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Legdeur N, Visser PJ, Woodworth DC, Muller M, Fletcher E, Maillard P, Scheltens P, DeCarli C, Kawas CH, Corrada MM. White Matter Hyperintensities and Hippocampal Atrophy in Relation to Cognition: The 90+ Study. J Am Geriatr Soc 2019; 67:1827-1834. [PMID: 31169919 PMCID: PMC6732042 DOI: 10.1111/jgs.15990] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/21/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the interactive effect of white matter hyperintensities (WMH) and hippocampal atrophy on cognition in the oldest old. DESIGN Ongoing longitudinal study. SETTING In Southern California, brain magnetic resonance imaging (MRI) scans were conducted between May 2014 and December 2017. PARTICIPANTS Individuals from The 90+ Study with a valid brain MRI scan (N = 141; 94 cognitively normal and 47 with cognitive impairment). MEASUREMENTS Cognitive testing was performed every 6 months with a mean follow-up of 2 years and included these tests: Mini-Mental State Examination (MMSE), modified MMSE (3MS), California Verbal Learning Test (CVLT) immediate recall over four trials and delayed recall, Digit Span Backward, Animal Fluency, and Trail Making Test (TMT) A, B, and C. We used one linear mixed model for each cognitive test to study the baseline and longitudinal association of WMH and hippocampal volume (HV) with cognition. Models were adjusted for age, sex, and education. RESULTS Mean age was 94.3 years (standard deviation [SD] = 3.2 y). At baseline, higher WMH volumes were associated with worse scores on the 3MS, CVLT immediate and delayed recall, and TMT B. Lower HVs were associated with worse baseline scores on all cognitive tests, except for the Digit Span Backward. Longitudinally, higher WMH and lower HVs were associated with faster decline in the 3MS and MMSE, and lower HV was also associated with faster decline in the CVLT immediate recall. No association was observed between WMH and HV and no interaction between WMH and HV in their association with baseline cognition or cognitive decline. CONCLUSION We show that WMH and hippocampal atrophy have an independent, negative effect on cognition that make these biomarkers relevant to evaluate in the diagnostic work-up of the oldest-old individuals with cognitive complaints. However, the predictive value of WMH for cognitive decline seems to be less evident in the oldest-old compared with a younger group of older adults. J Am Geriatr Soc 67:1827-1834, 2019.
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Affiliation(s)
- Nienke Legdeur
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Davis C. Woodworth
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Majon Muller
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Evan Fletcher
- Department of Neurology, University of California, Davis, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, CA, USA
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA
| | - Claudia H. Kawas
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - María M. Corrada
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Epidemiology, University of California, Irvine, CA, USA
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Farfel JM, Yu L, Boyle PA, Leurgans S, Shah RC, Schneider JA, Bennett DA. Alzheimer's disease frequency peaks in the tenth decade and is lower afterwards. Acta Neuropathol Commun 2019; 7:104. [PMID: 31269985 PMCID: PMC6609405 DOI: 10.1186/s40478-019-0752-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 01/26/2023] Open
Abstract
Age is the most robust risk factor for Alzheimer's dementia, however there is little data on the relation of age to Alzheimer's disease (AD) and other common neuropathologies that contribute to Alzheimer's dementia. We use data from two community-based, clinical-pathologic cohorts to examine the association of age with AD and other common pathologies. Participants were 1420 autopsied individuals from the Religious Orders Study or Rush Memory and Aging Project who underwent annual clinical evaluations for diagnosis of Alzheimer's dementia, mild cognitive impairment (MCI), and level of cognition. The neuropathologic traits of interest were pathologic AD according to modified NIA-Reagan criteria, three quantitative measures of AD pathology (global AD pathology score, β-amyloid load and PHFtau tangle density), macro- and micro-scopic infarcts, neocortical Lewy bodies, TDP-43 and hippocampal sclerosis. Semiparametric generalized additive models examined the nonlinear relationship between age and the clinical and pathological outcomes. The probability of Alzheimer's dementia at death increased with age such that for every additional year of age, the log odds of Alzheimer's dementia was 0.067 higher, corresponding to an odds ratio of 1.070 (p < 0.001). Results were similar for cognitive impairment and level of cognition. By contrast, a nonlinear relationship of age with multiple indices of AD pathology was observed (all ps < 0.05), such that pathologic AD reached a peak around 95 years of age and leveled off afterwards; the quantitative measures of AD pathology were significantly lower at ages above 95. The association of age with other neuropathologies was quite distinct from that of AD in that most increased with advancing age. AD pathology appears to peak around 95 years of age while other common pathologies continue to increase with age.
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Affiliation(s)
- Jose M Farfel
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL, 60612, USA.
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
- Department of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL, 60612, USA
- Department of Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Sue Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Raj C Shah
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL, 60612, USA
- Department of Family Medicine, Rush Medical College, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL, 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison, Suite 1000, Chicago, IL, 60612, USA
- Department of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Faster cognitive decline in dementia due to Alzheimer disease with clinically undiagnosed Lewy body disease. PLoS One 2019; 14:e0217566. [PMID: 31237877 PMCID: PMC6592515 DOI: 10.1371/journal.pone.0217566] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background Neuropathology has demonstrated a high rate of comorbid pathology in dementia due to Alzheimer’s disease (ADD). The most common major comorbidity is Lewy body disease (LBD), either as dementia with Lewy bodies (AD-DLB) or Alzheimer’s disease with Lewy bodies (AD-LB), the latter representing subjects with ADD and LBD not meeting neuropathological distribution and density thresholds for DLB. Although it has been established that ADD subjects with undifferentiated LBD have a more rapid cognitive decline than those with ADD alone, it is still unknown whether AD-LB subjects, who represent the majority of LBD and approximately one-third of all those with ADD, have a different clinical course. Methods Subjects with dementia included those with “pure” ADD (n = 137), AD-DLB (n = 64) and AD-LB (n = 114), all with two or more complete Mini Mental State Examinations (MMSE) and a full neuropathological examination. Results Linear mixed models assessing MMSE change showed that the AD-LB group had significantly greater decline compared to the ADD group (β = -0.69, 95% CI: -1.05, -0.33, p<0.001) while the AD-DLB group did not (β = -0.30, 95% CI: -0.73, 0.14, p = 0.18). Of those with AD-DLB and AD-LB, only 66% and 2.1%, respectively, had been diagnosed with LBD at any point during their clinical course. Compared with clinically-diagnosed AD-DLB subjects, those that were clinically undetected had significantly lower prevalences of parkinsonism (p = 0.046), visual hallucinations (p = 0.0008) and dream enactment behavior (0.013). Conclusions The probable cause of LBD clinical detection failure is the lack of a sufficient set of characteristic core clinical features. Core DLB clinical features were not more common in AD-LB as compared to ADD. Clinical identification of ADD with LBD would allow stratified analyses of ADD clinical trials, potentially improving the probability of trial success.
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Tellone E, Galtieri A, Ficarra S. Reviewing Biochemical Implications of Normal and Mutated Huntingtin in Huntington's Disease. Curr Med Chem 2019; 27:5137-5158. [PMID: 31223078 DOI: 10.2174/0929867326666190621101909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/08/2019] [Accepted: 05/22/2019] [Indexed: 12/17/2022]
Abstract
Huntingtin (Htt) is a multi-function protein of the brain. Normal Htt shows a common alpha-helical structure but conformational changes in the form with beta strands are the principal cause of Huntington's disease. Huntington's disease is a genetic neurological disorder caused by a repeated expansion of the CAG trinucleotide, causing instability in the N-terminal of the gene coding for the Huntingtin protein. The mutation leads to the abnormal expansion of the production of the polyglutamine tract (polyQ) resulting in the form of an unstable Huntingtin protein commonly referred to as mutant Huntingtin. Mutant Huntingtin is the cause of the complex neurological metabolic alteration of Huntington's disease, resulting in both the loss of all the functions of normal Huntingtin and the genesis of abnormal interactions due to the presence of this mutation. One of the problems arising from the misfolded Huntingtin is the increase in oxidative stress, which is common in many neurological diseases such as Alzheimer's, Parkinson's, Amyotrophic Lateral Sclerosis and Creutzfeldt-Jakob disease. In the last few years, the use of antioxidants had a strong incentive to find valid therapies for defence against neurodegenerations. Although further studies are needed, the use of antioxidant mixtures to counteract neuronal damages seems promising.
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Affiliation(s)
- Ester Tellone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Antonio Galtieri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Silvana Ficarra
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, V.le Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
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Yasar S, Varma VR, Harris GC, Carlson MC. Associations of Angiotensin Converting Enzyme-1 and Angiotensin II Blood Levels and Cognitive Function. J Alzheimers Dis 2019; 63:655-664. [PMID: 29660936 DOI: 10.3233/jad-170944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Emerging evidence suggests a possible role of the renin angiotensin system in the pathophysiologic process of Alzheimer's disease, of which angiotensin converting enzyme-1 (ACE-1) and angiotensin II (ANGII) are important proteins. Few studies evaluated associations between blood ACE-1 and none between ANGII levels, and cognition. OBJECTIVE Our pilot study was aimed to examine associations between blood ACE-1 and ANG II levels and cognitive function in non-demented participants at baseline and over a 1-year period. METHODS 56 participants were included from the Brain Health Substudy of the Baltimore Experience Corps Study. Linear regression analysis, adjusting for confounders, was used to determine associations between baseline ACE-1 and ANGII, and baseline and 1-year follow-up measures of psychomotor and processing speed, executive function, verbal learning memory and working memory, and whether these associations were mediated by blood pressure. RESULTS Participants were predominantly female (75%), African-American (93%), with mean age of 67.8 years and education of 14.3 years. There were no associations between baseline ACE-1 or ANGII levels and cognitive function; however, there were significant association between baseline ACE-1 levels and 1-year follow-up Trail Making Test, Part A (β= 0.003, p = 0.04) and Digit Span (β= -0.001, p = 0.02). CONCLUSIONS In this cognitively intact sample, elevated ACE-1 levels were associated with worse processing speed and working memory after 1 year. Findings from this pilot study suggest that changes in the RAS are associated with alterations in cognitive function warranting further assessment of the role of RAS in neurodegenerative disorders.
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Affiliation(s)
- Sevil Yasar
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Vijay R Varma
- National Institute on Aging, Intramural Research Program, Laboratory of Behavioral Neuroscience, Baltimore, MD, USA
| | | | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Jack CR, Wiste HJ, Therneau TM, Weigand SD, Knopman DS, Mielke MM, Lowe VJ, Vemuri P, Machulda MM, Schwarz CG, Gunter JL, Senjem ML, Graff-Radford J, Jones DT, Roberts RO, Rocca WA, Petersen RC. Associations of Amyloid, Tau, and Neurodegeneration Biomarker Profiles With Rates of Memory Decline Among Individuals Without Dementia. JAMA 2019; 321:2316-2325. [PMID: 31211344 PMCID: PMC6582267 DOI: 10.1001/jama.2019.7437] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE A National Institute on Aging and Alzheimer's Association workgroup proposed a research framework for Alzheimer disease in which biomarker classification of research participants is labeled AT(N) for amyloid, tau, and neurodegeneration biomarkers. OBJECTIVE To determine the associations between AT(N) biomarker profiles and memory decline in a population-based cohort of individuals without dementia age 60 years or older, and to determine whether biomarkers provide incremental prognostic value beyond more readily available clinical and genetic information. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study of cognitive aging in Olmsted County, Minnesota, that included 480 nondemented Mayo Clinic Study of Aging participants who had a clinical evaluation and amyloid positron emission tomography (PET) (A), tau PET (T), and magnetic resonance imaging (MRI) cortical thickness (N) measures between April 16, 2015, and November 1, 2017, and at least 1 clinical evaluation follow-up by November 12, 2018. EXPOSURES Age, sex, education, cardiovascular and metabolic conditions score, APOE genotype, and AT(N) biomarker profiles. Each of A, T, or (N) can be abnormal (+) or normal (-), resulting in 8 AT(N) profiles. MAIN OUTCOMES AND MEASURES Primary outcome was a composite memory score measured longitudinally at 15-month intervals. Analyses measured the associations between predictor variables and the memory score, and whether AT(N) biomarker profiles significantly improved prediction of memory z score rates of change beyond a model with clinical and genetic variables only. RESULTS Participants were followed up for a median of 4.8 years (interquartile range [IQR], 3.8-5.1) and 44% were women (211/480). Median (IQR) ages ranged from 67 years (65-73) in the A-T-(N)- group to 83 years (76-87) in the A+T+(N)+ group. Of the participants, 92% (441/480) were cognitively unimpaired but the A+T+(N)+ group had the largest proportion of mild cognitive impairment (30%). AT(N) biomarkers improved the prediction of memory performance over a clinical model from an R2 of 0.26 to 0.31 (P < .001). Memory declined fastest in the A+T+(N)+, A+T+(N)-, and A+T-(N)+ groups compared with the other 5 AT(N) groups (P = .002). Estimated rates of decline in the 3 fastest declining groups were -0.13 (95% CI, -0.17 to -0.09), -0.10 (95% CI, -0.16 to -0.05), and -0.10 (95% CI, -0.13 to -0.06) z score units per year, respectively, for an 85-year-old APOE ε4 noncarrier. CONCLUSIONS AND RELEVANCE Among older persons without baseline dementia followed for a median of 4.8 years, a prediction model that included amyloid PET, tau PET, and MRI cortical thickness resulted in a small but statistically significant improvement in predicting memory decline over a model with more readily available clinical and genetic variables. The clinical importance of this difference is uncertain.
