151
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Creavin ST, Noel-Storr AH, Richard E, Creavin AL, Cullum S, Ben-Shlomo Y, Purdy S. Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people. Hippokratia 2017. [DOI: 10.1002/14651858.cd012558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sam T Creavin
- University of Bristol; School of Social and Community Medicine; Carynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Anna H Noel-Storr
- University of Oxford; Radcliffe Department of Medicine; Room 4401c (4th Floor) John Radcliffe Hospital, Headington Oxford UK OX3 9DU
| | - Edo Richard
- Radboud University Nijmegen Medical Center; Department of Neurology; Nijmegen Netherlands
| | - Alexandra L Creavin
- University of Bristol; School of Social and Community Medicine; Carynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Sarah Cullum
- University of Auckland; Department of Psychological Medicine; Auckland New Zealand 1142
| | - Yoav Ben-Shlomo
- Canynge Hall; Dept of Social Medicine; Whiteladies Road Bristol UK BS8 2PR
| | - Sarah Purdy
- University of Bristol; Faculty of Health Sciences; Senate House, Tyndall Avenue Bristol UK BS8 1TH
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152
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Coutu JP, Lindemer ER, Konukoglu E, Salat DH. Two distinct classes of degenerative change are independently linked to clinical progression in mild cognitive impairment. Neurobiol Aging 2017; 54:1-9. [PMID: 28286328 DOI: 10.1016/j.neurobiolaging.2017.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 01/15/2017] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
Abstract
We previously demonstrated 2 statistically distinct factors of degeneration in Alzheimer's disease: one strongly related to white matter damage and age interpreted as "age- and vascular-related", and the other related to cortical atrophy thought to represent "neurodegenerative changes associated with Alzheimer's disease". Those factors are now replicated in a distinct cross-sectional data set of 364 participants from the Alzheimer's Disease Neuroimaging Initiative and their interpretation is improved using correlations with CSF biomarkers. Furthermore, we now show that changes in both factors over 2 years are independently associated with decline in Mini-Mental State Examination score in a longitudinal subset of 116 individuals with mild cognitive impairment. Progression in the "age- and vascular-related" factor was greater for individuals with 2 APOE ε4 alleles and linked to a greater attributable change in Mini-Mental State Examination than the "neurodegenerative" factor. These results suggest benefits of targeting white matter and vascular health to complement interventions focused on the neurodegenerative aspect of the disease, even in individuals with little discernable vascular comorbidity.
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Affiliation(s)
- Jean-Philippe Coutu
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Emily R Lindemer
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ender Konukoglu
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David H Salat
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, USA
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153
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Tanskanen M, Mäkelä M, Notkola IL, Myllykangas L, Rastas S, Oinas M, Lindsberg PJ, Polvikoski T, Tienari PJ, Paetau A. Population-based analysis of pathological correlates of dementia in the oldest old. Ann Clin Transl Neurol 2017; 4:154-165. [PMID: 28275649 PMCID: PMC5338150 DOI: 10.1002/acn3.389] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/13/2016] [Accepted: 12/16/2016] [Indexed: 12/12/2022] Open
Abstract
Objective The aim of this study was to analyze brain pathologies which cause dementia in the oldest old population. Methods All 601 persons aged ≥85 years living in the city of Vantaa (Finland), on April 1st, 1991 formed the study population of the Vantaa85 + study, 300 of whom were autopsied during follow‐up (79.5% females, mean age‐at‐death 92 ± 3.7 years). Alzheimer's disease (AD) pathology (tau and beta‐amyloid [Aβ]), cerebral amyloid angiopathy (CAA) and Lewy‐related pathologies were analyzed. Brain infarcts were categorized by size (<2 mm, 2–15 mm, >15 mm) and by location. Brain hemorrhages were classified as microscopic (<2 mm) and macroscopic. Results 195/300 (65%) were demented. 194/195 (99%) of the demented had at least one neuropathology. Three independent contributors to dementia were identified: AD‐type tau‐pathology (Braak stage V‐VI), neocortical Lewy‐related pathology, and cortical anterior 2–15 mm infarcts. These were found in 34%, 21%, and 21% of the demented, respectively, with the multivariate odds ratios (OR) for dementia 5.5, 4.5, and 3.4. Factor analysis investigating the relationships between different pathologies identified three separate factors: (1) AD‐spectrum, which included neurofibrillary tau, Aβ plaque, and neocortical Lewy‐related pathologies and CAA (2) >2 mm cortical and subcortical infarcts, and (3) <2 mm cortical microinfarcts and microhemorrhages. Multipathology was common and increased the risk of dementia significantly. Interpretation These results indicate that AD‐type neurodegenerative processes play the most prominent role in twilight cognitive decline. The high prevalence of both neurodegenerative and vascular pathologies indicates that multiple preventive and therapeutic approaches are needed to protect the brains of the oldest old.
