOG was positively correlated with scores on the Montreal Cognitive Assessment-Basic (MoCA-B), schooling, and reading and writing habits, and negatively correlated with the NIHSS and Rankin scales. Post-stroke adults scored lower and took longer to complete the instrument than neurologically healthy adults. Inter-rater agreement was achieved in scoring the TRIACOG. The TRIACOG presents evidence of validity based on its relationships to other variables (criterion and convergent) and on response processes, in addition to presenting reliability evidence established by inter-rater agreement. We expect that the TRIACOG will be employed by health workers in hospital settings, health units, and medical offices.
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Affiliation(s)
- Jaqueline de Carvalho Rodrigues
- Department of Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Jerusa Fumagalli de Salles
- Department of Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Denise Ruschel Bandeira
- Department of Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
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82
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McLeod A, Penalver Bernabe B, Xia Y, Sanchez-Flack J, Lamar M, Schiffer L, Castellanos K, Fantuzzi G, Maki P, Fitzgibbon M, Tussing-Humphreys L. Comparing the gut microbiome of obese, African American, older adults with and without mild cognitive impairment. PLoS One 2023; 18:e0280211. [PMID: 36827280 PMCID: PMC9955629 DOI: 10.1371/journal.pone.0280211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/08/2022] [Indexed: 02/25/2023] Open
Abstract
Those with mild cognitive impairment (MCI), a precursor to dementia, have a gut microbiome distinct from healthy individuals, but this has only been shown in healthy individuals, not in those exhibiting several risk factors for dementia. Using amplicon 16S rRNA gene sequencing in a case-control study of 60 older (ages 55-76), obese, predominately female, African American adults, those with MCI (cases) had different gut microbiota profiles than controls. While microbial community diversity was similar between cases and controls, the abundances of specific microbial taxa weren't, such as Parabacteroides distasonis (lower in cases) and Dialister invisus (higher in cases). These differences disappeared after adjusting for markers of oxidative stress and systemic inflammation. Cognitive scores were positively correlated with levels of Akkermansia muciniphila, a bacterium associated with reduced inflammation. Our study shows that gut microbial composition may be associated with inflammation, oxidative stress, and MCI in those at high risk for dementia.
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Affiliation(s)
- Andrew McLeod
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, United States of America
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Beatriz Penalver Bernabe
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Yinglin Xia
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Jennifer Sanchez-Flack
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois, United States of America
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Rush University, Chicago, Illinois, United States of America
| | - Linda Schiffer
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Karla Castellanos
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Pauline Maki
- Departments of Psychology and Psychiatry, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Marian Fitzgibbon
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois, United States of America
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, United States of America
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, Illinois, United States of America
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83
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Magalhães TNC, Casseb RF, Gerbelli CLB, Pimentel-Siva LR, Nogueira MH, Teixeira CVL, Carletti AFMK, de Rezende TJR, Joaquim HPG, Talib LL, Forlenza OV, Cendes F, Balthazar MLF. Whole-brain DTI parameters associated with tau protein and hippocampal volume in Alzheimer's disease. Brain Behav 2023; 13:e2863. [PMID: 36601694 PMCID: PMC9927845 DOI: 10.1002/brb3.2863] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
The causes of the neurodegenerative processes in Alzheimer's disease (AD) are not completely known. Recent studies have shown that white matter (WM) damage could be more severe and widespread than whole-brain cortical atrophy and that such damage may appear even before the damage to the gray matter (GM). In AD, Amyloid-beta (Aβ42 ) and tau proteins could directly affect WM, spreading across brain networks. Since hippocampal atrophy is common in the early phase of disease, it is reasonable to expect that hippocampal volume (HV) might be also related to WM integrity. Our study aimed to evaluate the integrity of the whole-brain WM, through diffusion tensor imaging (DTI) parameters, in mild AD and amnestic mild cognitive impairment (aMCI) due to AD (with Aβ42 alteration in cerebrospinal fluid [CSF]) in relation to controls; and possible correlations between those measures and the CSF levels of Aβ42 , phosphorylated tau protein (p-Tau) and total tau (t-Tau). We found a widespread WM alteration in the groups, and we also observed correlations between p-Tau and t-Tau with tracts directly linked to mesial temporal lobe (MTL) structures (fornix and hippocampal cingulum). However, linear regressions showed that the HV better explained the variation found in the DTI measures (with weak to moderate effect sizes, explaining from 9% to 31%) than did CSF proteins. In conclusion, we found widespread alterations in WM integrity, particularly in regions commonly affected by the disease in our group of early-stage disease and patients with Alzheimer's disease. Nonetheless, in the statistical models, the HV better predicted the integrity of the MTL tracts than the biomarkers in CSF.
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Affiliation(s)
- Thamires Naela Cardoso Magalhães
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil
| | - Raphael Fernandes Casseb
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Seaman Family MR Research Center, University of Calgary, Calgary, Canada
| | - Christian Luiz Baptista Gerbelli
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luciana Ramalho Pimentel-Siva
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil
| | - Mateus Henrique Nogueira
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil
| | - Camila Vieira Ligo Teixeira
- Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil.,National Institute on Aging, National Institute of Health, Baltimore, Maryland, USA
| | - Ana Flávia Mac Knight Carletti
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Thiago Junqueira Ribeiro de Rezende
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil
| | | | - Leda Leme Talib
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo (USP), São Paulo, Brazil
| | - Orestes Vicente Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo (USP), São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil
| | - Marcio Luiz Figueredo Balthazar
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil
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84
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Geng J, Gao F, Ramirez J, Honjo K, Holmes MF, Adamo S, Ozzoude M, Szilagyi GM, Scott CJM, Stebbins GT, Nyenhuis DL, Goubran M, Black SE. Secondary thalamic atrophy related to brain infarction may contribute to post-stroke cognitive impairment. J Stroke Cerebrovasc Dis 2023; 32:106895. [PMID: 36495644 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/24/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The thalamus is a key brain hub that is globally connected to many cortical regions. Previous work highlights thalamic contributions to multiple cognitive functions, but few studies have measured thalamic volume changes or cognitive correlates. This study investigates associations between thalamic volumes and post-stroke cognitive function. METHODS Participants with non-thalamic brain infarcts (3-42 months) underwent MRI and cognitive testing. Focal infarcts and thalami were traced manually. In cases with bilateral infarcts, the side of the primary infarct volume defined the hemisphere involved. Brain parcellation and volumetrics were extracted using a standardized and previously validated neuroimaging pipeline. Age and gender-matched healthy controls provided normal comparative thalamic volumes. Thalamic atrophy was considered when the volume exceeded 2 standard deviations greater than the controls. RESULTS Thalamic volumes ipsilateral to the infarct in stroke patients (n=55) were smaller than left (4.4 ± 1.4 vs. 5.4 ± 0.5 cc, p < 0.001) and right (4.4 ± 1.4 vs. 5.5 ± 0.6 cc, p < 0.001) thalamic volumes in the controls. After controlling for head-size and global brain atrophy, infarct volume independently correlated with ipsilateral thalamic volume (β= -0.069, p=0.024). Left thalamic atrophy correlated significantly with poorer cognitive performance (β = 4.177, p = 0.008), after controlling for demographics and infarct volumes. CONCLUSIONS Our results suggest that the remote effect of infarction on ipsilateral thalamic volume is associated with global post-stroke cognitive impairment.