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Affiliation(s)
| | - Heather J. Wiste
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Terry M. Therneau
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Stephen D. Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Michelle M. Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Val J. Lowe
- Department of Nuclear Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mary M. Machulda
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - David T. Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Rosebud O. Roberts
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Walter A. Rocca
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Latimer CS, Burke BT, Liachko NF, Currey HN, Kilgore MD, Gibbons LE, Henriksen J, Darvas M, Domoto-Reilly K, Jayadev S, Grabowski TJ, Crane PK, Larson EB, Kraemer BC, Bird TD, Keene CD. Resistance and resilience to Alzheimer's disease pathology are associated with reduced cortical pTau and absence of limbic-predominant age-related TDP-43 encephalopathy in a community-based cohort. Acta Neuropathol Commun 2019; 7:91. [PMID: 31174609 PMCID: PMC6556006 DOI: 10.1186/s40478-019-0743-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease neuropathologic change (ADNC) is defined by progressive accumulation of β-amyloid plaques and hyperphosphorylated tau (pTau) neurofibrillary tangles across diverse regions of brain. Non-demented individuals who reach advanced age without significant ADNC are considered to be resistant to AD, while those burdened with ADNC are considered to be resilient. Understanding mechanisms underlying ADNC resistance and resilience may provide important clues to treating and/or preventing AD associated dementia. ADNC criteria for resistance and resilience are not well-defined, so we developed stringent pathologic cutoffs for non-demented subjects to eliminate cases of borderline pathology. We identified 14 resistant (85+ years old, non-demented, Braak stage ≤ III, CERAD absent) and 7 resilient (non-demented, Braak stage VI, CERAD frequent) individuals out of 684 autopsies from the Adult Changes in Thought study, a long-standing community-based cohort. We matched each resistant or resilient subject to a subject with dementia and severe ADNC (Braak stage VI, CERAD frequent) by age, sex, year of death, and post-mortem interval. We expanded the neuropathologic evaluation to include quantitative approaches to assess neuropathology and found that resilient participants had lower neocortical pTau burden despite fulfilling criteria for Braak stage VI. Moreover, limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) was robustly associated with clinical dementia and was more prevalent in cases with high pTau burden, supporting the notion that resilience to ADNC may depend, in part, on resistance to pTDP-43 pathology. To probe for interactions between tau and TDP-43, we developed a C. elegans model of combined human (h) Tau and TDP-43 proteotoxicity, which exhibited a severe degenerative phenotype most compatible with a synergistic, rather than simply additive, interaction between hTau and hTDP-43 neurodegeneration. Pathways that underlie this synergy may present novel therapeutic targets for the prevention and treatment of AD.
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Affiliation(s)
- Caitlin S Latimer
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA.
| | - Bridget T Burke
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Nicole F Liachko
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heather N Currey
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Mitchell D Kilgore
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jonathan Henriksen
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | - Martin Darvas
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
| | | | - Suman Jayadev
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Tom J Grabowski
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Deparment of Radiology, University of Washington, Seattle, Washington, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Brian C Kraemer
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Thomas D Bird
- Geriatrics Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Division of Neuropathology, Department of Pathology, University of Washington, Seattle, WA, 98104, USA
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von Arnim CAF, Bartsch T, Jacobs AH, Holbrook J, Bergmann P, Zieschang T, Polidori MC, Dodel R. Diagnosis and treatment of cognitive impairment. Z Gerontol Geriatr 2019; 52:309-315. [PMID: 31161337 DOI: 10.1007/s00391-019-01560-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/07/2019] [Indexed: 01/14/2023]
Abstract
As a result of the aging population dementia is a growing challenge, especially in healthcare. Nevertheless, cognitive disorders are often not systematically evaluated, especially during hospital stays for other reasons; however, cognitive impairment is associated with a number of geriatric syndromes, including falls, delirium, dysphagia and lack of adherence to treatment plans. This article considers the current state of diagnosis and treatment of dementia. Non-pharmacological therapeutic approaches as well as current and future pharmacological treatment options are discussed. The drugs of choice for the symptomatic treatment of cognitive deficits in Alzheimer's disease and Parkinson-associated dementia are cholinesterase inhibitors and memantine; there is no specific pharmacological treatment for other types of dementia. Prevention and treatment of cardiovascular risk factors can potentially retard the progression of possibly all forms of dementia.
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Affiliation(s)
- Christine A F von Arnim
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | | | | | - Jill Holbrook
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | | | - Tania Zieschang
- University Clinic of Geriatric Medicine, Oldenburg University, Oldenburg, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Dpt. II Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Richard Dodel
- Geriatric Medicine, University Duisburg-Essen, Essen, Germany
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Legdeur N, van der Lee SJ, de Wilde M, van der Lei J, Muller M, Maier AB, Visser PJ. The association of vascular disorders with incident dementia in different age groups. ALZHEIMERS RESEARCH & THERAPY 2019; 11:47. [PMID: 31097030 PMCID: PMC6524321 DOI: 10.1186/s13195-019-0496-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/22/2019] [Indexed: 12/27/2022]
Abstract
Background There is increasing evidence that dementia risk associated with vascular disorders is age dependent. Large population-based studies of incident dementia are necessary to further elucidate this effect. Therefore, the aim of the present study was to determine the association of vascular disorders with incident dementia in different age groups in a large primary care database. Methods We included 442,428 individuals without dementia aged ≥ 65 years from the longitudinal primary care Integrated Primary Care Information (IPCI) database. We determined in 6 age groups (from 65–70 to ≥ 90 years) the risk of hypertension, diabetes mellitus, dyslipidemia, stroke, myocardial infarction, heart failure, and atrial fibrillation for all-cause dementia using incidence rate ratios, Cox regression, and Fine and Gray regression models. Results The mean age at inclusion of the total study sample was 72.4 years, 45.7% of the participants were male, and median follow-up was 3.6 years. During 1.4 million person-years of follow-up, 13,511 individuals were diagnosed with dementia. The risk for dementia decreased with increasing age for all risk factors and was no longer significant in individuals aged ≥ 90 years. Adjusting for mortality as a competing risk did not change the results. Conclusions We conclude that vascular disorders are no longer a risk factor for dementia at high age. Possible explanations include selective survival of individuals who are less susceptible to the negative consequences of vascular disorders and differences in follow-up time between individuals with and without a vascular disorder. Future research should focus on the identification of other risk factors than vascular disorders, for example, genetic or inflammatory processes, that can potentially explain the strong age-related increase in dementia risk. Electronic supplementary material The online version of this article (10.1186/s13195-019-0496-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nienke Legdeur
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
| | - Sven J van der Lee
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Marcel de Wilde
- Institute of Medical Informatics, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Johan van der Lei
- Institute of Medical Informatics, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Research Institute Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Hachinski V. Dementia: Paradigm shifting into high gear. Alzheimers Dement 2019; 15:985-994. [PMID: 30979540 DOI: 10.1016/j.jalz.2019.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/30/2022]
Abstract
Redressing the rising threat of dementia demands not only an increase, but a diversification of efforts. We need new approaches, trials, and partners. We cannot afford to continue to only round up the usual suspects, β amyloid, and tau and try to stop them with a single drug "silver bullet". Dementia of late onset is not a disease, but an amalgam of interactive pathologies on the shifting background of aging, requiring multimodal targeting. Cerebrovascular diseases coexist and coact with all major neurodegenerative pathologies, increasing two-fold the likelihood that they will manifest clinically. Cerebrovascular diseases need to be controlled, to give antidegenerative drugs a chance to succeed. This calls for new types of trials and designs. Stroke doubles the chances of developing dementia and decreases in stroke incidence correlate with decreases in dementia. Ninety percent of strokes are potentially preventable and so are a proportion of dementias. The stroke and dementia communities need to partner and complement the search for silver bullets with the golden opportunity of doing something now.
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Affiliation(s)
- Vladimir Hachinski
- Schulich School of Medicine & Dentistry, Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada.
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112
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Gilsanz P, Corrada MM, Kawas CH, Mayeda ER, Glymour MM, Quesenberry CP, Lee C, Whitmer RA. Incidence of dementia after age 90 in a multiracial cohort. Alzheimers Dement 2019; 15:497-505. [PMID: 30797730 PMCID: PMC6497045 DOI: 10.1016/j.jalz.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Little is known about dementia incidence in diverse populations of oldest-old, the age group with highest dementia incidence. METHODS Incident dementia diagnoses from 1/1/2010 to 9/30/2015 were abstracted from medical records for 2350 members of an integrated health care system in California (n = 1702 whites, n = 375 blacks, n = 105 Latinos, n = 168 Asians) aged ≥90 in 2010. We estimated race/ethnicity-specific age-adjusted dementia incidence rates and implemented Cox proportional hazards models and Fine and Gray competing risk of death models adjusted for demographics and comorbidities in midlife and late-life. RESULTS Dementia incidence rates (n = 771 cases) were lowest among Asians (89.9/1000 person-years), followed by whites (96.9/1000 person-years), Latinos (105.8/1000 person-years), and blacks (121.5/1000 person-years). Cox regression and competing risk models estimated 28% and 36% higher dementia risk for blacks versus whites adjusting for demographics and comorbidities. DISCUSSION Patterns of racial/ethnic disparities in dementia seen in younger older adults continue after the age of 90 years, though smaller in magnitude.
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Affiliation(s)
- Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Maria M Corrada
- Department of Neurology, University of California, Irvine, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Claudia H Kawas
- Department of Neurology, University of California, Irvine, Irvine, CA, USA; Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Catherine Lee
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Rachel A Whitmer
- Kaiser Permanente Division of Research, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Department of Public Health Sciences, University of California, Davis, Davis, CA, USA.
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Abstract
PURPOSE OF REVIEW Alzheimer disease (AD) is the most common cause of late-onset dementia. This article describes the epidemiology, genetic and environmental risk factors, clinical diagnosis, biomarkers, and treatment of late-onset AD, defined by age of onset of 65 years or older. RECENT FINDINGS An estimated 5.7 million Americans are living with AD dementia, with the number of affected individuals growing rapidly because of an aging population. Vascular risk factors, sleep disorders, and traumatic brain injury are associated with an increased risk of AD, while increased cognitive and physical activity throughout the lifespan reduce the risk of disease. The primary genetic risk factor for late-onset AD is the apolipoprotein E (APOE) ε4 allele. AD typically presents with early and prominent episodic memory loss, although this clinical syndrome is neither sensitive nor specific for underlying AD neuropathology. Emerging CSF and imaging biomarkers can now detect the key neuropathologic features of the disease (amyloid plaques, neurofibrillary tangles, and neurodegeneration) in living people, allowing for characterization of patients based on biological measures. A comprehensive treatment plan for AD includes use of symptomatic medications, optimal treatment of comorbid conditions and neuropsychiatric symptoms, counseling about safety and future planning, and referrals to community resources. SUMMARY AD is very common in older neurologic patients. Neurologists should set the standard for the diagnosis and care of patients with AD and should be familiar with emerging biomarkers that have transformed AD research and are primed to enter the clinical arena.