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Affiliation(s)
- Maarit Tanskanen
- Department of Pathology Huslab Helsinki University Hospital and Medicum University of Helsinki Helsinki Finland
| | - Mira Mäkelä
- Department of Pathology Huslab Helsinki University Hospital and Medicum University of Helsinki Helsinki Finland
| | | | - Liisa Myllykangas
- Department of Pathology Huslab Helsinki University Hospital and Medicum University of Helsinki Helsinki Finland
| | | | - Minna Oinas
- Neurosurgery Clinical Neurosciences Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Perttu J Lindsberg
- Neurology Clinical Neurosciences Helsinki University Hospital and University of Helsinki Helsinki Finland; Biomedicum Helsinki University of Helsinki Helsinki Finland
| | - Tuomo Polvikoski
- Institute of Neuroscience Newcastle University Newcastle upon Tyne United Kingdom
| | - Pentti J Tienari
- Neurology Clinical Neurosciences Helsinki University Hospital and University of Helsinki Helsinki Finland; Biomedicum Helsinki University of Helsinki Helsinki Finland
| | - Anders Paetau
- Department of Pathology Huslab Helsinki University Hospital and Medicum University of Helsinki Helsinki Finland
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154
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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: 52] [Impact Index Per Article: 7.4] [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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155
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Metabolic Syndrome and the Cellular Phase of Alzheimer's Disease. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 146:243-258. [DOI: 10.1016/bs.pmbts.2016.12.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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156
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Lindemer ER, Greve DN, Fischl B, Augustinack JC, Salat DH. Differential Regional Distribution of Juxtacortical White Matter Signal Abnormalities in Aging and Alzheimer's Disease. J Alzheimers Dis 2017; 57:293-303. [PMID: 28222518 PMCID: PMC5534349 DOI: 10.3233/jad-161057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND White matter signal abnormalities (WMSA) (also known as 'hyperintensities') on MRI are commonly seen in normal aging and increases have been noted in Alzheimer's disease (AD), but whether there is a spatial specificity to these increases is unknown. OBJECTIVE To discern whether or not there is a spatial pattern of WMSA in the brains of individuals with AD that differs from those who exhibit cognitively healthy aging. METHOD Structural MRI data from the Alzheimer's Disease Neuroimaging Initiative public database were used to quantify WMSA in 35 regions of interest (ROIs). Regional measures were compared between cognitively healthy older controls (OC; n = 107) and individuals with a clinical diagnosis of AD (n = 127). Regional WMSA volume was also assessed in individuals with mild cognitive impairment (MCI; n = 74) who were 6, 12, and 24 months away from AD conversion. RESULTS WMSA volume was significantly greater in AD compared to OC in 24 out of 35 ROIs after controlling for age, and nine were significantly higher after normalizing for total WMSA. Regions with greater WMSA volume in AD included rostral frontal, inferior temporal, and inferior parietal WM. In MCI, frontal and temporal regions demonstrated significantly greater WMSA volume with decreasing time-to-AD-conversion. DISCUSSION Individuals with AD have greater regional volume of WMSA compared to OC regardless of age or total WMSA volume. Accumulation of regional WMSA is linked to time to AD conversion in individuals with MCI. These findings indicate WMSA is an important pathological component of AD development.
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Affiliation(s)
- Emily R. Lindemer
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas N. Greve
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce Fischl
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Jean C. Augustinack
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David H. Salat
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, USA
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157
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Raman MR, Kantarci K, Murray ME, Jack CR, Vemuri P. Imaging markers of cerebrovascular pathologies: Pathophysiology, clinical presentation, and risk factors. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 5:5-14. [PMID: 28054023 PMCID: PMC5198884 DOI: 10.1016/j.dadm.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebrovascular pathologies (CVPs) are common pathologies associated with age-related cognitive decline along with Alzheimer disease pathologies. The impact of CVP on the prevalence of dementia is increasingly being recognized. The goal of this review is to improve our understanding of the pathophysiological underpinnings and the multimodal magnetic resonance imaging and positron emission tomography imaging changes that are associated with the hallmarks of CVP. This knowledge will facilitate the development of early detection, intervention, and prevention strategies that may contribute to lowering the risk of dementia. In this review, we will first discuss currently known risk factors of CVPs including cardiovascular, lifestyle, genetic, sex differences, and head injury. Next, we will focus on the pathophysiology of CVPs and their impact on neurodegeneration and downstream cognitive impairment. Specifically, we will discuss three of the most common cerebrovascular lesions seen on MRI: white-matter hyperintensity, microbleeds, and infarcts. Finally, we will discuss the unanswered open questions in this field.
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Affiliation(s)
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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158
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Brenowitz WD, Hubbard RA, Keene CD, Hawes SE, Longstreth WT, Woltjer RL, Kukull WA. Mixed neuropathologies and estimated rates of clinical progression in a large autopsy sample. Alzheimers Dement 2016; 13:654-662. [PMID: 27870939 DOI: 10.1016/j.jalz.2016.09.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/27/2016] [Accepted: 09/29/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Whether co-occurring neuropathologies interact or independently affect clinical disease progression is uncertain. We estimated rates of clinical progression and tested whether associations between clinical progression and Alzheimer's disease neuropathology (ADNP) were modified by co-occurring Lewy body disease (LBD) or vascular brain injury (VBI). METHODS Linear mixed effects models evaluated longitudinal trends in the Clinical Dementia Rating Scale Sum of Boxes on 2046 autopsied participants seen at a U.S. Alzheimer's Disease Center. RESULTS Annual clinical progression was slightly faster for ADNP + LBD compared with ADNP only (P = .06) and slightly slower for ADNP + VBI (P = .003). Differences in progression were less than expected if each neuropathology independently contributed to progression; ADNP interacted with LBD (P = .002) and VBI (P = .003). In secondary models, the effect of additional pathologies on clinical progression was greater in those with intermediate compared with high levels of ADNP. DISCUSSION The impact of co-occurring pathologies on progression may depend on severity of ADNP.