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Affiliation(s)
- Jieli Geng
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fuqiang Gao
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada
| | - Kie Honjo
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada
| | - Melissa F Holmes
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Sabrina Adamo
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Miracle Ozzoude
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Gregory M Szilagyi
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Christopher J M Scott
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Glen T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David L Nyenhuis
- Hauenstein Neuroscience Center, Saint Mary's Health Care, Grand Rapids, MI, USA; LCC International University
| | - Maged Goubran
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology, Dr. Sandra Black Centre for Brain Resilience & Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (Sunnybrook site), Toronto, Ontario, Canada; Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Ontario, Canada.
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85
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Kaddumukasa MN, Kaddumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. Prevalence and Predictors of Post-stroke Cognitive Impairment among Stroke Survivors in Uganda. RESEARCH SQUARE 2023:rs.3.rs-2456615. [PMID: 36711491 PMCID: PMC9882649 DOI: 10.21203/rs.3.rs-2456615/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Little is known about the characteristics and determinants of post-stroke cognitive impairments in low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. Methods From August 2019 to July 2020, patients were enrolled a minimum of 3-months post-stroke hospital admission. We collected data on their demographics, vascular risk factors and clinical factors using a questionnaire, clinical examination findings, and test results. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. Results The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. Discussion Further longitudinal, prospective studies are required to confirm these findings and identify strategies for reducing the risk of post-stroke cognitive impairment in this population.
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86
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Pavlovic A, Pekmezovic T, Mijajlovic M, Tomic G, Zidverc Trajkovic J. Is the female sex associated with an increased risk for long-term cognitive decline after the first-ever lacunar stroke? Prospective study on small vessel disease cohort. Front Neurol 2023; 13:1052401. [PMID: 36712431 PMCID: PMC9878188 DOI: 10.3389/fneur.2022.1052401] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background Sex is a significant determinant of survival and functional outcome after stroke. Long-term cognitive outcome after acute lacunar stroke in the context of sex differences has been rarely reported. Methods A cohort of small vessel disease (SVD) patients presenting with first-ever acute lacunar stroke and normal cognitive status has been evaluated 4 years after the qualifying event for the presence of cognitive impairment (CI) with a comprehensive neuropsychological battery. Differences in baseline clinical and neuroimaging characteristics were compared between sexes in relation to cognitive status. Results A total of 124 female and 150 male patients were analyzed. No difference was detected between the groups regarding age (p = 0.932) or frequency of common vascular risk factors (p > 0.1 for all). At the baseline assessment, women had more disabilities compared to men with a mean modified Rankin scale (mRS) score of 2.5 (1.5 in men, p < 0.0001). Scores of white matter hyperintensities (WMH) of presumed vascular origin and a total number of lacunes of presumed vascular origin on brain MRI were higher in women compared to men (p < 0.0001 for all). As many as 64.6% of patients had CI of any severity on follow-up, women more frequently (77.4%) than men (54.0%; p < 0.0001). Univariate logistic regression analysis showed that female sex, higher NIHSS and mRS scores, presence of depression, and increasing WMH severity were associated with an increased risk for CI. Multivariate regression analysis indicated that only depression (OR 1.74, 95%CI 1.25-2.44; p = 0.001) and WMH severity (OR 1.10, 95%CI 1.03-1.17; p = 0.004) were independently associated with the CI. Conclusion At the long-term follow-up, women lacunar stroke survivors, compared to men, more frequently had CI in the presence of more severe vascular brain lesions, but this association was dependent on the occurrence of depression and severity of WMH, and could not be explained by differences in common vascular risk factors.