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Hall A, Pekkala T, Polvikoski T, van Gils M, Kivipelto M, Lötjönen J, Mattila J, Kero M, Myllykangas L, Mäkelä M, Oinas M, Paetau A, Soininen H, Tanskanen M, Solomon A. Prediction models for dementia and neuropathology in the oldest old: the Vantaa 85+ cohort study. ALZHEIMERS RESEARCH & THERAPY 2019; 11:11. [PMID: 30670070 PMCID: PMC6343349 DOI: 10.1186/s13195-018-0450-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
Background We developed multifactorial models for predicting incident dementia and brain pathology in the oldest old using the Vantaa 85+ cohort. Methods We included participants without dementia at baseline and at least 2 years of follow-up (N = 245) for dementia prediction or with autopsy data (N = 163) for pathology. A supervised machine learning method was used for model development, considering sociodemographic, cognitive, clinical, vascular, and lifestyle factors, as well as APOE genotype. Neuropathological assessments included β-amyloid, neurofibrillary tangles and neuritic plaques, cerebral amyloid angiopathy (CAA), macro- and microscopic infarcts, α-synuclein pathology, hippocampal sclerosis, and TDP-43. Results Prediction model performance was evaluated using AUC for 10 × 10-fold cross-validation. Overall AUCs were 0.73 for dementia, 0.64–0.68 for Alzheimer’s disease (AD)- or amyloid-related pathologies, 0.72 for macroinfarcts, and 0.61 for microinfarcts. Predictors for dementia were different from those in previous reports of younger populations; for example, age, sex, and vascular and lifestyle factors were not predictive. Predictors for dementia versus pathology were also different, because cognition and education predicted dementia but not AD- or amyloid-related pathologies. APOE genotype was most consistently present across all models. APOE alleles had a different impact: ε4 did not predict dementia, but it did predict all AD- or amyloid-related pathologies; ε2 predicted dementia, but it was protective against amyloid and neuropathological AD; and ε3ε3 was protective against dementia, neurofibrillary tangles, and CAA. Very few other factors were predictive of pathology. Conclusions Differences between predictors for dementia in younger old versus oldest old populations, as well as for dementia versus pathology, should be considered more carefully in future studies. Electronic supplementary material The online version of this article (10.1186/s13195-018-0450-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anette Hall
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Timo Pekkala
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Tuomo Polvikoski
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Miia Kivipelto
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | | | - Mia Kero
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Liisa Myllykangas
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Mira Mäkelä
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Minna Oinas
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anders Paetau
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Maarit Tanskanen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Alina Solomon
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland. .,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.
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115
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Lopez OL, Kuller LH. Epidemiology of aging and associated cognitive disorders: Prevalence and incidence of Alzheimer's disease and other dementias. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:139-148. [DOI: 10.1016/b978-0-12-804766-8.00009-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Wisniewski T, Drummond E. Future horizons in Alzheimer's disease research. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 168:223-241. [PMID: 31699317 DOI: 10.1016/bs.pmbts.2019.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are growing genetic, transcriptomic and proteomic data pointing to the complexity of Alzheimer's disease (AD) pathogenesis. Unbiased "omics" approaches are essential for the future development of effective AD research, which will need to be combined and personalized, given that multiple distinct pathways can drive AD pathology. It is essential to gain a better understanding of the AD pathogenesis subtype variety and to develop several distinct therapeutic approaches tailored to address this diversity, as well as the common presence of mixed pathologies. These nonmutually exclusive therapeutic approaches include the targeting of multiple toxic oligomeric species concurrently, targeting the apolipoprotein E/amyloid β interaction and the modulation of innate immunity, as well as more "out of the box" ideas such as targeting infectious agents that may play a role in AD.
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Affiliation(s)
- Thomas Wisniewski
- Departments of Neurology, Pathology and Psychiatry, Center for Cognitive Neurology, NYU School of Medicine, New York, NY, United States.
| | - Eleanor Drummond
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Boyle PA, Yu L, Leurgans SE, Wilson RS, Brookmeyer R, Schneider JA, Bennett DA. Attributable risk of Alzheimer's dementia attributed to age-related neuropathologies. Ann Neurol 2019; 85:114-124. [PMID: 30421454 PMCID: PMC10128614 DOI: 10.1002/ana.25380] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The degree to which Alzheimer's versus other neuropathologies contribute to the risk of Alzheimer's dementia is unknown. We examined the risk of Alzheimer's dementia attributable to pathologic AD and 8 other neuropathologies. METHODS Participants (n = 1,161) came from 2 clinical-pathological studies of aging. Multivariable logistic regression models examined associations of 8 neuropathological indices with Alzheimer's dementia and quantified the percentage of cases attributable to each. Furthermore, because some dementia cases are not driven by common neuropathologies, we re-estimated the attributable risks after empirically adjusting for such cases. RESULTS Of 1,161 persons, 512 (44.1%) had Alzheimer's dementia at time of death. With the exception of microinfarcts, all neuropathological indices were independently associated with greater odds of Alzheimer's dementia. Two hundred ten (41.0%) Alzheimer's dementia cases were attributable to pathological AD. Separately, 8.9% were attributable to macroscopic infarcts, 10.8% to Lewy bodies, 5.2% to hippocampal sclerosis, 11.7% to transactive response DNA-binding protein 43, 8.1% to cerebral amyloid angiopathy, 6.0% to atherosclerosis, and 5.2% to arteriolosclerosis. A total of 83.3% of cases were attributable to all 8 indices combined. However, after further adjustment for cases driven by other factors, a total of 67.5% of cases were attributable to all 8 neuropathologic indices combined. INTERPRETATION Pathological AD accounts for a considerable percentage of Alzheimer's dementia cases, but multiple other neuropathologies also contribute. In total, just over two-thirds of Alzheimer's dementia cases are attributable to common age-related neuropathologies, suggesting that other disease and resilience factors are important. ANN NEUROL 2019;85:114-124.
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Affiliation(s)
- Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Ron Brookmeyer
- Department of Biostatistics, University of California at Los Angeles, CA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL.,Department of Pathology, Rush University Medical Center, Chicago, IL
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
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Oliveira DVD, Frongia LP, Bertolini SMMG, Soares VN, Nascimento Júnior JRAD, Cavaglieri CR. Perception of memory decline in physically active elderly: comparison between practitioners of systematized and non-systematized physical exercises. MOTRIZ: REVISTA DE EDUCACAO FISICA 2019. [DOI: 10.1590/s1980-6574201900010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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119
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Ihara R, Vincent BD, Baxter MR, Franklin EE, Hassenstab JJ, Xiong C, Morris JC, Cairns NJ. Relative neuron loss in hippocampal sclerosis of aging and Alzheimer's disease. Ann Neurol 2018; 84:741-753. [PMID: 30246887 DOI: 10.1002/ana.25344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To characterize the pattern of neuron loss in hippocampal sclerosis of aging (HS-Aging) and age-related diseases and to evaluate its contribution to cognitive impairment in the elderly. METHODS Participants (n = 1,361) came from longitudinal observational studies of aging at the Knight Alzheimer Disease Research Center, Washington University (St. Louis, MO). Relative neuron loss in the hippocampus of HS-Aging was measured using unbiased stereological methods. Transactive response DNA-binding protein of 43 kDa (TDP-43) proteinopathy, a putative marker of HS-Aging, was assessed. Clinical and cognitive data were analyzed using parametric statistical methods. RESULTS Ninety-three cases had HS-Aging (6.8%), 8 cases had "pure" HS-Aging, and 37 cases had comorbid intermediate or high Alzheimer's disease neuropathological change (i/h ADNC). Relative neuron loss (ratio of neuron number in hippocampal subfield CA1 to the neuron number in parahippocampal gyrus) was 0.15 for HS-Aging; this was significantly lower than 0.64 for i/h ADNC and 0.66 for control cases (Kruskal-Wallis test, p < 0.0001; p = 0.0003, respectively). TDP-43 proteinopathy was present in 92.4% of HS-Aging cases, higher than that in i/h ADNC (52%) and control (25%) cases. Pure HS-Aging cases were more likely to have cognitive impairment in the memory domain. INTERPRETATION Relative neuron loss in the hippocampus compared to the parahippocampus gyrus may be useful in distinguishing HS-Aging in the context of comorbid ADNC. HS-Aging contributes to cognitive impairment, which phenotypically resembles AD dementia. TDP proteinopathy is a frequent comorbidity in HS-Aging and may contribute to cognitive impairment to a modest degree. Ann Neurol 2018;84:749-761.
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Affiliation(s)
- Ryoko Ihara
- Department of Neuropathology, the University of Tokyo, Tokyo, Japan.,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO
| | - Benjamin D Vincent
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO.,Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Michael R Baxter
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO.,Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Erin E Franklin
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO.,Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Jason J Hassenstab
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO.,Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Chengjie Xiong
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO.,Department of Biostatistics, Washington University School of Medicine, St Louis, MO
| | - John C Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO.,Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Nigel J Cairns
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO.,Department of Neurology, Washington University School of Medicine, St Louis, MO.,Department of Pathology & Immunology, Washington University School of Medicine, St Louis, MO
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Pase MP, Davis-Plourde K, Himali JJ, Satizabal CL, Aparicio H, Seshadri S, Beiser AS, DeCarli C. Vascular risk at younger ages most strongly associates with current and future brain volume. Neurology 2018; 91:e1479-e1486. [PMID: 30232248 PMCID: PMC6202941 DOI: 10.1212/wnl.0000000000006360] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/09/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Given the potential therapeutic effect of vascular disease control timing to reduce dementia risk, we investigated the age-related influences of vascular risk factor burden on brain structure throughout the lifespan. METHODS We studied participants from the community-based prospective Framingham Heart Study. Overall vascular risk factor burden was calculated according to the Framingham Stroke Risk Profile, a validated algorithm that predicts stroke risk. Brain volume was estimated by MRI. We used cross-sectional data to examine how the strength of association between vascular risk factor burden and brain volume changed across each age decade from age 45-54 years through to 85-94 years (N = 2,887). Second, we leveraged up to 40 years of longitudinal data to determine how the strength of association between vascular risk factor burden and brain volume changed when vascular risk factors were examined at progressively earlier ages (N = 7,868). RESULTS In both cross-sectional and longitudinal analyses, higher vascular risk factor burden was associated with lower brain volume across each age decade. In the cross-sectional analysis, the strength of this association decreased with each decade of advancing age (p for trend < 0.0001). In longitudinal analysis, the strength of association between vascular risk factor burden and brain volume was stronger when vascular risk factors were measured at younger ages. For example, vascular risk factor burden was most strongly associated with lower brain volume in later life when vascular risk factors were measured at age 45 years. CONCLUSION Vascular risk factors at younger ages appear to have detrimental effects on current and future brain volume.