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Affiliation(s)
- Willa D Brenowitz
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA.
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, 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
| | - W T Longstreth
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Randy L Woltjer
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Walter A Kukull
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
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159
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Wyss-Coray T. Ageing, neurodegeneration and brain rejuvenation. Nature 2016; 539:180-186. [PMID: 27830812 PMCID: PMC5172605 DOI: 10.1038/nature20411] [Citation(s) in RCA: 653] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/02/2016] [Indexed: 02/08/2023]
Abstract
Although systemic diseases take the biggest toll on human health and well-being, increasingly, a failing brain is the arbiter of a death preceded by a gradual loss of the essence of being. Ageing, which is fundamental to neurodegeneration and dementia, affects every organ in the body and seems to be encoded partly in a blood-based signature. Indeed, factors in the circulation have been shown to modulate ageing and to rejuvenate numerous organs, including the brain. The discovery of such factors, the identification of their origins and a deeper understanding of their functions is ushering in a new era in ageing and dementia research.
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Affiliation(s)
- Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California 94304, USA
- Center for Tissue Regeneration, Repair and Restoration, VA Palo Alto Health Care System, Palo Alto, California 94304, USA
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160
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Hadar A, Milanesi E, Squassina A, Niola P, Chillotti C, Pasmanik-Chor M, Yaron O, Martásek P, Rehavi M, Weissglas-Volkov D, Shomron N, Gozes I, Gurwitz D. RGS2 expression predicts amyloid-β sensitivity, MCI and Alzheimer's disease: genome-wide transcriptomic profiling and bioinformatics data mining. Transl Psychiatry 2016; 6:e909. [PMID: 27701409 PMCID: PMC5315547 DOI: 10.1038/tp.2016.179] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 12/30/2022] Open
Abstract
Alzheimer's disease (AD) is the most frequent cause of dementia. Misfolded protein pathological hallmarks of AD are brain deposits of amyloid-β (Aβ) plaques and phosphorylated tau neurofibrillary tangles. However, doubts about the role of Aβ in AD pathology have been raised as Aβ is a common component of extracellular brain deposits found, also by in vivo imaging, in non-demented aged individuals. It has been suggested that some individuals are more prone to Aβ neurotoxicity and hence more likely to develop AD when aging brains start accumulating Aβ plaques. Here, we applied genome-wide transcriptomic profiling of lymphoblastoid cells lines (LCLs) from healthy individuals and AD patients for identifying genes that predict sensitivity to Aβ. Real-time PCR validation identified 3.78-fold lower expression of RGS2 (regulator of G-protein signaling 2; P=0.0085) in LCLs from healthy individuals exhibiting high vs low Aβ sensitivity. Furthermore, RGS2 showed 3.3-fold lower expression (P=0.0008) in AD LCLs compared with controls. Notably, RGS2 expression in AD LCLs correlated with the patients' cognitive function. Lower RGS2 expression levels were also discovered in published expression data sets from postmortem AD brain tissues as well as in mild cognitive impairment and AD blood samples compared with controls. In conclusion, Aβ sensitivity phenotyping followed by transcriptomic profiling and published patient data mining identified reduced peripheral and brain expression levels of RGS2, a key regulator of G-protein-coupled receptor signaling and neuronal plasticity. RGS2 is suggested as a novel AD biomarker (alongside other genes) toward early AD detection and future disease modifying therapeutics.