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Affiliation(s)
- Aleksandra Pavlovic
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia,Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia,*Correspondence: Aleksandra Pavlovic ✉
| | - Tatjana Pekmezovic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Milija Mijajlovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Tomic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasna Zidverc Trajkovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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87
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Quaye E, Galecki AT, Tilton N, Whitney R, Briceño EM, Elkind MSV, Fitzpatrick AL, Gottesman RF, Griswold M, Gross AL, Heckbert SR, Hughes TM, Longstreth WT, Sacco RL, Sidney S, Windham BG, Yaffe K, Levine DA. Association of Obesity With Cognitive Decline in Black and White Americans. Neurology 2023; 100:e220-e231. [PMID: 36257719 PMCID: PMC9841449 DOI: 10.1212/wnl.0000000000201367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are disparities in the prevalence of obesity by race, and the relationship between obesity and cognitive decline is unclear. The objective of this study was to determine whether obesity is independently associated with cognitive decline and whether the association between obesity and cognitive decline differs in Black and White adults. We hypothesized that obesity is associated with greater cognitive decline compared with normal weight and that the effect of obesity on cognitive decline is more pronounced in Black adults compared with their White counterparts. METHODS We pooled data from 28,867 participants free of stroke and dementia (mean, SD: age 61 [10.7] years at the first cognitive assessment, 55% female, 24% Black, and 29% obese) from 6 cohorts. The primary outcome was the annual change in global cognition. We performed linear mixed-effects models with and without time-varying cumulative mean systolic blood pressure (SBP) and fasting plasma glucose (FPG). Global cognition was set to a t-score metric (mean 50, SD 10) at a participant's first cognitive assessment; a 1-point difference represents a 0.1 SD difference in global cognition across the 6 cohorts. The median follow-up was 6.5 years (25th percentile, 75th percentile: 5.03, 20.15). RESULTS Obese participants had lower baseline global cognition than normal-weight participants (difference in intercepts, -0.36 [95% CI, -0.46 to -0.17]; p < 0.001). This difference in baseline global cognition was attenuated but was borderline significant after accounting for SBP and FPG (adjusted differences in intercepts, -0.19 [95% CI, -0.39 to 0.002]; p = 0.05). There was no difference in the rate of decline in global cognition between obese and normal-weight participants (difference in slope, 0.009 points/year [95% CI, -0.009 to 0.03]; p = 0.32). After accounting for SBP and FPG, obese participants had a slower decline in global cognition (adjusted difference in slope, 0.03 points/year slower [95% CI, 0.01 to 0.05]; p < 0.001). There was no evidence that race modified the association between body mass index and global cognitive decline (p = 0.34). DISCUSSION These results suggest that obesity is associated with lower initial cognitive scores and may potentially attenuate declines in cognition after accounting for BP and FPG.
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Affiliation(s)
- Emmanuel Quaye
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Andrzej T Galecki
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Nicholas Tilton
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Rachael Whitney
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Emily M Briceño
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Mitchell S V Elkind
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Annette L Fitzpatrick
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Rebecca F Gottesman
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Michael Griswold
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Alden L Gross
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Susan R Heckbert
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Timothy M Hughes
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - W T Longstreth
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Ralph L Sacco
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Stephen Sidney
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - B Gwen Windham
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Kristine Yaffe
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco
| | - Deborah A Levine
- From the University of Michigan Medical School (E.Q.), Ann Arbor; Departments of Internal Medicine and Cognitive Health Services Research Program (A.T.G., N.T., R.W., D.A.L.), Biostatistics (A.T.G.), Psychiatry and Michigan Alzheimer's Disease Center (E.M.B.), and Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Epidemiology (A.L.F., S.R.H., M.D.J.), School of Public Health, University of Washington, Seattle; Department of Neurology (R.F.G.), and Department of Epidemiology (A.L.G.), Bloomberg School of PublicHealth, Johns Hopkins University, Baltimore, MD; Department of Biostatistics (M.G.), University of Mississippi School of Medicine, Jackson, MS; Departments of Internal Medicine and Epidemiology and Prevention (T.M.H.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (M.D.J.), School of Medicine, University of Washington, Seattle; Department of Neurology (R.L.S./M.S.), University of Miami Leonard School of Medicine, FL; Kaiser Permanente Northern California Division of Research (S.S.), Oakland; Department of Internal Medicine (B.G.W.), University of Mississippi School of Medicine, Jackson; and Departments of Psychiatry (K.Y.), Neurology and Epidemiology, University of California, San Francisco.
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Gomes T, Benedetti A, Lafontaine AL, Kimoff RJ, Robinson A, Kaminska M. Validation of STOP, STOP-BANG, STOP-BAG, STOP-B28, and GOAL screening tools for identification of obstructive sleep apnea in patients with Parkinson disease. J Clin Sleep Med 2023; 19:45-54. [PMID: 36004740 PMCID: PMC9806789 DOI: 10.5664/jcsm.10262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is common in Parkinson disease (PD). Questionnaires can be used as screening tools and have been used as a surrogate definition of OSA in large-scale research. This study aimed to validate the performance of STOP, STOP-BANG, STOP-BAG, STOP-B28, and GOAL and OSA predictors as tools to identify OSA in PD. METHODS Data were analyzed from a PD cohort study in which OSA was diagnosed using laboratory polysomnography. We calculated sensitivity and specificity of each questionnaire for OSA using different definitions and performed receiver operating characteristics curve analysis. Linear regression was used to assess adjusted associations between questionnaires and outcomes: Montreal Cognitive Assessment, Epworth Sleepiness Scale, and Movement Disorder Society revision of the Unified Parkinson Disease Rating Scale. RESULTS Questionnaire data were available for 68 PD patients (61.8% male, mean age 64.5 [standard deviation 9.9] years, and Hoehn and Yahr score 2.1 [0.8]). OSA (apnea-hypopnea index ≥ 15 events/h) occurred in 69.4% of participants. STOP-B28 ≥ 2 presented a higher sensitivity for OSA than STOP ≥ 2 (0.76 vs 0.65, respectively) and slightly lower specificity (0.65 vs 0.70, respectively). GOAL ≥ 2 had the highest sensitivity but poor specificity. Loud snoring had sensitivity 0.63 and specificity 0.65. STOP and snoring were significantly associated with Montreal Cognitive Assessment, Epworth Sleepiness Scale, and Movement Disorder Society revision of the Unified Parkinson Disease Rating Scale (total, motor, and nonmotor); STOP-BANG, STOP-BAG, and STOP-B28 showed associations with most outcomes, but the GOAL showed none. CONCLUSIONS The STOP-B28 followed by STOP and presence of loud snoring alone seem to have the best overall properties to identify PD patients with OSA, whose clinical characteristics differ from the general population with OSA. CITATION Gomes T, Benedetti A, Lafontaine A-L, Kimoff RJ Robinson A, Kaminska M. Validation of STOP, STOP-BANG, STOP-BAG, STOP-B28, and GOAL screening tools for identification of obstructive sleep apnea in patients with Parkinson disease. J Clin Sleep Med. 2023;19(1):45-54.