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Affiliation(s)
- Matthew P Pase
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento.
| | - Kendra Davis-Plourde
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento
| | - Jayandra J Himali
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento
| | - Claudia L Satizabal
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento
| | - Hugo Aparicio
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento
| | - Sudha Seshadri
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento
| | - Alexa S Beiser
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento
| | - Charles DeCarli
- From the Melbourne Dementia Research Centre (M.P.P.), the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Australia; Department of Neurology (M.P.P., J.J.H., C.L.S., H.A., S.S., A.S.B), Boston University School of Medicine; Framingham Heart Study (M.P.P., K.D-.P., J.J.H., H.A., S.S., A.S.B., C.D.), MA; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Australia; Department of Biostatistics (K.D.-P., J.J.H., A.S.B.), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S., C.D.), University of Texas Health Sciences Center, San Antonio; and Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento
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Trieu T, Sajjadi SA, Kawas CH, Nelson PT, Corrada MM. Risk factors of hippocampal sclerosis in the oldest old: The 90+ Study. Neurology 2018; 91:e1788-e1798. [PMID: 30315072 DOI: 10.1212/wnl.0000000000006455] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/31/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To examine the risk factors and comorbidities of hippocampal sclerosis (HS) in the oldest-old. METHODS A total of 134 participants with dementia from The 90+ Study with longitudinal evaluations and autopsy were included in this investigation. Participants were divided into 2 groups, one with and one without HS pathology, and differences in clinical and pathologic characteristics were compared. RESULTS Persons with HS tended to have a longer duration of dementia compared to participants without HS (mean 4.0 years vs 6.7 years, odds ratio [OR] 1.26; 95% confidence interval [CI] 1.11-1.42; p < 0.001). HS was more likely in participants with a history of autoimmune diseases (rheumatoid arthritis or thyroid disease, OR 3.15; 95% CI 1.30-7.62; p = 0.011), high thyroid-stimulating hormone (OR 4.94; 95% CI 1.40-17.46; p = 0.013), or high thyroid antibodies (OR 3.45; 95% CI 1.09-10.88; p = 0.035). Lewy body disease (LBD) pathology was also associated with an increased likelihood of HS (OR 5.70; 95% CI 1.22-26.4; p = 0.027). CONCLUSION We identified autoimmune conditions (rheumatoid arthritis and thyroid disease) as potential risk factors for HS in our cohort. LBD was the only pathology that was associated with increased odds of HS and those harboring HS pathology had a longer duration of dementia. This suggests multiple pathways of HS pathology among the oldest-old.
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Affiliation(s)
- Thomas Trieu
- From the College of Medicine (T.T.), The Pennsylvania State University, State College; Departments of Neurology (S.A.S., C.H.K., M.M.C.), Neurobiology and Behavior (C.H.K.), and Epidemiology (M.M.C.), University of California, Irvine; and Department of Pathology, University of Kentucky Sanders-Brown Center on Aging (P.T.N.), University of Kentucky, Lexington
| | - Seyed Ahmad Sajjadi
- From the College of Medicine (T.T.), The Pennsylvania State University, State College; Departments of Neurology (S.A.S., C.H.K., M.M.C.), Neurobiology and Behavior (C.H.K.), and Epidemiology (M.M.C.), University of California, Irvine; and Department of Pathology, University of Kentucky Sanders-Brown Center on Aging (P.T.N.), University of Kentucky, Lexington
| | - Claudia H Kawas
- From the College of Medicine (T.T.), The Pennsylvania State University, State College; Departments of Neurology (S.A.S., C.H.K., M.M.C.), Neurobiology and Behavior (C.H.K.), and Epidemiology (M.M.C.), University of California, Irvine; and Department of Pathology, University of Kentucky Sanders-Brown Center on Aging (P.T.N.), University of Kentucky, Lexington
| | - Peter T Nelson
- From the College of Medicine (T.T.), The Pennsylvania State University, State College; Departments of Neurology (S.A.S., C.H.K., M.M.C.), Neurobiology and Behavior (C.H.K.), and Epidemiology (M.M.C.), University of California, Irvine; and Department of Pathology, University of Kentucky Sanders-Brown Center on Aging (P.T.N.), University of Kentucky, Lexington
| | - María M Corrada
- From the College of Medicine (T.T.), The Pennsylvania State University, State College; Departments of Neurology (S.A.S., C.H.K., M.M.C.), Neurobiology and Behavior (C.H.K.), and Epidemiology (M.M.C.), University of California, Irvine; and Department of Pathology, University of Kentucky Sanders-Brown Center on Aging (P.T.N.), University of Kentucky, Lexington.
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Wang R, Laveskog A, Laukka EJ, Kalpouzos G, Bäckman L, Fratiglioni L, Qiu C. MRI load of cerebral microvascular lesions and neurodegeneration, cognitive decline, and dementia. Neurology 2018; 91:e1487-e1497. [PMID: 30232255 PMCID: PMC6202944 DOI: 10.1212/wnl.0000000000006355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/12/2018] [Indexed: 12/03/2022] Open
Abstract
Objective To explore the differential associations of neurodegeneration and microvascular lesion load with cognitive decline and dementia in older people and the modifying effect of the APOE genotype on these associations. Methods A sample of 436 participants (age ≥ 60 years) was derived from the population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, and clinically examined at baseline (2001–2003) and 3 occasions during the 9-year follow-up. At baseline, we assessed microvascular lesion load using a summary score for MRI markers of lacunes, white matter hyperintensities (WMHs), and perivascular spaces and neurodegeneration load for markers of enlarged ventricles, smaller hippocampus, and smaller gray matter. We assessed cognitive function using the Mini-Mental State Examination (MMSE) test and diagnosed dementia following the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. We analyzed data using linear mixed-effects, mediation, and random-effects Cox models. Results During the follow-up, 46 participants were diagnosed with dementia. Per 1-point increase in microvascular lesion and neurodegeneration score (range 0–3) was associated with multiple adjusted β-coefficients of −0.35 (95% confidence interval, −0.51 to −0.20) and −0.44 (−0.56 to −0.32), respectively, for the MMSE score and multiple adjusted hazard ratios of 1.68 (1.12–2.51) and 2.35 (1.58–3.52), respectively, for dementia; carrying APOE ε4 reinforced the associations with MMSE decline. WMH volume changes during the follow-up mediated 66.9% and 12.7% of the total association of MMSE decline with the baseline microvascular score and neurodegeneration score, respectively. Conclusions Both cerebral microvascular lesion and neurodegeneration loads are strongly associated with cognitive decline and dementia. The cognitive decline due to microvascular lesions is exacerbated by APOE ε4 and is largely attributed to progression and development of microvascular lesions.
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Affiliation(s)
- Rui Wang
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden.
| | - Anna Laveskog
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Erika J Laukka
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Grégoria Kalpouzos
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Lars Bäckman
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Laura Fratiglioni
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Chengxuan Qiu
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden.
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Robinson JL, Corrada MM, Kovacs GG, Dominique M, Caswell C, Xie SX, Lee VMY, Kawas CH, Trojanowski JQ. Non-Alzheimer's contributions to dementia and cognitive resilience in The 90+ Study. Acta Neuropathol 2018; 136:377-388. [PMID: 29916037 DOI: 10.1007/s00401-018-1872-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
The diagnosis of Alzheimer's disease (AD) in the oldest-old is complicated by the increasing prevalence of age-related neurofibrillary tangles, plaques and non-AD pathologies such as cerebrovascular disease (CVD), hippocampal sclerosis (HS), aging-related tau astrogliopathy (ARTAG), as well as TDP-43 and Lewy pathology. The contribution of these non-AD pathologies to dementia and cognitive resilience is unclear. We assessed the level of AD neuropathologic change (ADNPC) and non-AD pathology in 185 participants enrolled in The 90+ Study with available cognitive assessments and brain tissue. Logistic regression models-adjusting for age, sex and education-determined the association between each pathology and dementia or between subgroups. 53% had dementia, primarily AD or mixed AD; 23% had cognitive impairment without dementia (CIND); 23% were not impaired. Both AD and non-AD pathology was prevalent. 100% had tangles, 81% had plaques, and both tangles and plaques associated with dementia. ARTAG distributed across limbic (70%), brainstem (39%) and cortical regions (24%). 49% had possible CVD and 26% had definite CVD, while HS was noted in 15%. Cortical ARTAG, CVD and HS were each associated with dementia, but limbic and brainstem ARTAGs were not. TDP-43 and Lewy pathologies were found in 36 and 17% and both associated with dementia. No pathology distinguished CIND and the not impaired. By NIA-AA criteria and dementia status, the cohort was subdivided into four groups: those with minimal ADNPC included the not dementia (ND) and Not AD dementia groups; and those with significant ADNPC included the Resilient without dementia and AD dementia groups. Compared to the ND group, the Not AD dementia group had more HS, cortical ARTAG, TDP-43, and Lewy pathology. Compared to the AD dementia group, the Resilient group had less CVD, no HS and less cortical ARTAG, TDP-43 and Lewy pathology. Our findings imply that reductions in non-AD pathologies including CVD contribute to cognitive resilience in the oldest-old.
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Affiliation(s)
- John L Robinson
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria M Corrada
- Department of Neurology, Department of Epidemiology, Institute for Memory Impairments and Neurological Disorders, University of California at Irvine, Irvine, CA, USA
| | - Gabor G Kovacs
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Myrna Dominique
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie Caswell
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia M-Y Lee
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Claudia H Kawas
- Department of Neurology, Department of Neurobiology and Behavior, Institute for Memory Impairments and Neurological Disorders, University of California at Irvine, Irvine, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA.
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Ganz AB, Beker N, Hulsman M, Sikkes S, Netherlands Brain Bank, Scheltens P, Smit AB, Rozemuller AJM, Hoozemans JJM, Holstege H. Neuropathology and cognitive performance in self-reported cognitively healthy centenarians. Acta Neuropathol Commun 2018; 6:64. [PMID: 30037350 PMCID: PMC6055341 DOI: 10.1186/s40478-018-0558-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/23/2022] Open
Abstract
With aging, the incidence of neuropathological hallmarks of neurodegenerative diseases increases in the brains of cognitively healthy individuals. It is currently unclear to what extent these hallmarks associate with symptoms of disease at extreme ages. Forty centenarians from the 100-plus Study cohort donated their brain. Centenarians self-reported to be cognitively healthy at baseline, which was confirmed by a proxy. Objective ante-mortem measurements of cognitive performance were associated with the prevalence, distribution and quantity of age- and AD-related neuropathological hallmarks. Despite self-reported cognitive health, objective neuropsychological testing suggested varying levels of ante-mortem cognitive functioning. Post-mortem, we found that neuropathological hallmarks related to age and neurodegenerative diseases, such as Aβ and Tau pathology, as well as atherosclerosis, were abundantly present in most or all centenarians, whereas Lewy body and pTDP-43 pathology were scarce. We observed that increased pathology loads correlated across pathology subtypes, and an overall trend of higher pathology loads to associate with a lower cognitive test performance. This trend was carried especially by the presence of neurofibrillary tangles (NFTs) and granulovacuolar degeneration (GVD) and to a lesser extent by Aβ-associated pathologies. Cerebral Amyloid Angiopathy (CAA) specifically associated with lower executive functioning in the centenarians. In conclusion, we find that while the centenarians in this cohort escaped or delayed cognitive impairment until extreme ages, their brains reveal varying levels of disease-associated neuropathological hallmarks, some of which associate with cognitive performance.
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Affiliation(s)
- Andrea B Ganz
- Department of Molecular and Cellular Neuroscience, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- Alzheimer Centre, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Nina Beker
- Alzheimer Centre, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Marc Hulsman
- Department of Clinical Genetics, Amsterdam Neuroscience, VU University Medical Center, de Boelelaan, 1118 1081 HV, Amsterdam, The Netherlands
| | - Sietske Sikkes
- Alzheimer Centre, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Netherlands Brain Bank
- Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Centre, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - August B Smit
- Department of Molecular and Cellular Neuroscience, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Jeroen J M Hoozemans
- Department of Pathology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Henne Holstege
- Alzheimer Centre, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of Clinical Genetics, Amsterdam Neuroscience, VU University Medical Center, de Boelelaan, 1118 1081 HV, Amsterdam, The Netherlands.
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125
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Power MC, Mormino E, Soldan A, James BD, Yu L, Armstrong NM, Bangen KJ, Delano-Wood L, Lamar M, Lim YY, Nudelman K, Zahodne L, Gross AL, Mungas D, Widaman KF, Schneider J. Combined neuropathological pathways account for age-related risk of dementia. Ann Neurol 2018; 84:10-22. [PMID: 29944741 PMCID: PMC6119518 DOI: 10.1002/ana.25246] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Our objectives were to characterize the inter-relation of known dementia-related neuropathologies in one comprehensive model and quantify the extent to which accumulation of neuropathologies accounts for the association between age and dementia. METHODS We used data from 1,362 autopsied participants of three community-based clinicopathological cohorts: the Religious Orders Study, the Rush Memory and Aging Project, and the Minority Aging Research Study. We estimated a series of structural equation models summarizing a priori hypothesized neuropathological pathways between age and dementia risk individually and collectively. RESULTS At time of death (mean age, 89 years), 44% of our sample had a clinical dementia diagnosis. When considered individually, our vascular, amyloid/tau, neocortical Lewy body, and TAR DNA-binding protein 43 (TDP-43)/hippocampal sclerosis pathology pathways each accounted for a substantial proportion of the association between age and dementia. When considered collectively, the four pathways fully accounted for all variance in dementia risk previously attributable to age. Pathways involving amyloid/tau, neocortical Lewy bodies, and TDP-43/hippocampal sclerosis were interdependent, attributable to the importance of amyloid beta plaques in all three. The importance of the pathways varied, with the vascular pathway accounting for 32% of the association between age and dementia, wheraes the remaining three inter-related degenerative pathways together accounted for 68% (amyloid/tau, 24%; the Lewy body, 1%; and TDP-43/hippocampal sclerosis, 43%). INTERPRETATION Age-related increases in dementia risk can be attributed to accumulation of multiple pathologies, each of which contributes to dementia risk. Multipronged approaches may be necessary if we are to develop effective therapies. Ann Neurol 2018;84:10-22.