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Affiliation(s)
- A Hadar
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Milanesi
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Squassina
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - P Niola
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - C Chillotti
- Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy
| | - M Pasmanik-Chor
- Bioinformatics Unit, George Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - O Yaron
- The Genomic Analysis Laboratory, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Martásek
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - M Rehavi
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - D Weissglas-Volkov
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Shomron
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Adams Super Center for Brain Studies, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - I Gozes
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Adams Super Center for Brain Studies, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. E-mail: or
| | - D Gurwitz
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Adams Super Center for Brain Studies, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. E-mail: or
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161
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Power MC, Adar SD, Yanosky JD, Weuve J. Exposure to air pollution as a potential contributor to cognitive function, cognitive decline, brain imaging, and dementia: A systematic review of epidemiologic research. Neurotoxicology 2016; 56:235-253. [PMID: 27328897 PMCID: PMC5048530 DOI: 10.1016/j.neuro.2016.06.004] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dementia is a devastating condition typically preceded by a long prodromal phase characterized by accumulation of neuropathology and accelerated cognitive decline. A growing number of epidemiologic studies have explored the relation between air pollution exposure and dementia-related outcomes. METHODS We undertook a systematic review, including quality assessment, to interpret the collective findings and describe methodological challenges that may limit study validity. Articles, which were identified according to a registered protocol, had to quantify the association of an air pollution exposure with cognitive function, cognitive decline, a dementia-related neuroimaging feature, or dementia. RESULTS We identified 18 eligible published articles. The quality of most studies was adequate to exemplary. Almost all reported an adverse association between at least one pollutant and one dementia-related outcome. However, relatively few studies considered outcomes that provide the strongest evidence for a causal effect, such as within-person cognitive or pathologic changes. Reassuringly, differential selection would likely bias toward a protective association in most studies, making it unlikely to account for observed adverse associations. Likewise, using a formal sensitivity analysis, we found that unmeasured confounding is also unlikely to explain reported adverse associations. DISCUSSION We also identified several common challenges. First, most studies of incident dementia identified cases from health system records. As dementia in the community is underdiagnosed, this could generate either non-differential or differential misclassification bias. Second, almost all studies used recent air pollution exposures as surrogate measures of long-term exposure. Although this approach may be reasonable if the measured and etiologic exposure windows are separated by a few years, its validity is unknown over longer intervals. Third, comparing the magnitude of associations may not clearly pinpoint which, if any, pollutants are the probable causal agents, because the degree of exposure misclassification differs across pollutants. The epidemiologic evidence, alongside evidence from other lines of research, provides support for a relation of air pollution exposure to dementia. Future studies with improved design, analysis and reporting would fill key evidentiary gaps and provide a solid foundation for recommendations and possible interventions.
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Affiliation(s)
- Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC 20052, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | - Sara D Adar
- Department of Epidemiology, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Jeff D Yanosky
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, 90 Hope Drive, Hershey, PA, 17033, USA.
| | - Jennifer Weuve
- Rush Institute for Healthy Aging, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 675, Chicago, IL 60612, USA; Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
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162
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Mowrey WB, Lipton RB, Katz MJ, Ramratan WS, Loewenstein DA, Zimmerman ME, Buschke H. Memory Binding Test Predicts Incident Amnestic Mild Cognitive Impairment. J Alzheimers Dis 2016; 53:1585-1595. [DOI: 10.3233/jad-160291] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Wenzhu B. Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J. Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy S. Ramratan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David A. Loewenstein
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miami, FL, USA
| | - Molly E. Zimmerman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Herman Buschke
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY, USA
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163
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Swardfager W, Black SE. Coronary Artery Calcification: A Canary in the Cognitive Coalmine. J Am Coll Cardiol 2016; 67:1023-1026. [PMID: 26940920 DOI: 10.1016/j.jacc.2016.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Walter Swardfager
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada; Cardiac Rehabilitation Program, University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medicine (Neurology), Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Ontario, Canada.
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Bullain SS, Corrada MM, Perry SM, Kawas CH. Sound Body Sound Mind? Physical Performance and the Risk of Dementia in the Oldest-Old: The 90+ Study. J Am Geriatr Soc 2016; 64:1408-15. [DOI: 10.1111/jgs.14224] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Szofia S. Bullain
- Department of Neurology; University of California at Irvine; Irvine California USA
- Institute for Memory Impairments and Neurological Disorders; University of California at Irvine; Irvine California USA
| | - Maria M. Corrada
- Department of Neurology; University of California at Irvine; Irvine California USA
- Institute for Memory Impairments and Neurological Disorders; University of California at Irvine; Irvine California USA
- Department of Epidemiology; University of California at Irvine; Irvine California USA
| | - Shawna M. Perry
- Department of Neurology; University of California at Irvine; Irvine California USA
| | - Claudia H. Kawas
- Department of Neurology; University of California at Irvine; Irvine California USA
- Institute for Memory Impairments and Neurological Disorders; University of California at Irvine; Irvine California USA
- Department of Epidemiology; University of California at Irvine; Irvine California USA
- Department of Neurobiology and Behavior; University of California at Irvine; Irvine California USA