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Affiliation(s)
- Teresa Gomes
- Department of Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Translational Research in Respiratory Diseases, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Medicine and Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Richard John Kimoff
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann Robinson
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marta Kaminska
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
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Abstract
Memory impairment occurs in over a third of patients after symptomatic stroke. Memory deficits rarely occur in isolation but are an important component of the poststroke cognitive syndrome because of the strong relationship with the risk of poststroke dementia. In this review, we summarize available data on impairment of episodic memory, with a particular emphasis on the natural history of memory impairment after stroke and the factors influencing trajectory informed by an updated systematic review. We next discuss the pathophysiology of memory impairment and mechanisms of both decline and recovery of function. We then turn to the practical issue of measurement of memory deficits after stroke, emerging biomarkers, and therapeutic approaches. Our review identifies critical gaps, particularly in studies of the natural history that properly map the long-term trajectory of memory and the associations with factors that modulate prognosis. Few studies have used advanced neuroimaging and this, in conjunction with other biomarker approaches, has the potential to provide a much richer understanding of the mechanisms at play and promising therapeutic avenues.
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Affiliation(s)
- Michael J O'Sullivan
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Australia (M.J.O.).,UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia (M.J.O., X.L., D.G.).,Department of Neurology, Royal Brisbane and Women's Hospital, QLD, Australia (M.J.O.)
| | - Xuqian Li
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia (M.J.O., X.L., D.G.)
| | - Dana Galligan
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia (M.J.O., X.L., D.G.)
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (S.T.P.).,Departments of Medicine and Geratology and UK National Institute for Health and Care Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, United Kingdom (S.T.P.)
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90
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Chen C, Yang K, Nan H, Unverzagt F, McClure LA, Irvin MR, Judd S, Cushman M, Kamin Mukaz D, Klaunig JE, D'Alton ME, Kahe K. Associations of Telomere Length and Change With Cognitive Decline Were Modified by Sex and Race: The REGARDS Study. Am J Alzheimers Dis Other Demen 2023; 38:15333175231175797. [PMID: 37340856 PMCID: PMC10624094 DOI: 10.1177/15333175231175797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION We examined the associations of baseline telomere length (TL) and TL change with cognitive function over time in older US adults, as well as differences by sex and race. METHODS A total of 1820 cognitively healthy individuals (median baseline age: 63 years) were included. Telomere length was measured using qPCR-based method at baseline and among 614 participants in the follow-up examination 10 years later. Cognitive function was assessed by a four-test battery every 2 years. RESULTS In multivariable-adjusted linear mixed models, longer baseline TL and smaller attrition/lengthening of TL over time were associated with better Animal Fluency Test score. Longer baseline TL was also linearly associated with better Letter Fluency Test score. The observed associations were consistently more pronounced in women than men and in Black compared to White participants. DISCUSSION Telomere length may be a biomarker that predicts long-term verbal fluency and executive function, particularly in women and Black Americans.
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Affiliation(s)
- Cheng Chen
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Keming Yang
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital & Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hongmei Nan
- Department of Global Health, Richard M. Fairbanks School of Public Health, Indiana University–Purdue University Indianapolis, Indianapolis, IN, USA
| | - Frederick Unverzagt
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Marguerite R. Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - James E. Klaunig
- Department of Environmental and Occupational Health, School of Public Health, Indiana University–Bloomington, Bloomington, IN, USA
| | - Mary E. D'Alton
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University, New York, NY, USA
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Salvadori E, Brambilla M, Maestri G, Nicotra A, Cova I, Pomati S, Pantoni L. The clinical profile of cerebral small vessel disease: Toward an evidence-based identification of cognitive markers. Alzheimers Dement 2023; 19:244-260. [PMID: 35362229 PMCID: PMC10084195 DOI: 10.1002/alz.12650] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 01/18/2023]
Abstract
There is no consensus on which test is more suited to outline the cognitive deficits of cerebral small vessel disease (cSVD) patients. We explored the ability of eight cognitive tests, selected in a previous systematic review as the most commonly used in this population, to differentiate among cSVD patients, controls, and other dementing conditions performing a meta-analysis of 86 studies. We found that cSVD patients performed worse than healthy controls in all tests while data on the comparison to neurodegenerative diseases were limited. We outlined a lack of data on these tests' accuracy on the diagnosis. Cognitive tests measuring processing speed were those mostly associated with neuroimaging cSVD markers. There is currently incomplete evidence that a single test could differentiate cSVD patients with cognitive decline from other dementing diseases. We make preliminary proposals on possible strategies to gain information about the clinical definition of cSVD that currently remains a neuroimaging-based one.
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Affiliation(s)
| | | | - Giorgia Maestri
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Alessia Nicotra
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Ilaria Cova
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Simone Pomati
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Stroke and Dementia Lab, 'Luigi Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Li J, Wang S, Li J, Fang Y, Wang Y, Zhang Y. Nomogram to Predict Cognitive Impairment in Patients with Asymptomatic Middle Cerebral Artery Stenosis. Int J Gen Med 2023; 16:1333-1343. [PMID: 37089137 PMCID: PMC10115204 DOI: 10.2147/ijgm.s407728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose This study aims to investigate the characteristics and influencing factors of cognitive impairment in patients with asymptomatic middle cerebral artery stenosis (aMCAS) and to construct a nomogram to predict the risk of cognitive impairment in patients with aMCAS. Patients and Methods We collected 54 patients with aMCAS and 35 healthy controls to investigate the impaired cognitive domains and pathogenesis in patients with aMCAS. All patients underwent a cranial MRI, CT perfusion, transcranial Doppler ultrasound, blood tests, and a comprehensive neuropsychological evaluation. According to the MoCA score, patients were divided into cognitively normal and cognitively impaired groups. To construct the nomogram, we conducted univariate and multivariate logistic regression analyses to identify factors that affect cognitive function. And the performance of nomogram was evaluated by ROC curves, calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC). Results In 54 patients with aMCAS, 24 patients presented with cognitive normal, and 30 patients presented with cognitive impairment. The results of multivariate logistic regression suggested that perfusion decompensation, middle cerebral artery mean flow velocity, and LDL-cholesterol levels were independent influencing factors of cognitive impairment. In the following step, a nomogram was constructed. The AUC of the nomogram is 0.862. Calibrating curves show good agreement between nomogram predictions and actual observations, while DCA and CIC show great clinical usefulness. Conclusion Patients with aMCAS have cognitive impairment in multiple cognitive domains, and impaired executive function was observed during the perfusion compensation period. Furthermore, a nomogram was constructed and validated to predict the risk of cognitive impairment in patients with aMCAS, which can help clinicians to identify at an early stage and improve the management of patients.