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Affiliation(s)
- Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Elizabeth Mormino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL.,Department of Internal Medicine, Rush University, Chicago, IL
| | - Lei Yu
- Department of Neurological Sciences, Rush University, Chicago, IL
| | - Nicole M Armstrong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA.,Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA.,Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Yen Ying Lim
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Kelly Nudelman
- Department of Radiology and Imaging Sciences, Indiana University-Purdue University at Indianapolis, Indianapolis, IN
| | - Laura Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Center on Aging and Health, Baltimore, MD.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dan Mungas
- Department of Neurology, University of California-Davis, Davis, CA
| | - Keith F Widaman
- Graduate School of Education, University of California Riverside, Riverside, CA
| | - Julie Schneider
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL.,Department of Neurological Sciences, Rush University, Chicago, IL.,Department of Pathology, Rush University Medical Center, Chicago, IL
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Vale TC, Barbosa MT, Resende EDPF, Maia DP, Cunningham MCQ, Guimarães HC, Machado JCB, Teixeira AL, Cardoso F, Caramelli P. Parkinsonism in a population-based study of individuals aged 75+ years: The Pietà study. Parkinsonism Relat Disord 2018; 56:76-81. [PMID: 29934195 DOI: 10.1016/j.parkreldis.2018.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Parkinsonism is one of the most prevalent neurological syndromes in the elderly. There are only a few epidemiological studies focusing on parkinsonism in oldest-old individuals, particularly in Latin America. This study aims to investigate the prevalence and characteristics of parkinsonism in subjects aged 75 + years living in the community. METHODS The Pietà study is a population-based investigation on brain aging conducted in Caeté, southeast Brazil. A sample composed of 610 community-dwelling individuals aged 75 + years (48.7% of the total population within this age range) underwent clinical, neurological, cognitive and functional assessments. RESULTS The sample comprised mostly women (61.5%), with mean age of 83.3 years and mean schooling of 2.5 years. Parkinsonism was identified in 65 subjects (crude prevalence = 10.7%). Parkinson's disease, Parkinsonism + dementia syndrome, drug-induced parkinsonism, vascular parkinsonism and Lewy-body dementia were identified in, respectively, 19 (29.2%), 19 (29.2%), 8 (12.3%), 4 (6.1%) and 1 (1.5%) subjects. In 14 individuals (21.5%), the etiology of parkinsonism could not be determined. The most important vascular risk factor was hypertension (64.6%). Cognitive evaluation disclosed dementia in 37 (56.9%) subjects. Mean Pfeffer's functional activities questionnaire score was 12.2 points and 22 (33.8%) subjects were impaired in basic activities of daily living. CONCLUSION Parkinsonism was common in this oldest-old population, being associated with dementia and vascular risk factors, particularly hypertension. Different confounders, such as concomitant dementia and exposure to anti-dopaminergic drugs, were present in this population, challenging the definition of causes of parkinsonism.
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Affiliation(s)
- Thiago Cardoso Vale
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Juiz de Fora (MG), Brazil
| | - Maira Tonidandel Barbosa
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil; Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Elisa de Paula França Resende
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Débora Palma Maia
- Movement Disorders Unit, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Mauro César Quintão Cunningham
- Movement Disorders Unit, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Henrique Cerqueira Guimarães
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | | | - Antônio Lucio Teixeira
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Francisco Cardoso
- Movement Disorders Unit, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil.
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Lim EY, Yang DW, Kim JS, Cho AH. Safety and Efficacy of Anti-dementia Agents in the Extremely Elderly Patients with Dementia. J Korean Med Sci 2018; 33:e133. [PMID: 29736156 PMCID: PMC5934516 DOI: 10.3346/jkms.2018.33.e133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are debates on representation and generalizability of previous randomized controlled trials about anti-dementia agents in the oldest old population. In this context, we aimed to investigate the efficacy and safety of anti-dementia agents in the very elderly patients with dementia. METHODS We conducted a retrospective study of patients with dementia 1) who were 85 years or older, 2) got started anti-dementia agents, and 3) went through follow-up evaluation about one year thereafter. As a control, patients with dementia who were less than 85 years old with similar inclusion criteria were randomly selected during the same period. The adverse drug effects and discontinuation rates were investigated with self-reported complaint after starting or increasing anti-dementia drugs. For efficacy outcome, we also analyzed the change in neuropsychological results during follow-up period. RESULTS A total of 77 dementia patients who were at least 85 years were enrolled. As a control group, 78 patients with dementia who were younger than 85 was analyzed. The adverse drug effects were observed in 26 (33.3%) patients in the younger old and in 26 (33.8%) in the oldest old (P = 0.095). Twenty-one patients (26.9%) in the younger old group and 13 patients (16.9%) in the oldest old group discontinued their medication (P = 0.131). There were no differences between the two groups about changes of Mini-Mental State Examination and Instrumental Activity of Daily Living scores over time. CONCLUSION The use of anti-dementia agents in the oldest old dementia patients may be safe and effective as the younger old dementia patients.
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Affiliation(s)
- Eun-Ye Lim
- Department of Neurology, The Catholic University of Korea, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Won Yang
- Department of Neurology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Seok Kim
- Department of Neurology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - A-Hyun Cho
- Department of Neurology, The Catholic University of Korea, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lopez OL, Becker JT, Chang Y, Klunk WE, Mathis C, Price J, Aizenstein HJ, Snitz B, Cohen AD, DeKosky ST, Ikonomovic M, Kamboh MI, Kuller LH. Amyloid deposition and brain structure as long-term predictors of MCI, dementia, and mortality. Neurology 2018; 90:e1920-e1928. [PMID: 29695596 DOI: 10.1212/wnl.0000000000005549] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/14/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To test the hypothesis that brain structural integrity (i.e., hippocampal [HIP] volume), white matter lesions (WMLs), and β-amyloid deposition are associated with long-term increased risk of incident dementia and mortality in 183 cognitively normal individuals and patients with mild cognitive impairment (MCI) aged 80 years and older. METHODS All participants had a brain structural MRI scan and PET scan with 11C-labeled Pittsburgh compound B in 2009 and were reexamined yearly through 2015 (mean follow-up time 5.2 ± 1.3 years). RESULTS In the last evaluation through 2010-2015, 56 (31%) participants were cognitively normal, 67 (37%) had MCI, and 60 (33%) had dementia. Fifty-seven (31%) died during follow-up, and 20 (35%) developed dementia before their death. All 3 biomarkers were independent predictors of incident dementia in all participants. After adjusting for the risk of dying, amyloid deposition and WMLs remained strong predictors. Of the 60 participants with incident dementia, 54 (90%) had at least one imaging abnormality. Participants with no biomarker positivity had a very low risk of dementia (16%), while 75% of the participants with the 3 biomarkers progressed to dementia. HIP volume and β-amyloid deposition were associated with death only in participants with MCI. CONCLUSIONS This study showed the presence of more than one biomarker was a stronger long-term predictor of incident dementia than any biomarker alone. After adjusting for the risk of dying, amyloid deposition and WMLs were stronger predictors of dementia than HIP volume. The risk of dying during follow-up was associated with both neurodegeneration and amyloid deposition, especially in individuals with MCI.
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Affiliation(s)
- Oscar L Lopez
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville.
| | - James T Becker
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - YueFang Chang
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - William E Klunk
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Chester Mathis
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Julia Price
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Howard J Aizenstein
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Beth Snitz
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Ann D Cohen
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Steven T DeKosky
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Milos Ikonomovic
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - M Ilyas Kamboh
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
| | - Lewis H Kuller
- From the Departments of Neurology (O.L.L., J.T.B., B.S., M.I.), Psychiatry (O.L.L., J.T.B., W.E.K., H.J.A., A.D.C.), Psychology (J.T.B.), Neurosurgery (Y.C.), Epidemiology, Graduate School of Public Health (Y.C., L.H.K.), Radiology (C.M., J.P.), Pharmaceutical Sciences (C.M.), and Genetics (M.I.K.), University of Pittsburgh, School of Medicine, PA; and Department of Neurology (S.T.D.), University of Florida, Gainesville
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Lindemer ER, Greve DN, Fischl B, Salat DH, Gomez-Isla T. White matter abnormalities and cognition in patients with conflicting diagnoses and CSF profiles. Neurology 2018; 90:e1461-e1469. [PMID: 29572277 DOI: 10.1212/wnl.0000000000005353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/01/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether white matter changes influence progression of cognitive decline in individuals with clinically diagnosed Alzheimer disease (AD) and differing biomarker profiles. METHODS Two hundred thirty-six individuals from the Alzheimer's Disease Neuroimaging Initiative database with clinical diagnoses of cognitively normal older adult (older controls [OCs]), mild cognitive impairment, and AD were studied. Support vector machine experiments were first performed to determine the utility of various biomarkers for classifying individuals by clinical diagnosis. General linear models were implemented to assess the relationships between CSF measures of β-amyloid 1-42, phosphorylated tau181p, and MRI-based white matter signal abnormality (WMSA) volumes and cognitive decline. Analyses were performed across all patients as well as within subgroups of individuals that were defined by clinical cutoff points for both CSF measures. RESULTS CSF biomarkers alone classified individuals with AD vs OCs with 82% accuracy, and the addition of WMSA did not enhance this. Both CSF biomarkers as well as WMSA volume significantly contributed to predicting cognitive decline in executive and memory domains when assessed across all 236 individuals. In individuals with pathologic levels of both CSF biomarkers, WMSA only significantly contributed to models of future executive function decline. In individuals with subpathologic CSF biomarker levels (levels similar to those in OC individuals), WMSA significantly contributed to prediction of memory decline and were the sole significant predictor of executive function decline. CONCLUSIONS WMSA hold additional predictive power regarding cognitive progression in older individuals and are most effective as biomarkers in individuals who are cognitively impaired but do not fit the expected CSF biomarker profile of AD.