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Wilson RS, Capuano AW, Bennett DA, Schneider JA, Boyle PA. Temporal course of neurodegenerative effects on cognition in old age. Neuropsychology 2016; 30:591-9. [PMID: 27111293 PMCID: PMC4988317 DOI: 10.1037/neu0000282] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To test the hypothesis that different forms of neurodegeneration are differentially related to longitudinal cognitive trajectories in old age. METHODS Participants are 420 older persons from 2 clinical-pathologic studies without cognitive impairment at study onset. They completed a battery of 17 cognitive tests annually for a minimum of 5 years, died, and underwent a neuropathologic examination to quantify neuronal neurofibrillary tangles and transactive response DNA-binding protein 43 (TDP-43) pathology and to identify Lewy bodies and hippocampal sclerosis. The authors used sigmoid mixed models based on the 4-parameter logistic distribution to decompose nonlinear global cognitive trajectories into components and assess the relation of each neuropathologic marker to each trajectory component. RESULTS Cognitive function was assessed for a mean of 10.5 years before death. In the absence of pathology, global cognition was relatively stable before declining moderately in the last 3 to 4 years of life. Tangles were related to all trajectory components except initial level. TDP-43 pathology was the only marker related to initial level of function. It was also associated with an earlier midpoint of decline but not to slope of decline. Hippocampal sclerosis was related to an earlier midpoint of decline and more rapid slope of decline. Lewy bodies were associated with faster slope of decline and lower level of function proximate to death. CONCLUSION Neurodegenerative processes are differentially related to cognitive trajectories, with TDP-43 pathology most potently impacting incipient cognitive decline, AD pathology and hippocampal sclerosis affecting the progression of cognitive decline, and Lewy bodies impacting terminal decline. (PsycINFO Database Record
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Affiliation(s)
- Robert S Wilson
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center
| | | | | | - Julie A Schneider
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center
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Nelson PT, Trojanowski JQ, Abner EL, Al-Janabi OM, Jicha GA, Schmitt FA, Smith CD, Fardo DW, Wang WX, Kryscio RJ, Neltner JH, Kukull WA, Cykowski MD, Van Eldik LJ, Ighodaro ET. "New Old Pathologies": AD, PART, and Cerebral Age-Related TDP-43 With Sclerosis (CARTS). J Neuropathol Exp Neurol 2016; 75:482-98. [PMID: 27209644 PMCID: PMC6366658 DOI: 10.1093/jnen/nlw033] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 12/12/2022] Open
Abstract
The pathology-based classification of Alzheimer's disease (AD) and other neurodegenerative diseases is a work in progress that is important for both clinicians and basic scientists. Analyses of large autopsy series, biomarker studies, and genomics analyses have provided important insights about AD and shed light on previously unrecognized conditions, enabling a deeper understanding of neurodegenerative diseases in general. After demonstrating the importance of correct disease classification for AD and primary age-related tauopathy, we emphasize the public health impact of an underappreciated AD "mimic," which has been termed "hippocampal sclerosis of aging" or "hippocampal sclerosis dementia." This pathology affects >20% of individuals older than 85 years and is strongly associated with cognitive impairment. In this review, we provide an overview of current hypotheses about how genetic risk factors (GRN, TMEM106B, ABCC9, and KCNMB2), and other pathogenetic influences contribute to TDP-43 pathology and hippocampal sclerosis. Because hippocampal sclerosis of aging affects the "oldest-old" with arteriolosclerosis and TDP-43 pathologies that extend well beyond the hippocampus, more appropriate terminology for this disease is required. We recommend "cerebral age-related TDP-43 and sclerosis" (CARTS). A detailed case report is presented, which includes neuroimaging and longitudinal neurocognitive data. Finally, we suggest a neuropathology-based diagnostic rubric for CARTS.
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Affiliation(s)
- Peter T Nelson
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC).
| | - John Q Trojanowski
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Erin L Abner
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Omar M Al-Janabi
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Gregory A Jicha
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Frederick A Schmitt
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Charles D Smith
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - David W Fardo
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Wang-Xia Wang
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Richard J Kryscio
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Janna H Neltner
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Walter A Kukull
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Matthew D Cykowski
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Linda J Van Eldik
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
| | - Eseosa T Ighodaro
- From the Department of Pathology, Division of Neuropathology (PTN, JHN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (DWF, RJK), Department of Anatomy and Neurobiology (PTN, JHN, LJVE, ETI), Department of Epidemiology (ELA), and Sanders-Brown Center on Aging (PTN, ELA, OMA-J, GAJ, FAS, CDS, DWF, WXW, RJK, LJVE, ETI), University of Kentucky, Lexington, Kentucky; Department of Pathology & Laboratory Medicine and Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, Pennsylvannia (JQT); Department of Epidemiology, University of Washington, Seattle, Washington (WAK); and Department of Pathology, Houston Methodist Hospital, Houston, Texas (MDC)
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Corrada MM, Sonnen JA, Kim RC, Kawas CH. Microinfarcts are common and strongly related to dementia in the oldest-old: The 90+ study. Alzheimers Dement 2016; 12:900-8. [PMID: 27243907 DOI: 10.1016/j.jalz.2016.04.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/08/2016] [Accepted: 04/27/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We estimated the prevalence of microinfarcts and their association with dementia in a cohort of oldest-old participants. METHODS Participants were from The 90+ Study, a population-based study of people 90 years and older. Dementia diagnoses were assigned postmortem during a consensus conference. Microinfarcts were evaluated in six brain regions. RESULTS At death, the 213 participants were on average 97 years old, 69% were women, and 52% had dementia. Of the participants, 51% had microinfarcts and 17% had 3+ microinfarcts. The odds ratio (OR) for dementia was similar for 3+ microinfarcts (OR = 4.75, P < .01) and tangle stage V-VI (OR = 4.70, P < .001). Only microinfarcts in cortical regions (other than occipital) were associated to dementia. DISCUSSION In this oldest-old cohort, microinfarcts are common and contribute independently and similarly in magnitude to dementia as tangles. As risk factors for microinfarcts and other dementing pathologies are likely to differ, identifying these factors is crucial to developing prevention strategies for dementia in the oldest-old.