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Affiliation(s)
- Jiayang Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Shaoshuai Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jun Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yalan Fang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Ying Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yuanyuan Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- Correspondence: Yuanyuan Zhang, Shanxi Medical University, No. 56 South Xinjian Road, Yingze District, Taiyuan, Shanxi Province, 03000, People’s Republic of China, Tel +8619834516348, Fax +863414867027, Email
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93
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Jeffares I, Merriman NA, Doyle F, Horgan F, Hickey A. Designing stroke services for the delivery of cognitive rehabilitation: A qualitative study with stroke rehabilitation professionals. Neuropsychol Rehabil 2023; 33:24-47. [PMID: 34648412 DOI: 10.1080/09602011.2021.1977155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This qualitative study explored the potential to deliver cognitive rehabilitation for post-stroke cognitive impairment (PSCI), with a specific focus on barriers and facilitators to its delivery from the perspective of Irish stroke rehabilitation professionals. Sixteen semi-structured interviews were completed with healthcare professionals in both hospital and community settings. The sample comprised physiotherapists, occupational therapists, nurses, a stroke physician, a psychologist, a neuropsychologist, a speech and language therapist, a dietician, and a public health nurse. Interviews were audio-recorded and analysed in NVivo using inductive Thematic Analysis. Barriers and facilitators to the delivery of cognitive rehabilitation were identified and described under four key themes: (i) Cognitive screening; (ii) Cognitive rehabilitation: no one size fits all; (iii) Psychology: the lost dimension of stroke rehabilitation; and (iv) Joining the dots in the community. Staffing required to deliver cognitive rehabilitation for PSCI was highlighted as under-resourced in the Republic of Ireland. Inadequate resourcing of neuropsychology and stroke-related psychological services, in particular, has had negative implications for the delivery of cognitive rehabilitation. Stroke-specific cognitive rehabilitation expertise is virtually inaccessible in the community, highlighting an urgent need for investment in specialist rehabilitation teams to deliver cognitive rehabilitation in this setting.
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Affiliation(s)
- Isabelle Jeffares
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh A Merriman
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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94
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Muir RT, Kapoor A, Cayley ML, Sicard MN, Lien K, Southwell A, Dowlatshahi D, Sahlas DJ, Saposnik G, Mandzia J, Casaubon LK, Hassan A, Perez Y, Selchen D, Murray BJ, Lanctot K, Kapral MK, Herrmann N, Strother S, Yu AYX, Austin PC, Bronskill SE, Swartz RH. Language discordance as a marker of disparities in cerebrovascular risk and stroke outcomes: A multi-center Canadian study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 4:100163. [PMID: 36909680 PMCID: PMC9996323 DOI: 10.1016/j.cccb.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 02/26/2023]
Abstract
Background Differences in ischemic stroke outcomes occur in those with limited English proficiency. These health disparities might arise when a patient's spoken language is discordant from the primary language utilized by the health system. Language concordance is an understudied concept. We examined whether language concordance is associated with differences in vascular risk or post-stroke functional outcomes, depression, obstructive sleep apnea and cognitive impairment. Methods This was a multi-center observational cross-sectional cohort study. Patients with ischemic stroke/transient ischemic attack (TIA) were consecutively recruited across eight regional stroke centers in Ontario, Canada (2012 - 2018). Participants were language concordant (LC) if they spoke English as their native language, ESL if they used English as a second language, or language discordant (LD) if non-English speaking and requiring translation. Results 8156 screened patients. 6,556 met inclusion criteria: 5067 LC, 1207 ESL and 282 LD. Compared to LC patients: (i) ESL had increased odds of diabetes (OR = 1.28, p = 0.002), dyslipidemia (OR = 1.20, p = 0.007), and hypertension (OR = 1.37, p<0.001) (ii) LD speaking patients had an increased odds of having dyslipidemia (OR = 1.35, p = 0.034), hypertension (OR = 1.37, p<0.001), and worse functional outcome (OR = 1.66, p<0.0001). ESL (OR = 1.88, p<0.0001) and LD (OR = 1.71, p<0.0001) patients were more likely to have lower cognitive scores. No associations were noted with obstructive sleep apnea (OSA) or depression. Conclusions Measuring language concordance in stroke/TIA reveals differences in neurovascular risk and functional outcome among patients with limited proficiency in the primary language of their health system. Lower cognitive scores must be interpreted with caution as they may be influenced by translation and/or greater vascular risk. Language concordance is a simple, readily available marker to identify those at risk of worse functional outcome. Stroke systems and practitioners must now study why these differences exist and devise adaptive care models, treatments and education strategies to mitigate barriers influenced by language discordance.