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Affiliation(s)
- Emily R Lindemer
- From the Division of Health Sciences and Technology (E.R.L.), Massachusetts Institute of Technology/Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (E.R.L., D.N.G., D.H.S.), Massachusetts General Hospital, Charlestown; Department of Neurology (T.G.-I.), Massachusetts General Hospital (B.F.), Boston; Department of Radiology (D.N.G., D.H.S.), Harvard Medical School (B.F.), Charlestown; Health Sciences and Technology/Electrical Engineering and Computer Science (B.F.), Massachusetts Institute of Technology, Boston; and NeRVe Neuroimaging Center for Veterans (D.H.S.), Boston VA Healthcare System, MA.
| | - Douglas N Greve
- From the Division of Health Sciences and Technology (E.R.L.), Massachusetts Institute of Technology/Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (E.R.L., D.N.G., D.H.S.), Massachusetts General Hospital, Charlestown; Department of Neurology (T.G.-I.), Massachusetts General Hospital (B.F.), Boston; Department of Radiology (D.N.G., D.H.S.), Harvard Medical School (B.F.), Charlestown; Health Sciences and Technology/Electrical Engineering and Computer Science (B.F.), Massachusetts Institute of Technology, Boston; and NeRVe Neuroimaging Center for Veterans (D.H.S.), Boston VA Healthcare System, MA
| | - Bruce Fischl
- From the Division of Health Sciences and Technology (E.R.L.), Massachusetts Institute of Technology/Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (E.R.L., D.N.G., D.H.S.), Massachusetts General Hospital, Charlestown; Department of Neurology (T.G.-I.), Massachusetts General Hospital (B.F.), Boston; Department of Radiology (D.N.G., D.H.S.), Harvard Medical School (B.F.), Charlestown; Health Sciences and Technology/Electrical Engineering and Computer Science (B.F.), Massachusetts Institute of Technology, Boston; and NeRVe Neuroimaging Center for Veterans (D.H.S.), Boston VA Healthcare System, MA
| | - David H Salat
- From the Division of Health Sciences and Technology (E.R.L.), Massachusetts Institute of Technology/Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (E.R.L., D.N.G., D.H.S.), Massachusetts General Hospital, Charlestown; Department of Neurology (T.G.-I.), Massachusetts General Hospital (B.F.), Boston; Department of Radiology (D.N.G., D.H.S.), Harvard Medical School (B.F.), Charlestown; Health Sciences and Technology/Electrical Engineering and Computer Science (B.F.), Massachusetts Institute of Technology, Boston; and NeRVe Neuroimaging Center for Veterans (D.H.S.), Boston VA Healthcare System, MA
| | - Teresa Gomez-Isla
- From the Division of Health Sciences and Technology (E.R.L.), Massachusetts Institute of Technology/Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (E.R.L., D.N.G., D.H.S.), Massachusetts General Hospital, Charlestown; Department of Neurology (T.G.-I.), Massachusetts General Hospital (B.F.), Boston; Department of Radiology (D.N.G., D.H.S.), Harvard Medical School (B.F.), Charlestown; Health Sciences and Technology/Electrical Engineering and Computer Science (B.F.), Massachusetts Institute of Technology, Boston; and NeRVe Neuroimaging Center for Veterans (D.H.S.), Boston VA Healthcare System, MA
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130
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Raunio A, Myllykangas L, Kero M, Polvikoski T, Paetau A, Oinas M. Amygdala α-Synuclein Pathology in the Population-Based Vantaa 85+ Study. J Alzheimers Dis 2018; 58:669-674. [PMID: 28482633 PMCID: PMC6218117 DOI: 10.3233/jad-170104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated the frequency of Lewy-related pathology (LRP) in the amygdala among the population-based Vantaa 85+ study. Data of amygdala samples (N = 304) immunostained with two α-synuclein antibodies (clone 42 and clone 5G4) was compared with the previously analyzed LRP and AD pathologies from other brain regions. The amygdala LRP was present in one third (33%) of subjects. Only 5% of pure AD subjects, but 85% of pure DLB subjects had LRP in the amygdala. The amygdala LRP was associated with dementia; however, the association was dependent on LRP on other brain regions, and thus was not an independent risk factor. The amygdala-predominant category was a rare (4%) and heterogeneous group.
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Affiliation(s)
- Anna Raunio
- Department of Pathology, University of Helsinkiand Helsinki University Hospital, Helsinki, Finland
| | - Liisa Myllykangas
- Department of Pathology, University of Helsinkiand Helsinki University Hospital, Helsinki, Finland
| | - Mia Kero
- Department of Pathology, University of Helsinkiand Helsinki University Hospital, Helsinki, Finland
| | - Tuomo Polvikoski
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Anders Paetau
- Department of Pathology, University of Helsinkiand Helsinki University Hospital, Helsinki, Finland
| | - Minna Oinas
- Department of Pathology, University of Helsinkiand Helsinki University Hospital, Helsinki, Finland.,Department of Neurosurgery, University ofHelsinki and Helsinki University Hospital, Helsinki, Finland
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131
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Swardfager W, Cogo-Moreira H, Masellis M, Ramirez J, Herrmann N, Edwards JD, Saleem M, Chan P, Yu D, Nestor SM, Scott CJM, Holmes MF, Sahlas DJ, Kiss A, Oh PI, Strother SC, Gao F, Stefanovic B, Keith J, Symons S, Swartz RH, Lanctôt KL, Stuss DT, Black SE. The effect of white matter hyperintensities on verbal memory: Mediation by temporal lobe atrophy. Neurology 2018; 90:e673-e682. [PMID: 29374101 DOI: 10.1212/wnl.0000000000004983] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/27/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the relationship between white matter hyperintensities (WMH) presumed to indicate disease of the cerebral small vessels, temporal lobe atrophy, and verbal memory deficits in Alzheimer disease (AD) and other dementias. METHODS We recruited groups of participants with and without AD, including strata with extensive WMH and minimal WMH, into a cross-sectional proof-of-principle study (n = 118). A consecutive case series from a memory clinic was used as an independent validation sample (n = 702; Sunnybrook Dementia Study; NCT01800214). We assessed WMH volume and left temporal lobe atrophy (measured as the brain parenchymal fraction) using structural MRI and verbal memory using the California Verbal Learning Test. Using path modeling with an inferential bootstrapping procedure, we tested an indirect effect of WMH on verbal recall that depends sequentially on temporal lobe atrophy and verbal learning. RESULTS In both samples, WMH predicted poorer verbal recall, specifically due to temporal lobe atrophy and poorer verbal learning (proof-of-principle -1.53, 95% bootstrap confidence interval [CI] -2.45 to -0.88; and confirmation -0.66, 95% CI [-0.95 to -0.41] words). This pathway was significant in subgroups with (-0.20, 95% CI [-0.38 to -0.07] words, n = 363) and without (-0.71, 95% CI [-1.12 to -0.37] words, n = 339) AD. Via the identical pathway, WMH contributed to deficits in recognition memory (-1.82%, 95% CI [-2.64% to -1.11%]), a sensitive and specific sign of AD. CONCLUSIONS Across dementia syndromes, WMH contribute indirectly to verbal memory deficits considered pathognomonic of Alzheimer disease, specifically by contributing to temporal lobe atrophy.
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Affiliation(s)
- Walter Swardfager
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada.
| | - Hugo Cogo-Moreira
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Mario Masellis
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Joel Ramirez
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Nathan Herrmann
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Jodi D Edwards
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Mahwesh Saleem
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Parco Chan
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Di Yu
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Sean M Nestor
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Christopher J M Scott
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Melissa F Holmes
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Demetrios J Sahlas
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Alexander Kiss
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Paul I Oh
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Stephen C Strother
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Fuqiang Gao
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Bojana Stefanovic
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Julia Keith
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Sean Symons
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Richard H Swartz
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Krista L Lanctôt
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Donald T Stuss
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Sandra E Black
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
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Yasar S, Whitmer R. Statin use and risk of Alzheimer disease: A new view on an old relationship. Neurology 2018; 90:103-104. [PMID: 29247074 DOI: 10.1212/wnl.0000000000004837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sevil Yasar
- From the Departments of Medicine and Neurology (S.Y.), Johns Hopkins School of Medicine, Baltimore, MD; Division of Research (R.W.), Kaiser Permanente; and Departments of Epidemiology and Biostatistics (R.W.), University of California San Francisco.
| | - Rachel Whitmer
- From the Departments of Medicine and Neurology (S.Y.), Johns Hopkins School of Medicine, Baltimore, MD; Division of Research (R.W.), Kaiser Permanente; and Departments of Epidemiology and Biostatistics (R.W.), University of California San Francisco
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Irimata KE, Dugger BN, Wilson JR. Impact of the Presence of Select Cardiovascular Risk Factors on Cognitive Changes among Dementia Subtypes. Curr Alzheimer Res 2018; 15:1032-1044. [PMID: 29962344 PMCID: PMC6162109 DOI: 10.2174/1567205015666180702105119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/26/2018] [Accepted: 06/29/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies have shown select associations between cardiovascular risk factors and dementia, but mostly focused on Alzheimer's Disease (AD). OBJECTIVE We enhance these works by evaluating the relationship between the presence of cardiovascular risk factors and the rate of cognitive decline, measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SUM) on four common dementia subtypes (AD, dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VaD), as well as non-demented elderly individuals (normal)). METHOD We used generalized linear mixed models with random intercepts to account for correlation at the patient and center levels for each dementia subtype adjusting for time since initial visit, baseline cognitive score, age, and demographic factors. The cardiovascular risk factors evaluated included body mass index, diabetes, years of smoking, atrial fibrillation, hypertension, and hypercholesterolemia. RESULTS Patients diagnosed with AD (n=1899), DLB (n=65), FTD (n=168), or VaD (n=13); or lacked cognitive impairment (normal) (n=3583) were evaluated using data from the National Alzheimer's Coordinating Centers. Cardiovascular risk factors were associated with select dementia subtypes including AD and FTD. Using MMSE and CDR-SUM, recent or active hypertension and hypercholesterolemia were associated with a slower cognitive decline for AD patients, while higher body mass index and years of smoking were associated with a slower cognitive decline for FTD patients. However, several cardiovascular factors demonstrated associations with more rapid cognitive decline. CONCLUSION These results demonstrate disease specific associations and can provide clinicians guidance on predicted cognitive changes at the group level using information about cardiovascular risk factors.
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Affiliation(s)
- Katherine E. Irimata
- Arizona State University, School of Mathematical and Statistical Sciences, Tempe, AZ
| | - Brittany N. Dugger
- University of California Davis, Department of Pathology and Laboratory Medicine, Sacramento, CA
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Pontecorvo MJ, Siderowf A, Dubois B, Doraiswamy PM, Frisoni GB, Grundman M, Nobili F, Sadowsky CH, Salloway S, Arora AK, Chevrette A, Deberdt W, Dell'Agnello G, Flitter M, Galante N, Lowrey MJ, Lu M, McGeehan A, Devous Sr. MD, Mintun MA. Effectiveness of Florbetapir PET Imaging in Changing Patient Management. Dement Geriatr Cogn Disord 2017; 44:129-143. [PMID: 28787712 PMCID: PMC5806476 DOI: 10.1159/000478007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS To evaluate the impact of amyloid PET imaging on diagnosis and patient management in a multicenter, randomized, controlled study. METHODS Physicians identified patients seeking a diagnosis for mild cognitive impairment or dementia, possibly due to Alzheimer disease (AD), and recorded a working diagnosis and a management plan. The patients underwent florbetapir PET scanning and were randomized to either immediate or delayed (1-year) feedback regarding amyloid status. At the 3-month visit, the physician updated the diagnosis and recorded a summary of the actual patient management since the post-scan visit. The study examined the impact of immediate versus delayed feedback on patient diagnosis/management at 3 and 12 months. RESULTS A total of 618 subjects were randomized (1:1) to immediate or delayed feedback arms, and 602 subjects completed the 3-month primary endpoint visit. A higher proportion of patients in the immediate feedback arm showed a change in diagnosis compared to the controls (32.6 vs. 6.4%; p = 0.0001). Similarly, a higher proportion of patients receiving immediate feedback had a change in management plan (68 vs. 55.5%; p < 0.002), mainly driven by changes in AD medication. Specifically, acetylcholinesterase inhibitors were prescribed to 67% of the amyloid-positive and 27% of the amyloid-negative subjects in the information group compared with 56 and 43%, respectively, in the control group (p < 0.0001). These between-group differences persisted until the 12-month visit. CONCLUSION Knowledge of the amyloid status affects the diagnosis and alters patient management.
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Affiliation(s)
- Michael J. Pontecorvo
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA,*Michael J. Pontecorvo, PhD, Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), 3711 Market Street, Philadelphia, PA 19104 (USA), E-Mail
| | - Andrew Siderowf
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Bruno Dubois
- Dementia Research Center (IM2A), Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - P. Murali Doraiswamy
- Department of Psychiatry, Duke University Health System and the Duke Institute for Brain Sciences, Durham, North Carolina, USA
| | - Giovanni B. Frisoni
- Department of Psychiatry, University Hospitals and University of Geneva, Geneva, Switzerland,Department of Internal Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michael Grundman
- Global R&D Partners, LLC, California, USA,University of California, San Diego, California, USA
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | | | | | - Anupa K. Arora
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Antoine Chevrette
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | | | | | - Matthew Flitter
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Nick Galante
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Mark J. Lowrey
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Ming Lu
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Anne McGeehan
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Michael D. Devous Sr.