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Affiliation(s)
- María M Corrada
- Department of Neurology, University of California, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, CA, USA.
| | - Joshua A Sonnen
- Department of Pathology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ronald C Kim
- Department of Pathology, University of California, Irvine, CA, USA
| | - Claudia H Kawas
- Department of Neurology, University of California, Irvine, CA, USA; Department of Neurobiology & Behavior, University of California, Irvine, CA, USA
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Maloney B, Lahiri DK. Epigenetics of dementia: understanding the disease as a transformation rather than a state. Lancet Neurol 2016; 15:760-774. [PMID: 27302240 DOI: 10.1016/s1474-4422(16)00065-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/22/2016] [Accepted: 02/11/2016] [Indexed: 12/26/2022]
Abstract
Alzheimer's disease and other idiopathic dementias are associated with epigenetic transformations. These transformations connect the environment and genes to pathogenesis, and have led to the investigation of epigenetic-based therapeutic targes for the treatment of these diseases. Epigenetic changes occur over time in response to environmental effects. The epigenome-based latent early-life associated regulation (LEARn) hypothetical model indicates that accumulated environmental hits produce latent epigenetic changes. These hits can alter biochemical pathways until a pathological threshold is reached, which appears clinically as the onset of dementia. The hypotheses posed by LEARn are testable via longitudinal epigenome-wide, envirome-wide, and exposome-wide association studies (LEWAS) of the genome, epigenome, and environment. We posit that the LEWAS design could lead to effective prevention and treatments by identifying potential therapeutic strategies. Epigenetic evidence suggests that dementia is not a suddenly occurring and sharply delineated state, but rather a gradual change in crucial cellular pathways, that transforms an otherwise healthy state, as a result of neurodegeneration, to a dysfunctional state. Evidence from epigenetics could lead to ways to detect, prevent, and reverse such processes before clinical dementia.
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Affiliation(s)
- Bryan Maloney
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Center, Indianapolis, IN, USA
| | - Debomoy K Lahiri
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Neuroscience Research Center, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.
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Kuller LH, Lopez OL, Mackey RH, Rosano C, Edmundowicz D, Becker JT, Newman AB. Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years. J Am Coll Cardiol 2016; 67:1013-1022. [PMID: 26940919 PMCID: PMC5502352 DOI: 10.1016/j.jacc.2015.12.034] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia. OBJECTIVES The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores. METHODS We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years). RESULTS Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia. CONCLUSIONS In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia. (Cardiovascular Health Study [CHS]; NCT00005133).
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Affiliation(s)
- Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rachel H Mackey
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel Edmundowicz
- Department of Medicine, Section of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - James T Becker
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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White LR, Edland SD, Hemmy LS, Montine KS, Zarow C, Sonnen JA, Uyehara-Lock JH, Gelber RP, Ross GW, Petrovitch H, Masaki KH, Lim KO, Launer LJ, Montine TJ. Neuropathologic comorbidity and cognitive impairment in the Nun and Honolulu-Asia Aging Studies. Neurology 2016; 86:1000-8. [PMID: 26888993 DOI: 10.1212/wnl.0000000000002480] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/01/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To examine frequencies and relationships of 5 common neuropathologic abnormalities identified at autopsy with late-life cognitive impairment and dementia in 2 different autopsy panels. METHODS The Nun Study (NS) and the Honolulu-Asia Aging Study (HAAS) are population-based investigations of brain aging that included repeated cognitive assessments and comprehensive brain autopsies. The neuropathologic abnormalities assessed were Alzheimer disease (AD) neuropathologic changes, neocortical Lewy bodies (LBs), hippocampal sclerosis, microinfarcts, and low brain weight. Associations with screening tests for cognitive impairment were examined. RESULTS Neuropathologic abnormalities occurred at levels ranging from 9.7% to 43%, and were independently associated with cognitive impairment in both studies. Neocortical LBs and AD changes were more frequent among the predominantly Caucasian NS women, while microinfarcts were more common in the Japanese American HAAS men. Comorbidity was usual and very strongly associated with cognitive impairment. Apparent cognitive resilience (no cognitive impairment despite Braak stage V) was strongly associated with minimal or no comorbid abnormalities, with fewer neocortical AD lesions, and weakly with longer interval between final testing and autopsy. CONCLUSIONS Total burden of comorbid neuropathologic abnormalities, rather than any single lesion type, was the most relevant determinant of cognitive impairment in both cohorts, often despite clinical diagnosis of only AD. These findings emphasize challenges to dementia pathogenesis and intervention research and to accurate diagnoses during life.
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Affiliation(s)
- Lon R White
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI.
