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Maestre G, Hill C, Griffin P, Hall S, Hu W, Flatt J, Babulal G, Thorpe R, Henderson JN, Buchwald D, Manson S, Cicero E, Gilmore‐Bykovskyi A, Gamaldo A, Glover C, Barnes L, Kind A, James B, Zeki Al Hazzouri A, Wharton W, Caramelli P, Szanton S, Whitmer R, Benn Torres J, Deters K, Okonkwo O, Das R, Martinez‐Gonzalez K, Carrillo M. Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias. Alzheimers Dement 2024; 20:3099-3107. [PMID: 38460119 PMCID: PMC11032522 DOI: 10.1002/alz.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.
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Affiliation(s)
- Gladys Maestre
- School of MedicineAlzheimer's Disease Resource Center for Minority Aging ResearchUniversity of Texas Rio Grande ValleyBrownsvilleTexasUSA
| | - Carl Hill
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Percy Griffin
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Stephen Hall
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - William Hu
- Rutgers Robert Wood Johnson Medical School and Rutgers Institute for HealthHealth Care Policy, and Aging ResearchNew BrunswickNew JerseyUSA
| | - Jason Flatt
- Department of Social and Behavioral HealthSchool of Public HealthUniversity of Nevada Las VegasLas VegasNevadaUSA
| | - Ganesh Babulal
- Department of NeurologySchool of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Roland Thorpe
- Center on AgingCenter on Health Disparities SolutionsHopkins Population CenterAlzheimer's Disease Resource Center for Minority Aging ResearchJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health Elson S Floyd College of Medicine Washington State UniversitySeattleWashingtonUSA
| | - Spero Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Andrea Gilmore‐Bykovskyi
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Alyssa Gamaldo
- Pennsylvania State UniversityState CollegePennsylvaniaUSA
| | | | - Lisa Barnes
- Rush University Medical CenterChicagoIllinoisUSA
| | - Amy Kind
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Bryan James
- Rush University Medical CenterChicagoIllinoisUSA
| | - Adina Zeki Al Hazzouri
- Mailman School of Public HealthDepartment of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Sarah Szanton
- Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Rachel Whitmer
- Department of Public Health SciencesDepartment of NeurologyUniversity of California DavisDavisCaliforniaUSA
| | | | - Kacie Deters
- Department of NeurosciencesUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
| | - Ozioma Okonkwo
- Department of Medicine and the Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rina Das
- National Institute on Minority Health and Health DisparitiesBethesdaMarylandUSA
| | | | - Maria Carrillo
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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Suchy-Dicey AM, Vo TT, Oziel K, King R, Barbosa-Leiker C, Rhoads K, Verney S, Buchwald DS, French BF. Psychometric Properties of Controlled Oral Word Association (COWA) Test and Associations With Education and Bilingualism in American Indian Adults: The Strong Heart Study. Assessment 2024; 31:745-757. [PMID: 37338127 PMCID: PMC10840386 DOI: 10.1177/10731911231180127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The Controlled Oral Word Association (COWA) test is used to assess phonemic fluency and executive function. Formal validation of test scores is important for accurate cognitive evaluation. However, there is a dearth of psychometric validation among American Indian adults. Given high burden of dementia risk and key contextual factors associated with cognitive assessments, this represents a critical oversight. In a large, longitudinal population-based cohort study of adult American Indians, we examined several validity inferences for COWA, including scoring, generalization, and extrapolation inferences, by investigation of factor structure, internal consistency, test-retest reliability, and differential test functioning. We found adequate unidimensional model fit, with high factor loadings. Internal consistency reliability and test-retest reliability were 0.88 and 0.77, respectively, for the full group. COWA scores were lowest among the oldest, lowest education, bilingual speakers; group effects for sex and bilingual status were small; age effect was medium; and education effect was largest. However, Wide Range Achievement Test (WRAT) score effect was stronger than education effect, suggesting better contextualization may be needed. These results support interpretation of total COWA score, including across sex, age, or language use strata.