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Affiliation(s)
- Ryan T Muir
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arunima Kapoor
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Megan L Cayley
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle N Sicard
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Karen Lien
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alisia Southwell
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dar Dowlatshahi
- Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Demetrios J Sahlas
- McMaster University, Department of Medicine (Neurology), Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Gustavo Saposnik
- St. Michael's Hospital, Division of Neurology, Toronto, ON, Canada
| | - Jennifer Mandzia
- London Health Sciences Centre, Division of Neurology, London, ON, Canada
| | - Leanne K Casaubon
- University Health Network/Toronto Western Hospital, Division of Neurology, Toronto, ON, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Sciences Centre, Division of Neurology, Thunder Bay, ON, Canada
| | - Yael Perez
- Trillium Health Partners, Department of Medicine (Neurology), Mississauga, ON, Canada
| | - Daniel Selchen
- St. Michael's Hospital, Division of Neurology, Toronto, ON, Canada
| | - Brian J Murray
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Krista Lanctot
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Moira K Kapral
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Department of Medicine, Division of General Internal Medicine, Toronto, Canada.,ICES, Toronto, ON, Canada.,University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Stephen Strother
- Rotman Research Institute, Centre for Stroke Recovery, Baycrest Site, Toronto, ON, Canada
| | - Amy Y X Yu
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Peter C Austin
- ICES, Toronto, ON, Canada.,University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Susan E Bronskill
- Sunnybrook Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Richard H Swartz
- University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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95
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Finlay J, Jang J, Esposito M, McClure L, Judd S, Clarke P. 'My neighbourhood is fuzzy, not hard and fast': Individual and contextual associations with perceived residential neighbourhood boundaries among ageing Americans. URBAN STUDIES (EDINBURGH, SCOTLAND) 2023; 60:85-108. [PMID: 37636583 PMCID: PMC10449103 DOI: 10.1177/00420980221089582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Neighborhoods are fluid social and spatial constructs that vary by person and place. How do residential neighborhoods shift as people age? This mixed-method study investigates how perceived neighborhood boundaries and size vary by individual and contextual characteristics. Semi-structured interviews with 125 adults aged 55-92 living in the Minneapolis (Minnesota) metropolitan area suggested that neighborhood boundaries are "fuzzy". Qualitative thematic analysis identified duration of residence and housing stability, race, life-space mobility, social capital, sense of safety, and the built and social environment as key neighborhood determinants. This informed quantitative analyses among 7,811 respondents (mean age 72) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study who self-reported how many blocks composed their neighborhoods. We tested individual and contextual factors identified in the qualitative results as related to perceived neighborhood size. Three-level gamma regression models showed that being older, white, less educated, lower income, less physically and cognitively healthy, less active, less socially supported, and feeling unsafe were significantly associated with smaller self-reported neighborhood sizes. Further, living in less racially diverse, less dense, and less affluent areas were significantly associated with smaller neighborhoods. The mixed-methods findings deepen understanding of scale in neighborhood-based research, inform urban planning interventions, and help understand what "neighborhood" means among diverse aging Americans.
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Affiliation(s)
- Jessica Finlay
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, United States, 48104
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States, 48109
| | - Joy Jang
- Inter-university Consortium for Political and Social Research, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, United States, 48104
| | - Michael Esposito
- Department of Sociology, Washington University in St. Louis, St. Louis, MO, United States, 63130
| | - Leslie McClure
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, United States, 19104
| | - Suzanne Judd
- School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, United States, 35233
| | - Philippa Clarke
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, United States, 48104
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States, 48109
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96
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Sa ZY, Xu JS, Pan XH, Zheng SX, Huang QR, Wan L, Zhu XX, Lan CL, Ye XR. Effects of electroacupuncture on rats with cognitive impairment: An iTRAQ-based proteomics analysis. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:89-98. [PMID: 36424268 DOI: 10.1016/j.joim.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study explores the effects of electroacupuncture (EA) at the governing vessel (GV) on proteomic changes in the hippocampus of rats with cognitive impairment. METHODS Healthy male rats were randomly divided into 3 groups: sham, model and EA. Cognitive impairment was induced by left middle cerebral artery occlusion in the model and EA groups. Rats in the EA group were treated with EA at Shenting (GV24) and Baihui (GV20) for 7 d. Neurological deficit was scored using the Longa scale, the learning and memory ability was detected using the Morris water maze (MWM) test, and the proteomic profiling in the hippocampus was analyzed using protein-labeling technology based on the isobaric tag for relative and absolute quantitation (iTRAQ). The Western blot (WB) analysis was used to detect the proteins and validate the results of iTRAQ. RESULTS Compared with the model group, the neurological deficit score was significantly reduced, and the escape latency in the MWM test was significantly shortened, while the number of platform crossings increased in the EA group. A total of 2872 proteins were identified by iTRAQ. Differentially expressed proteins (DEPs) were identified between different groups: 92 proteins were upregulated and 103 were downregulated in the model group compared with the sham group, while 142 proteins were upregulated and 126 were downregulated in the EA group compared with the model group. Most of the DEPs were involved in oxidative phosphorylation, glycolipid metabolism and synaptic transmission. Furthermore, we also verified 4 DEPs using WB technology. Although the WB results were not exactly the same as the iTRAQ results, the expression trends of the DEPs were consistent. The upregulation of heat-shock protein β1 (Hspb1) was the highest in the EA group compared to the model group. CONCLUSION EA can effect proteomic changes in the hippocampus of rats with cognitive impairment. Hspb1 may be involved in the molecular mechanism by which acupuncture improves cognitive impairment.
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Affiliation(s)
- Zhe-Yan Sa
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China
| | - Jin-Sen Xu
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China.
| | - Xiao-Hua Pan
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China.
| | - Shu-Xia Zheng
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China
| | - Qian-Ru Huang
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China
| | - Long Wan
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China
| | - Xiao-Xiang Zhu
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China
| | - Cai-Lian Lan
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China
| | - Xiao-Ran Ye
- Department of Meridian Research, Fujian Academy of Chinese Medical Sciences, Fuzhou 350003, Fujian Province, China; Key Laboratory of Propagated Sensation along Meridian of Fujian Province, Fuzhou 350003, Fujian Province, China
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Winder Z, Sudduth TL, Anderson S, Patel E, Neltner J, Martin BJ, Snyder KE, Abner EL, Jicha GA, Nelson PT, Wilcock DM. Examining the association between blood-based biomarkers and human post mortem neuropathology in the University of Kentucky Alzheimer's Disease Research Center autopsy cohort. Alzheimers Dement 2023; 19:67-78. [PMID: 35266629 PMCID: PMC9463400 DOI: 10.1002/alz.12639] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/07/2022] [Accepted: 01/26/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Clinically, detection of disease-causing pathology associated with Alzheimer's disease (AD) and vascular contributions to cognitive impairment and dementia (VCID) is limited to magnetic resonance imaging and positron emission tomography scans, which are expensive and not widely accessible. Here, we assess angiogenic, inflammatory, and AD-related plasma biomarkers to determine their relationships with human post mortem neuropathology. METHOD Plasma samples were analyzed using a digital immunoassay and pathological evaluation was performed by University of Kentucky Alzheimer's Disease Research Center neuropathologists. The association of plasma markers with neuropathology was estimated via proportional odds and logistic regressions adjusted for age. RESULTS Included cases (N = 90) showed increased tau/amyloid beta (Aβ)42 ratio, glial fibrillary acidic protein (GFAP), vascular endothelial growth factor A (VEGF-A), and placental growth factor (PlGF) were positively associated with higher level of AD neuropathological change, while higher Aβ42/Aβ40 ratio was inversely associated. Higher PlGF, VEGF-A, and interleukin 6 were inversely associated with chronic cerebrovascular disease, while Aβ42/Aβ40 ratio was positively associated. DISCUSSION Our results provide support for the continued study of plasma biomarkers as a clinical screening tool for AD and VCID pathology.