| | - Steven D Edland
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Laura S Hemmy
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Kathleen S Montine
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Chris Zarow
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Joshua A Sonnen
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Jane H Uyehara-Lock
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Rebecca P Gelber
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - G Webster Ross
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Helen Petrovitch
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Kamal H Masaki
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Kelvin O Lim
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Lenore J Launer
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
| | - Thomas J Montine
- From the Pacific Health Research and Education Institute (L.R.W., R.P.G., G.W.R., H.P.); Departments of Geriatric Medicine (L.R.W., H.P., K.H.M.), Pathology (J.H.U.-L.), and Medicine (G.W.R., H.P.), University of Hawaii John A. Burns School of Medicine, Honolulu; Laboratory of Epidemiology and Population Sciences Intramural Research Program (L.R.W., L.J.L.), National Institute on Aging, NIH, Bethesda, MD; Departments of Family Preventive Medicine (S.D.E.) and Neurosciences (S.D.E.), University of California San Diego, La Jolla; Department of Psychiatry (L.S.H., K.O.L.), University of Minnesota, Minneapolis; Geriatric Research, Education, and Clinical Center (L.R.W., L.S.H., K.O.L.), VA Medical Center, Minneapolis, MN; Department of Pathology (K.S.M., T.J.M.), University of Washington, Seattle; Department of Neurology (C.Z.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Pathology (J.A.S.), University of Utah, Salt Lake City; VA Pacific Islands Health Care System (R.P.G., G.W.R., H.P.); and Kuakini Medical Center (K.H.M.), Honolulu, HI
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171
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Brookmeyer R, Kawas CH, Abdallah N, Paganini-Hill A, Kim RC, Corrada MM. Impact of interventions to reduce Alzheimer's disease pathology on the prevalence of dementia in the oldest-old. Alzheimers Dement 2016; 12:225-32. [PMID: 26900132 DOI: 10.1016/j.jalz.2016.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/08/2015] [Accepted: 01/05/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The number of persons aged >90 years will grow significantly in coming decades. This group has the highest rates of dementia, most commonly Alzheimer's disease (AD). METHODS Using The 90+ Study, we developed a statistical model for dementia risk based on brain pathologies. Intervention scenarios which reduce or eliminate AD pathology were considered, and the numbers of dementia cases among the U.S. oldest-old that could be prevented were estimated. RESULTS The U.S. dementia prevalence among the oldest-old will increase from 1.35 million in 2015 to 4.72 million in 2050. If interventions eliminate AD pathology, dementia prevalence would be reduced by approximately 50%, averting nearly 2.4 million cases in 2050. However, large numbers of dementia cases would still remain. DISCUSSION Reducing AD pathology would significantly decrease the public health burden of dementia. However, other interventions are needed to address the burden associated with other dementing pathologies prevalent in the oldest-old.
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Affiliation(s)
- Ron Brookmeyer
- Department of Biostatistics, University of California, Los Angeles, CA, USA.
| | - Claudia H Kawas
- Department of Neurology, University of California, Irvine, CA, USA; Department of Neurobiology and Behavior, University of California, Irvine, CA, USA; Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Nada Abdallah
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | | | - Ronald C Kim
- Department of Pathology, University of California, Irvine Medical Center, Orange, 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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172
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Jack CR, Knopman DS, Chételat G, Dickson D, Fagan AM, Frisoni GB, Jagust W, Mormino EC, Petersen RC, Sperling RA, van der Flier WM, Villemagne VL, Visser PJ, Vos SJB. Suspected non-Alzheimer disease pathophysiology--concept and controversy. Nat Rev Neurol 2016; 12:117-24. [PMID: 26782335 PMCID: PMC4784257 DOI: 10.1038/nrneurol.2015.251] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Suspected non-Alzheimer disease pathophysiology (SNAP) is a biomarker-based concept that applies to individuals with normal levels of amyloid-β biomarkers in the brain, but in whom biomarkers of neurodegeneration are abnormal. The term SNAP has been applied to clinically normal individuals (who do not meet criteria for either mild cognitive impairment or dementia) and to individuals with mild cognitive impairment, but is applicable to any amyloid-negative, neurodegeneration-positive individual regardless of clinical status, except when the pathology underlying neurodegeneration can be reliably inferred from the clinical presentation. SNAP is present in ∼23% of clinically normal individuals aged >65 years and in ∼25% of mildly cognitively impaired individuals. APOE*ε4 is underrepresented in individuals with SNAP compared with amyloid-positive individuals. Clinically normal and mildly impaired individuals with SNAP have worse clinical and/or cognitive outcomes than individuals with normal levels of neurodegeneration and amyloid-β biomarkers. In this Perspectives article, we describe the available data on SNAP and address topical controversies in the field.