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Mark A. Mintun
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
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Swardfager W, Yu D, Scola G, Cogo-Moreira H, Chan P, Zou Y, Herrmann N, Lanctôt KL, Ramirez J, Gao F, Masellis M, Swartz RH, Sahlas DJ, Chan PC, Ojeda-Lopez C, Milan-Tomas A, Pettersen JA, Andreazza AC, Black SE. Peripheral lipid oxidative stress markers are related to vascular risk factors and subcortical small vessel disease. Neurobiol Aging 2017; 59:91-97. [DOI: 10.1016/j.neurobiolaging.2017.06.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/19/2017] [Accepted: 06/30/2017] [Indexed: 11/28/2022]
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Azarpazhooh MR, Avan A, Cipriano LE, Munoz DG, Sposato LA, Hachinski V. Concomitant vascular and neurodegenerative pathologies double the risk of dementia. Alzheimers Dement 2017; 14:148-156. [PMID: 28974416 DOI: 10.1016/j.jalz.2017.07.755] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/12/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The relative contributions of vascular and degenerative pathology to dementia are unknown. We aim to quantify the proportion of dementia explained by potentially preventable vascular lesions. METHODS We systematically searched for population-based cohorts before February 2017 reporting clinicopathological data for individuals with and without dementia. We calculated the summary proportion and absolute risk of dementia comparing subjects with and without the pathology. RESULTS We identified 10 studies comprising 2856 subjects. Vascular-type pathology and mixed pathology are respectively two and three times more likely in demented patients. The summary proportion of dementia is 77%-86% in subjects with mixed degenerative and vascular pathology and 45% in subjects with pure Alzheimer-type pathology. DISCUSSION Patients with mixed pathologies have nearly twice the incremental risk of dementia compared with patients with only Alzheimer-type lesions. Consequently, many cases of dementia could be prevented or delayed by targeting the vascular component.
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Affiliation(s)
- Mahmoud Reza Azarpazhooh
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Abolfazl Avan
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lauren E Cipriano
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada
| | - David G Munoz
- Department of Pathology and Laboratory Medicine, University of Toronto & Department of Laboratory Medicine, and Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St Michael's Hospital Toronto, Ontario, Canada
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Stroke, Dementia and Heart Disease Laboratory, Western University, London, Ontario, Canada; Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Brenowitz WD, Hubbard RA, Keene CD, Hawes SE, Longstreth WT, Woltjer RL, Kukull WA. Mixed neuropathologies and associations with domain-specific cognitive decline. Neurology 2017; 89:1773-1781. [PMID: 28939667 DOI: 10.1212/wnl.0000000000004567] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/31/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test whether decline in specific cognitive domains associated with Alzheimer disease neuropathologic change (ADNC) is modified by co-occurrence of other neuropathologies such as Lewy body disease (LBD) or vascular brain injury (VBI). METHODS Data came from 1,603 autopsied participants evaluated at US Alzheimer's Disease Centers. Standardized z scores in memory, attention, language, and executive function were derived from neuropsychological test scores assessed at each annual visit. Multivariable linear mixed-effects models assessed associations between neuropathologies and longitudinal trajectories of domain scores. RESULTS Compared to other participants, those with ADNC + LBD generally had worse cognitive trajectories, particularly lower initial executive function and faster attention decline. Participants with ADNC + VBI typically had less impairment and slower decline. Interactions were significant between LBD and ADNC for memory (p = 0.046) and between VBI and ADNC for language (p = 0.03); decline was slower than expected if these neuropathologies acted additively on the rate of decline. In secondary models, these interactions were limited to those with high ADNC (but not intermediate ADNC). In a subset of 260 participants with data on microinfarct location, cortical and subcortical microinfarcts were associated with decline in memory, language, and executive function in those without ADNC, but this effect was reduced among those with ADNC. CONCLUSIONS ADNC + LBD (but not ADNC + VBI) was associated with poorer executive function and attention compared to other pathology groupings. However, the effect of co-occurring pathologies on cognitive trajectories may depend on the severity of ADNC. Future studies using antemortem biomarkers should seek to replicate these neuropathologic observations.
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Affiliation(s)
- Willa D Brenowitz
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco.
| | - Rebecca A Hubbard
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - C Dirk Keene
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Stephen E Hawes
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - W T Longstreth
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Randy L Woltjer
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Walter A Kukull
- From the National Alzheimer's Coordinating Center (W.D.B., W.T.L., W.A.K.), Department of Pathology (C.D.K.), Department of Epidemiology (S.E.H., W.D.B., W.T.L., W.A.K.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Department of Biostatistics, Epidemiology and Informatics (R.A.H.), University of Pennsylvania, Philadelphia; and Department of Pathology (R.L.W.), Oregon Health & Science University, Portland. W.D.B. is currently with the Department of Epidemiology and Biostatistics, University of California, San Francisco
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van Veluw SJ, Shih AY, Smith EE, Chen C, Schneider JA, Wardlaw JM, Greenberg SM, Biessels GJ. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol 2017; 16:730-740. [PMID: 28716371 PMCID: PMC5861500 DOI: 10.1016/s1474-4422(17)30196-5] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/17/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
Cerebral microinfarcts are small lesions that are presumed to be ischaemic. Despite the small size of these lesions, affected individuals can have hundreds to thousands of cerebral microinfarcts, which cause measurable disruption to structural brain connections, and are associated with dementia that is independent of Alzheimer's disease pathology or larger infarcts (ie, lacunar infarcts, and large cortical and non-lacunar subcortical infarcts). Substantial progress has been made with regard to understanding risk factors and functional consequences of cerebral microinfarcts, partly driven by new in-vivo detection methods and the development of animal models that closely mimic multiple aspects of cerebral microinfarcts in human beings. Evidence from these advances suggests that cerebral microinfarcts can be manifestations of both small vessel and large vessel disease, that cerebral microinfarcts are independently associated with cognitive impairment, and that these lesions are likely to cause damage to brain structure and function that extends beyond their actual lesion boundaries. Criteria for the identification of cerebral microinfarcts with in-vivo MRI are provided to support further studies of the association between these lesions and cerebrovascular disease and dementia.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andy Y Shih
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Chen
- Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
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139
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Bennett IJ, Greenia DE, Maillard P, Sajjadi SA, DeCarli C, Corrada MM, Kawas CH. Age-related white matter integrity differences in oldest-old without dementia. Neurobiol Aging 2017; 56:108-114. [PMID: 28527525 PMCID: PMC5647141 DOI: 10.1016/j.neurobiolaging.2017.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/07/2017] [Accepted: 04/15/2017] [Indexed: 12/30/2022]
Abstract
Aging is known to have deleterious effects on cerebral white matter, yet little is known about these white matter alterations in advanced age. In this study, 94 oldest-old adults without dementia (90-103 years) underwent diffusion tensor imaging to assess relationships between chronological age and multiple measures of integrity in 18 white matter regions across the brain. Results revealed significant age-related declines in integrity in regions previously identified as being sensitive to aging in younger-old adults (corpus callosum, fornix, cingulum, external capsule). For the corpus callosum, the effect of age on genu fractional anisotropy was significantly weaker than the relationship between age and splenium fractional anisotropy. Importantly, age-related declines in white matter integrity did not differ in cognitively normal and cognitively impaired not demented oldest-old, suggesting that they were not solely driven by cognitive dysfunction or preclinical dementia in this advanced age group. Instead, white matter in these regions appears to remain vulnerable to normal aging processes through the 10th decade of life.
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Affiliation(s)
- Ilana J Bennett
- Department of Psychology, University of California, Riverside, CA, USA.
| | - Dana E Greenia
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, CA, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA; Alzheimer's Disease Center, University of California, Davis, CA, USA
| | - Maria M Corrada
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, CA, USA
| | - Claudia H Kawas
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, CA, USA; Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
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140
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Kapasi A, DeCarli C, Schneider JA. Impact of multiple pathologies on the threshold for clinically overt dementia. Acta Neuropathol 2017; 134:171-186. [PMID: 28488154 PMCID: PMC5663642 DOI: 10.1007/s00401-017-1717-7] [Citation(s) in RCA: 412] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/14/2022]
Abstract
Longitudinal clinical-pathological studies have increasingly recognized the importance of mixed pathologies (the coexistence of one or more neurodegenerative and cerebrovascular disease pathologies) as important factors in the development of Alzheimer's disease (AD) and other forms of dementia. Older persons with AD pathology, often have concomitant cerebrovascular disease pathologies (macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy) as well as other concomitant neurodegenerative disease pathologies (Lewy bodies, TDP-43, hippocampal sclerosis). These additional pathologies lower the threshold for clinical diagnosis of AD. Many of these findings from pathologic studies, especially for CVD, have been confirmed using sophisticated neuroimaging technologies. In vivo biomarker studies are necessary to provide an understanding of specific pathologic contributions and time course relationships along the spectrum of accumulating pathologies. In this review, we provide a clinical-pathological perspective on the role of multiple brain pathologies in dementia followed by a review of the available clinical and biomarker data on some of the mixed pathologies.
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Affiliation(s)
- Alifiya Kapasi
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, USA
- Department of Pathology, Rush University Medical Center, Chicago, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, USA.
- Department of Pathology, Rush University Medical Center, Chicago, USA.
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA.
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141
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Han P, Nielsen M, Song M, Yin J, Permenter MR, Vogt JA, Engle JR, Dugger BN, Beach TG, Barnes CA, Shi J. The Impact of Aging on Brain Pituitary Adenylate Cyclase Activating Polypeptide, Pathology and Cognition in Mice and Rhesus Macaques. Front Aging Neurosci 2017; 9:180. [PMID: 28659785 PMCID: PMC5467357 DOI: 10.3389/fnagi.2017.00180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/23/2017] [Indexed: 01/30/2023] Open
Abstract
Pituitary adenylate cyclase activating polypeptide (PACAP) is associated with Alzheimer's disease (AD), but its age-related effects are unknown. We chose the rhesus macaque due to its closeness to human anatomy and physiology. We examined four variables: aging, cognitive performance, amyloid plaques and PACAP. Delayed nonmatching-to-sample recognition memory scores declined with age and correlated with PACAP levels in the striatum, parietal and temporal lobes. Because amyloid plaques were the only AD pathology in the old rhesus macaque, we further studied human amyloid precursor protein (hAPP) transgenic mice. Aging was associated with decreased performance in the Morris Water Maze (MWM). In wild type (WT) C57BL/6 mice, the performance was decreased at age 24-26 month whereas in hAPP transgenic mice, it was decreased as early as 9-12 month. Neuritic plaques in adult hAPP mice clustered in hippocampus and adjacent cortical regions, but did not propagate further into the frontal cortex. Cerebral PACAP protein levels were reduced in hAPP mice compared to age-matched WT mice, but the genetic predisposition dominated cognitive decline. Taken together, these data suggest an association among PACAP levels, aging, cognitive function and amyloid load in nonhuman primates, with both similarities and differences from human AD brains. Our results suggest caution in choosing animal models and in extrapolating data to human AD studies.