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Affiliation(s)
- Zachary Winder
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Departments of Physiology, University of Kentucky, Lexington, Kentucky, USA
| | - Tiffany L Sudduth
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sonya Anderson
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Ela Patel
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Janna Neltner
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Barbara J Martin
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Katherine E Snyder
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Erin L Abner
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Neurology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Departments of Physiology, University of Kentucky, Lexington, Kentucky, USA
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Liao X, Zuo L, Dong Y, Pan Y, Yan H, Meng X, Li H, Zhao X, Wang Y, Shi J, Wang Y. Persisting cognitive impairment predicts functional dependence at 1 year after stroke and transient ischemic attack: a longitudinal, cohort study. BMC Geriatr 2022; 22:1009. [PMID: 36585624 PMCID: PMC9805269 DOI: 10.1186/s12877-022-03609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/11/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Minor stroke or transient ischemic attack (TIA) usually have mild and nondisabling symptoms, and these functional deficits may recover fully e.g., TIA, however, part of them still suffer from cognitive impairment and poor outcomes. We conducted a study to determine the relationship between cognition evaluated by Montreal Cognitive Assessment (MoCA) and poor functional outcomes assessed by the Modified Rankin Scale (mRS) (mRS ≥ 2) and Stroke Impact Scale (SIS)-16(SIS-16<25%). METHODS The data of this study come from the impairment of cognition and Sleep (ICONS) after acute ischemic stroke or transient ischemic attack in Chinese patients study. A total of 1675 minor stroke patients and TIA patients were finally recruited. Patients' cognition were evaluated by Montreal Cognitive Assessment (MoCA) scale at 2-week (2w), 3 months (3 m) and 1 year(1y). Cognitive impairment (CI) was defined as MoCA score ≤ 22. According to MoCA score, patients were divided into 4 groups: no PSCI group: with MoCA-2w>22 and MoCA-3 m>22; improved PSCI group: with MoCA-2w ≤ 2 and MoCA-3 m>22;delayed PSCI group: MoCA-2w>22 and MoCA-3 m ≤ 22; persisting PSCI group: with MoCA-2w ≤ 22 and MoCA-3 m ≤ 22. RESULTS A total of 1675 stroke patients were recruited in this study. There were 818 patients (48.84%) who had PSCI at baseline. Of these, 123 patients (15%) had mRS ≥2 at 3 months. The persisting PSCI group was a significant predictor of functional dependence at 3 months and 1 year after stroke and when adjusted for covariates such as gender, age, history of stroke, depression and intracranial atherosclerotic stenosis, stroke subtype and acute infarction type. CONCLUSION Persisting PSCI increased the risk of poor functional outcome after 3 months and 1 year follow-up. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcome.
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Affiliation(s)
- Xiaoling Liao
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Lijun Zuo
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yanhong Dong
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Dr., Singapore, 117597 Singapore
| | - Yuesong Pan
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongyi Yan
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yilong Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Jiong Shi
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yongjun Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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99
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Application of Immersive Virtual-Reality-Based Puzzle Games in Elderly Patients with Post-Stroke Cognitive Impairment: A Pilot Study. Brain Sci 2022; 13:brainsci13010079. [PMID: 36672060 PMCID: PMC9856594 DOI: 10.3390/brainsci13010079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: The society is aging in China, and the cognitive level of elderly post-stroke patients gradually declines. Face-to-face cognitive functional training is no longer sufficient. Immersive virtual reality (IVR) is a promising rehabilitation training device. In this study, we developed an IVR-based puzzle game to explore its effectiveness, feasibility, and safety in elderly stroke patients with cognitive dysfunction. Methods: A total of 30 patients with mild post-stroke cognitive impairment after stroke were randomly assigned to a control or IVR group. Patients in both groups received routine rehabilitation therapy. Patients in the control group received traditional cognitive training, and those in the IVR group received IVR-based puzzle game therapy. Before and after treatment, Montreal cognitive assessment (MOCA), trail-making test-A (TMT-A), digit symbol substitution test (DSST), digital span test (DST), verbal fluency test (VFT), and modified Barthel index (MBI) were evaluated in both groups. In addition, the IVR group was administered a self-report questionnaire to obtain feedback on user experience. Results: There was no significant difference in the baseline data between the two groups. After six weeks of treatment, the cognitive assessment scores were improved in both groups. Moreover, the IVR group showed more improvements than the control group in the DSST (Z = 2.203, p = 0.028 < 0.05, η2 = 0.16); MOCA (T = 1.186, p = 0.246 > 0.05, d = 0.44), TMT-A (T = 1.791, p = 0.084 > 0.05, d = 0.65), MBI (T = 0.783, p = 0.44 > 0.05, d = 0.28), FDST (Z = 0.78, p = 0.435 > 0.05, η2 = 0.02), BDST (Z = 0.347, p = 0.728 > 0.05, η2 = 0.004), and VFT(Z = 1.087, p = 0.277 > 0.05, η2 = 0.039) did not significantly improve. The significant difference in DSST represents an improvement in executive function and visual−spatial cognitive characteristics. The other assessment scores did not show such features. Therefore, we did not observe significant differences through this measure. According to the results of the self-report questionnaire, most of the patients were satisfied with the equipment stability and training content. Several individuals reported mild adverse reactions. Conclusions: This pilot study suggests that IVR-based puzzle games are a promising approach to improve post-stroke cognitive function, especially executive cognitive function, and visual−spatial attention in older adults.