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Affiliation(s)
- Clifford R Jack
- Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Gaël Chételat
- INSERM, Université de Caen, EPHE, CHU de Caen, U1077, Caen, France
| | - Dennis Dickson
- Department of Pathology, Mayo Clinic and Foundation, 4500 San Pablo Road South, Jacksonville, Florida 32224, USA
| | - Anne M Fagan
- Department of Neurology, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, 4488 Forest Park Avenue, Suite 101, St Louis, Missouri 63108, USA
| | - Giovanni B Frisoni
- University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, 175 Li Ka Shing Center, Berkeley, California 94720, USA
| | - Elizabeth C Mormino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Wiesje M van der Flier
- Alzheimer Center, Department of Neurology, VU University Medical Center, Neuroscience Campus Amsterdam, PO Box 7057, 1007 MB Amsterdam, Netherlands
| | - Victor L Villemagne
- Department of Molecular Imaging &Therapy, Centre for PET, Austin Health, 145 Studley Road, PO Box 5555 Melbourne, Victoria, Australia 3084
| | - Pieter J Visser
- Department of Psychiatry and Neuropsychology, Institute of Mental Health and Neuroscience, Maastricht University, PO Box 616 MD Maastricht, Netherlands
| | - Stephanie J B Vos
- Department of Psychiatry and Neuropsychology, Institute of Mental Health and Neuroscience, Maastricht University, PO Box 616 MD Maastricht, Netherlands
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173
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Neltner JH, Abner EL, Jicha GA, Schmitt FA, Patel E, Poon LW, Marla G, Green RC, Davey A, Johnson MA, Jazwinski SM, Kim S, Davis D, Woodard JL, Kryscio RJ, Van Eldik LJ, Nelson PT. Brain pathologies in extreme old age. Neurobiol Aging 2015; 37:1-11. [PMID: 26597697 DOI: 10.1016/j.neurobiolaging.2015.10.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/28/2015] [Accepted: 10/08/2015] [Indexed: 12/31/2022]
Abstract
With an emphasis on evolving concepts in the field, we evaluated neuropathologic data from very old research volunteers whose brain autopsies were performed at the University of Kentucky Alzheimer's Disease Center, incorporating data from the Georgia Centenarian Study (n = 49 cases included), Nun Study (n = 17), and University of Kentucky Alzheimer's Disease Center (n = 11) cohorts. Average age of death was 102.0 (range: 98-107) years overall. Alzheimer's disease pathology was not universal (62% with "moderate" or "frequent" neuritic amyloid plaque densities), whereas frontotemporal lobar degeneration was absent. By contrast, some hippocampal neurofibrillary tangles (including primary age-related tauopathy) were observed in every case. Lewy body pathology was seen in 16.9% of subjects and hippocampal sclerosis of aging in 20.8%. We describe anatomic distributions of pigment-laden macrophages, expanded Virchow-Robin spaces, and arteriolosclerosis among Georgia Centenarians. Moderate or severe arteriolosclerosis pathology, throughout the brain, was associated with both hippocampal sclerosis of aging pathology and an ABCC9 gene variant. These results provide fresh insights into the complex cerebral multimorbidity, and a novel genetic risk factor, at the far end of the human aging spectrum.
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Affiliation(s)
- Janna H Neltner
- Department of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, USA
| | - Erin L Abner
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Gregory A Jicha
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA; Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Frederick A Schmitt
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA; Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Ela Patel
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Leonard W Poon
- Institute of Gerontology, The University of Georgia, Athens, GA, USA
| | - Gearing Marla
- Department of Pathology, Emory University, Atlanta, GA, USA
| | - Robert C Green
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam Davey
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, USA
| | - Mary Ann Johnson
- Institute of Gerontology, The University of Georgia, Athens, GA, USA
| | - S Michal Jazwinski
- Department of Medicine, Tulane Center for Aging, Tulane University, New Orleans, LA, USA
| | - Sangkyu Kim
- Department of Medicine, Tulane Center for Aging, Tulane University, New Orleans, LA, USA
| | - Daron Davis
- Department of Pathology, Baptist Health Care, Lexington, KY, USA
| | - John L Woodard
- Department of Psychology, Wayne State University, Detroit MI, USA
| | - Richard J Kryscio
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA; Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, KY, USA
| | - Peter T Nelson
- Department of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.
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174
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Michalski B, Corrada MM, Kawas CH, Fahnestock M. Brain-derived neurotrophic factor and TrkB expression in the "oldest-old," the 90+ Study: correlation with cognitive status and levels of soluble amyloid-beta. Neurobiol Aging 2015; 36:3130-3139. [PMID: 26410307 DOI: 10.1016/j.neurobiolaging.2015.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 12/20/2022]
Abstract
Factors associated with maintaining good cognition into old age are unclear. Decreased brain-derived neurotrophic factor (BDNF) contributes to memory loss in Alzheimer's disease (AD), and soluble assemblies of amyloid-beta (Aβ) and tau contribute to neurodegeneration. However, it is unknown whether AD-type neuropathology, soluble Aβ and tau, or levels of BDNF and its receptor tropomyosin-related kinase B (TrkB) correlate with dementia in the oldest-old. We examined these targets in postmortem Brodmann's areas 7 and 9 (BA7 and BA9) in 4 groups of subjects >90 years old: (1) no dementia/no AD pathology, (2) no dementia/AD pathology, (3) dementia/no AD pathology, (4) dementia/AD pathology. In BA7, BDNF messenger RNA correlated with Mini-Mental State Examination scores and was decreased in demented versus nondemented subjects, regardless of pathology. Soluble Aβ42 was increased in both groups with AD pathology, demented or not, compared to no dementia/no AD pathology subjects. Groups did not differ in TrkB isoform levels or in levels of total soluble tau, individual tau isoforms, threonine-181 tau phosphorylation, or ratio of phosphorylated 3R-4R isoforms. In BA9, soluble Aβ42 correlated with Mini-Mental State Examination scores and with BDNF messenger RNA expression. Thus, soluble Aβ42 and BDNF, but not TrkB or soluble tau, correlate with dementia in the oldest-old.
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Affiliation(s)
- Bernadeta Michalski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maria M Corrada
- Department of Epidemiology, University of California, Irvine, CA, USA; Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Claudia H Kawas
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Margaret Fahnestock
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
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