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Affiliation(s)
- Pengcheng Han
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenix, AZ, United States
- Department of Pathology and Laboratory Medicine Resident Program, Medical University of South CarolinaCharleston, SC, United States
| | - Megan Nielsen
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenix, AZ, United States
| | - Melissa Song
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenix, AZ, United States
| | - Junxiang Yin
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenix, AZ, United States
| | - Michele R. Permenter
- California National Primate Research Center, University of California, DavisDavis, CA, United States
| | - Julie A. Vogt
- California National Primate Research Center, University of California, DavisDavis, CA, United States
| | - James R. Engle
- California National Primate Research Center, University of California, DavisDavis, CA, United States
- Evely F. McKnight Brain Institute, University of ArizonaTucson, AZ, United States
| | - Brittany N. Dugger
- Institute for Neurodegenerative Diseases, University of California, San FranciscoSan Francisco, CA, United States
- Civin Laboratory for Neuropathology, Banner Sun Health Research InstituteSun City, AZ, United States
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research InstituteSun City, AZ, United States
| | - Carol A. Barnes
- California National Primate Research Center, University of California, DavisDavis, CA, United States
- Evely F. McKnight Brain Institute, University of ArizonaTucson, AZ, United States
- Division of Neural Systems, Memory and Aging, University of ArizonaTucson, AZ, United States
- Departments of Psychology, Neurology, and Neuroscience, University of ArizonaTucson, AZ, United States
| | - Jiong Shi
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenix, AZ, United States
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General HospitalTianjin, China
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142
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Caselli RJ, Beach TG, Knopman DS, Graff-Radford NR. Alzheimer Disease: Scientific Breakthroughs and Translational Challenges. Mayo Clin Proc 2017; 92:978-994. [PMID: 28578785 PMCID: PMC5536337 DOI: 10.1016/j.mayocp.2017.02.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/17/2017] [Accepted: 02/13/2017] [Indexed: 01/13/2023]
Abstract
Alzheimer disease (AD) was originally conceived as a rare disease that caused presenile dementia but has come to be understood as the most prevalent cause of dementia at any age worldwide. It has an extended preclinical phase characterized by sequential changes in imaging and cerebrospinal fluid biomarkers with subtle memory decline beginning more than a decade before the emergence of symptomatic memory loss heralding the beginning of the mild cognitive impairment stage. The apolipoprotein E ε4 allele is a prevalent and potent risk factor for AD that has facilitated research into its preclinical phase. Cerebral Aβ levels build from preclinical through early dementia stages followed by hyperphosphorylated tau-related pathology, the latter driving cognitive deficits and dementia severity. Structural and molecular imaging can now recapitulate the neuropathology of AD antemortem. Autosomal dominant forms of early-onset familial AD gave rise to the amyloid hypothesis of AD, which, in turn, has led to therapeutic trials of immunotherapy designed to clear cerebral amyloid, but to date results have been disappointing. Genome-wide association studies have identified multiple additional risk factors, but to date none have yielded an effective alternate therapeutic target. Current and future trials aimed at presymptomatic individuals either harboring cerebral amyloid or at genetically high risk offer the hope that earlier intervention might yet succeed where trials in patients with established dementia have failed. A major looming challenge will be that of expensive, incompletely effective disease-modifying therapy: who and when to treat, and how to pay for it.
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Affiliation(s)
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ
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143
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Dodge HH, Zhu J, Woltjer R, Nelson PT, Bennett DA, Cairns NJ, Fardo DW, Kaye JA, Lyons DE, Mattek N, Schneider JA, Silbert LC, Xiong C, Yu L, Schmitt FA, Kryscio RJ, Abner EL. Risk of incident clinical diagnosis of Alzheimer's disease-type dementia attributable to pathology-confirmed vascular disease. Alzheimers Dement 2017; 13:613-623. [PMID: 28017827 PMCID: PMC5466467 DOI: 10.1016/j.jalz.2016.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/10/2016] [Accepted: 11/16/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The presence of cerebrovascular pathology may increase the risk of clinical diagnosis of Alzheimer's disease (AD). METHODS We examined excess risk of incident clinical diagnosis of AD (probable and possible AD) posed by the presence of lacunes and large infarcts beyond AD pathology using data from the Statistical Modeling of Aging and Risk of Transition study, a consortium of longitudinal cohort studies with more than 2000 autopsies. We created six mutually exclusive pathology patterns combining three levels of AD pathology (low, moderate, or high AD pathology) and two levels of vascular pathology (without lacunes and large infarcts or with lacunes and/or large infarcts). RESULTS The coexistence of lacunes and large infarcts results in higher likelihood of clinical diagnosis of AD only when AD pathology burden is low. DISCUSSION Our results reinforce the diagnostic importance of AD pathology in clinical AD. Further harmonization of assessment approaches for vascular pathologies is required.
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Affiliation(s)
- Hiroko H Dodge
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Michigan Alzheimer's Disease Center, Department of Neurology, University of Michigan, Ann Arbor, MI.
| | - Jian Zhu
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Randy Woltjer
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; Department of Pathology, University of Kentucky, Lexington, KY
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - David W Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Public Health, Department of Biostatistics, University of Kentucky, Lexington, KY
| | - Jeffrey A Kaye
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Portland VA Medical Center, Portland, OR
| | - Deniz-Erten Lyons
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Portland VA Medical Center, Portland, OR
| | - Nora Mattek
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Lisa C Silbert
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Portland VA Medical Center, Portland, OR
| | - Chengjie Xiong
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Medicine, Departments of Neurology and Psychiatry, University of Kentucky, Lexington, KY
| | - Richard J Kryscio
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Public Health, Department of Biostatistics, University of Kentucky, Lexington, KY
| | - Erin L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Public Health, Department of Epidemiology, University of Kentucky, Lexington, KY
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Abstract
PURPOSE OF THE REVIEW A wide array of sleep and circadian deficits have been observed in patients with Alzheimer's Disease (AD). However, the vast majority of these studies have focused on later-stage AD, and do not shed light on the possibility that circadian dysfunction contributes to AD pathogenesis. The goal of this review it to examine the evidence supporting or refuting the hypothesis that circadian dysfunction plays an important role in early AD pathogenesis or AD risk in humans. RECENT FINDINGS Few studies have addressed the role of the circadian system in very early AD, or prior to AD diagnosis. AD appears to have a long presymtomatic phase during which pathology is present but cognition remains normal. Studies evaluating circadian function in cognitively-normal elderly or early-stage AD have thus far not incorporated AD biomarkers. Thus, the cause-and-effect relationship between circadian dysfunction and early-stage AD remains unclear. SUMMARY Circadian dysfunction becomes apparent in AD as dementia progresses, but it is unknown at which point in the pathogenic process rhythms begin to deteriorate. Further, it is unknown if exposure to circadian disruption in middle age increases AD risk later in life. This review address gaps in current knowledge on this topic, and proposes several critical directions for future research which might help to clarify the potential pathogenic role of circadian clock dysfunction in AD.
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Affiliation(s)
- Erik S. Musiek
- Dept. of Neurology, Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis MO, USA
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145
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Wilson RS, Bennett DA. How Does Psychosocial Behavior Contribute to Cognitive Health in Old Age? Brain Sci 2017; 7:brainsci7060056. [PMID: 28545247 PMCID: PMC5483629 DOI: 10.3390/brainsci7060056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 11/16/2022] Open
Abstract
With the aging of the U.S. population, the number of cognitively disabled persons is expected to substantially increase in coming decades, underscoring the urgent need for effective interventions. Here, we review the current evidence linking psychosocial factors to late-life cognitive loss and consider the study design needed to illuminate the biologic bases of the associations. We then examine an ongoing study that includes several of the key design elements, the Rush Memory and Aging Project. In this longitudinal clinical-pathological cohort study, indicators of personality, social connectedness, and psychological well-being were shown to predict late-life cognitive outcomes. Participants who died underwent a uniform neuropathologic examination to quantify common dementia-related pathologies. Some psychosocial indicators were associated with cerebral infarction; some indicators modified the association of neurodegenerative pathologies with cognitive loss; and the association of some indicators with cognitive outcomes appears to be independent of the pathologies traditionally associated with late-life dementia. These findings suggest that psychosocial behavior influences late-life cognitive health through multiple neurobiologic mechanisms. A better understanding of these mechanisms may lead to novel strategies for preserving cognitive health in old age.
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Affiliation(s)
- Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA.
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA.
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146
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Brenowitz WD, Keene CD, Hawes SE, Hubbard RA, Longstreth WT, Woltjer RL, Crane PK, Larson EB, Kukull WA. Alzheimer's disease neuropathologic change, Lewy body disease, and vascular brain injury in clinic- and community-based samples. Neurobiol Aging 2017; 53:83-92. [PMID: 28236716 PMCID: PMC5385292 DOI: 10.1016/j.neurobiolaging.2017.01.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/02/2017] [Accepted: 01/22/2017] [Indexed: 02/02/2023]
Abstract
We examined the relationships between Alzheimer's disease neuropathologic change (ADNC), Lewy body disease (LBD), and vascular brain injury (VBI) in 2 large autopsy samples. Because findings may differ between study populations, data came from U.S. Alzheimer's Disease Centers contributing to the National Alzheimer's Coordinating Center (n = 2742) and from the population-based Adult Changes in Thought study (n = 499). Regardless of study population, over 50% of participants with ADNC had co-occurring LBD or VBI; the majority of whom had a clinical AD dementia diagnosis prior to death. Overlap of pathologies was similar between studies, especially after standardizing to the distribution of age and dementia status in the Adult Changes in Thought population. LBD, but not VBI, was positively associated with ADNC in both studies. Interestingly, cortical LBD was more common in those with intermediate ADNC compared to low or high ADNC, especially in the National Alzheimer's Coordinating Center (p < 0.001). High prevalence of co-occurring neuropathologies among older adults with dementia has implications for accurate diagnosis of dementia etiologies and development of disease-modifying strategies.
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Affiliation(s)
- Willa D Brenowitz
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - W T Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Randy L Woltjer
- Department of Pathology, Health Sciences University of Oregon, Portland, OR, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA; Group Health Research Institute, Seattle, WA, USA
| | - Walter A Kukull
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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147
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Abstract
The oldest-old represent the fastest growing segment of society, and the risk of developing dementia continues to increase with advancing age into the 9th and 10th decades of life. The most common form of dementia in the oldest-old is Alzheimer disease (AD), although there are often mixed pathologies contributing to dementia in addition to amyloid plaques and neurofibrillary tangles. Diagnosing AD in the oldest-old is challenging due to cognitive and physical changes associated with aging. Treatment remains supportive, with current approved medications able to provide modest symptomatic benefit but unable to slow the progression of disease.
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Affiliation(s)
- Aimee L Pierce
- Department of Neurology and Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, 1100 Medical Plaza Drive, Irvine, CA 92697, USA.
| | - Szofia S Bullain
- Department of Neurology and Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, 1515 Hewitt Hall, Irvine, CA 92697, USA
| | - Claudia H Kawas
- Departments of Neurology, Neurobiology & Behavior, Epidemiology, and Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, 1121 Gillespie, Irvine, CA 92697, USA
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148
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Sotolongo-Costa O, Gaggero-Sager LM, Becker JT, Maestu F, Sotolongo-Grau O. A physical model for dementia. PHYSICA A 2017; 472:86-93. [PMID: 28827893 PMCID: PMC5562389 DOI: 10.1016/j.physa.2016.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aging associated brain decline often result in some kind of dementia. Even when this is a complex brain disorder a physical model can be used in order to describe its general behavior. A probabilistic model for the development of dementia is obtained and fitted to some experimental data obtained from the Alzheimer's Disease Neuroimaging Initiative. It is explained how dementia appears as a consequence of aging and why it is irreversible.
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Affiliation(s)
- O Sotolongo-Costa
- CInC-(IICBA), Universidad Autónoma del Estado de Morelos, 62209 Cuernavaca, Morelos, Mexico
| | - L M Gaggero-Sager
- CIICAP-(IICBA), Universidad Autónoma del Estado de Morelos, 62209 Cuernavaca, Morelos, Mexico
| | - J T Becker
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh PA 15213, USA
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh PA 15213, USA
- Department of Psychology, School of Medicine, University of Pittsburgh, Pittsburgh PA 15213, USA
| | - F Maestu
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Centre for Biomedical Technology (CTB), Campus de Montegancedo s/n, Pozuelo de Alarcón, 28223, Madrid, Spain
| | - O Sotolongo-Grau
- Alzheimer Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, 08029 Barcelona, Spain
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149
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Abstract
As the world's population continues to age, an understanding of the aging brain becomes increasingly crucial. This review focuses on several recent ideas and findings in the study of neurocognitive aging, specifically focusing on episodic memory, and discusses how they can be considered and used to guide us moving forward. Topics include dysfunction in neural circuits, the roles of neurogenesis and inhibitory signaling, vulnerability in the entorhinal cortex, individual differences, and comorbidities. These avenues of study provide a brief overview of promising themes in the field and together provide a snapshot of what we believe will be important emerging topics in selective vulnerabilities in the aging brain.
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Affiliation(s)
- Zachariah Reagh
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Michael Yassa
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
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150
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Aktuelle Einblicke in die Anämie im Alter. Z Gerontol Geriatr 2017; 51:343-348. [DOI: 10.1007/s00391-017-1212-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/16/2017] [Indexed: 12/19/2022]
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