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100
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Yu D, Liang N, Zebarth J, Shen Q, Ozzoude M, Goubran M, Rabin JS, Ramirez J, Scott CJM, Gao F, Bartha R, Symons S, Haddad SMH, Berezuk C, Tan B, Kwan D, Hegele RA, Dilliott AA, Nanayakkara ND, Binns MA, Beaton D, Arnott SR, Lawrence‐Dewar JM, Hassan A, Dowlatshahi D, Mandzia J, Sahlas D, Casaubon L, Saposnik G, Otoki Y, Lanctôt KL, Masellis M, Black SE, Swartz RH, Taha AY, Swardfager W. Soluble Epoxide Hydrolase Derived Linoleic Acid Oxylipins, Small Vessel Disease Markers, and Neurodegeneration in Stroke. J Am Heart Assoc 2022; 12:e026901. [PMID: 36583428 PMCID: PMC9973594 DOI: 10.1161/jaha.122.026901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Cerebral small vessel disease is associated with higher ratios of soluble-epoxide hydrolase derived linoleic acid diols (12,13-dihydroxyoctadecenoic acid [DiHOME] and 9,10-DiHOME) to their parent epoxides (12(13)-epoxyoctadecenoic acid [EpOME] and 9(10)-EpOME); however, the relationship has not yet been examined in stroke. Methods and Results Participants with mild to moderate small vessel stroke or large vessel stroke were selected based on clinical and imaging criteria. Metabolites were quantified by ultra-high-performance liquid chromatography-mass spectrometry. Volumes of stroke, lacunes, white matter hyperintensities, magnetic resonance imaging visible perivascular spaces, and free water diffusion were quantified from structural and diffusion magnetic resonance imaging (3 Tesla). Adjusted linear regression models were used for analysis. Compared with participants with large vessel stroke (n=30), participants with small vessel stroke (n=50) had a higher 12,13-DiHOME/12(13)-EpOME ratio (β=0.251, P=0.023). The 12,13-DiHOME/12(13)-EpOME ratio was associated with more lacunes (β=0.266, P=0.028) but not with large vessel stroke volumes. Ratios of 12,13-DiHOME/12(13)-EpOME and 9,10-DiHOME/9(10)-EpOME were associated with greater volumes of white matter hyperintensities (β=0.364, P<0.001; β=0.362, P<0.001) and white matter MRI-visible perivascular spaces (β=0.302, P=0.011; β=0.314, P=0.006). In small vessel stroke, the 12,13-DiHOME/12(13)-EpOME ratio was associated with higher white matter free water diffusion (β=0.439, P=0.016), which was specific to the temporal lobe in exploratory regional analyses. The 9,10-DiHOME/9(10)-EpOME ratio was associated with temporal lobe atrophy (β=-0.277, P=0.031). Conclusions Linoleic acid markers of cytochrome P450/soluble-epoxide hydrolase activity were associated with small versus large vessel stroke, with small vessel disease markers consistent with blood brain barrier and neurovascular-glial disruption, and temporal lobe atrophy. The findings may indicate a novel modifiable risk factor for small vessel disease and related neurodegeneration.
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Affiliation(s)
- Di Yu
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada
| | - Nuanyi Liang
- Department of Food Science and TechnologyUniversity of CaliforniaDavisCA
| | - Julia Zebarth
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada
| | - Qing Shen
- Department of Food Science and TechnologyUniversity of CaliforniaDavisCA
| | - Miracle Ozzoude
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Maged Goubran
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences CentreTorontoCanada,Department of Medical BiophysicsUniversity of TorontoTorontoCanada
| | - Jennifer S. Rabin
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences CentreTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Rehabilitation Sciences InstituteUniversity of TorontoTorontoCanada
| | - Joel Ramirez
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Christopher J. M. Scott
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Fuqiang Gao
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Robert Bartha
- Department of Medical BiophysicsWestern UniversityLondonCanada,Center for Functional and Metabolic Mapping, Robarts Research InstituteWestern UniversityLondonCanada
| | - Sean Symons
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | | | - Courtney Berezuk
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada
| | - Donna Kwan
- Centre for Neuroscience StudiesQueen’s UniversityKingstonCanada
| | | | | | | | - Malcolm A. Binns
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Derek Beaton
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada
| | - Stephen R. Arnott
- Rotman Research Institute, Baycrest Health Sciences CentreTorontoCanada
| | - Jane M. Lawrence‐Dewar
- Thunder Bay Regional Health Research InstituteNorthern Ontario School of Medicine UniversityThunder BayCanada
| | - Ayman Hassan
- Thunder Bay Regional Health Research InstituteNorthern Ontario School of Medicine UniversityThunder BayCanada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), Ottawa Hospital Research InstituteUniversity of OttawaOttawaCanada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, Schulich School of Medicine and DentistryWestern UniversityLondonCanada
| | - Demetrios Sahlas
- Division of Neurology, Department of Medicine, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
| | - Leanne Casaubon
- Krembil Research InstituteUniversity Health NetworkTorontoCanada
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit, Division of Neurology, St. Michael’s HospitalUniversity of TorontoTorontoCanada
| | - Yurika Otoki
- Division of Agricultural Chemistry, Graduate School of Agricultural ScienceTohoku UniversitySendaiJapan
| | - Krista L. Lanctôt
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada,Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada
| | - Mario Masellis
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Department of Neurology, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Sandra E. Black
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Department of Neurology, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Richard H. Swartz
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Division of Neurology, Department of MedicineSunnybrook Health Sciences CentreTorontoCanada,Department of Neurology, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Ameer Y. Taha
- Department of Food Science and TechnologyUniversity of CaliforniaDavisCA
| | - Walter Swardfager
- Dr. Sandra Black Center for Brain Resilience & Recovery, LC Campbell Cognitive Neurology, Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoCanada,Department of Pharmacology and ToxicologyUniversity of TorontoTorontoCanada,Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
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