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Affiliation(s)
| | - Thao T. Vo
- Washington State University, Seattle, USA
| | - Kyra Oziel
- Washington State University, Seattle, USA
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Suchy‐Dicey AM, Longstreth WT, Rhoads K, Umans J, Buchwald D, Grabowski T, Blennow K, Reiman E, Zetterberg H. Plasma biomarkers of Alzheimer's disease and related dementias in American Indians: The Strong Heart Study. Alzheimers Dement 2024; 20:2072-2079. [PMID: 38215191 PMCID: PMC10984473 DOI: 10.1002/alz.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Identification of Alzheimer's disease (AD) needs inexpensive, noninvasive biomarkers, with validation in all populations. METHODS We collected plasma markers in older American Indian individuals: phosphorylated-tau181 (pTau181); amyloid-beta (Aβ) 40,42; glial fibrillary acidic protein (GFAP); and neurofilament light chain (NfL). Plasma markers were analyzed for discriminant properties with cognitive status and etiology using receiver operating characteristic (ROC) analysis. RESULTS PTau181, GFAP, NfL plasma values were significantly associated with cognition, but Aβ were not. Discriminant performance was moderate for individual markers, with pTau181, GFAP, NfL performing best, but an empirically selected panel of markers (age, sex, education, pTau181, GFAP, NfL, Aβ4240 ratio) had excellent discriminant performance (AUC > 0.8). DISCUSSION In American Indian individuals, pTau181 and Aβ values suggested more common pathology than in majority populations. Aβ was less informative than in other populations; however, all four markers were needed for a best-performing dementia diagnostic model. These data validate utility of AD plasma markers, while suggesting population-specific diagnostic characteristics.
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Affiliation(s)
- Astrid M. Suchy‐Dicey
- Washington State University Elson S Floyd College of MedicineSpokaneWashingtonUSA
- Huntington Medical Research InstitutesPasadenaCaliforniaUSA
- Washington State University Institute for Research and Education to Address Community HealthSeattleWashingtonUSA
- University of Washington Alzheimer's Disease Research CenterSeattleWashingtonUSA
| | - W. T. Longstreth
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kristoffer Rhoads
- University of Washington Alzheimer's Disease Research CenterSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Jason Umans
- MedStar Health Research InstituteHyattsvilleMarylandUSA
| | - Dedra Buchwald
- Washington State University Institute for Research and Education to Address Community HealthSeattleWashingtonUSA
| | - Thomas Grabowski
- University of Washington Alzheimer's Disease Research CenterSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kaj Blennow
- Institute of Neuroscience and Physiologythe Sahlgrenska Academy at University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Eric Reiman
- Banner Alzheimer's InstitutePhoenixArizonaUSA
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiologythe Sahlgrenska Academy at University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
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Xu C, Acevedo P, Lu Y, Su BB, Ozuna K, Padilla V, Karithara A, Mao C, Navia RO, Piamjariyakul U, Wang K. Racial differences in the effect of APOE-ε4 genotypes on trail making test B in Alzheimer's disease: A longitudinal study. Int J Geriatr Psychiatry 2023; 38:e6037. [PMID: 38100638 DOI: 10.1002/gps.6037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES The trail making test part B (TMT-B) evaluates executive functions, memory, and sensorimotor functions. No previous study was found to examine the longitudinal effect of APOE-ε4 genotypes on the TMT-B scores in Alzheimer's disease (AD) across racial groups. METHODS This study used the data from Alzheimer's Disease Neuroimaging Initiative (ADNI): 382 participants with AD, 503 with cognitive normal (CN), 1293 with mild cognitive impairment (MCI) at baseline and follow-up of four years. The multivariable linear mixed model was used to investigate the effect of APOE-ε4 genotypes on changes in TMT-B scores. RESULTS Compared with Whites, African Americans (AA) and Hispanics had higher TMT-B scores (poor cognitive function). Furthermore, Whites subjects with 1 or 2 APOE-ε4 alleles had significantly higher TMT-B scores compared with individuals without APOE-ε4 allele at baseline and four follow-up visits; however, no differences in TMT-B were found between APOE-ε4 alleles in the Hispanic and AA groups. No APOE-ε4 by visit interactions was found for 3 racial groups. Stratified by AD diagnosis, the APOE-ε4 allele was associated with TMT-B scores only in the MCI group, while there were significant interactions for visit by education, APOE-ε4 allele, and the Mini Mental State Examination (MMSE) score in the MCI group. In addition, TMT-B was significantly correlated with the MMSE, AD Assessment Scale-cognitive subscale 13 (ADAS13), tTau, pTau, Aβ42, and hippocampus. CONCLUSIONS APOE-ɛ4 allele is associated with TMT-B scores in Whites subjects, but not in the Hispanic and AA groups. APOE-ε4 showed interaction with visit in the MCI group.
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Affiliation(s)
- Chun Xu
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Priscila Acevedo
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Yongke Lu
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Brenda Bin Su
- Department of Pediatrics - Allergy and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Kaysie Ozuna
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Victoria Padilla
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Annu Karithara
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - ChunXiang Mao
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - R Osvaldo Navia
- Department of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Ubolrat Piamjariyakul
- School of Nursing, Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Kesheng Wang
- School of Nursing, Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
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Canales C, Ibarra AJ, Burton BN, Cole DJ, Whittington R, Cannesson M. Perspectives on Ethnic and Language Diversity in Perioperative Neurocognitive Disorders. Anesth Analg 2023; 137:782-787. [PMID: 37712470 PMCID: PMC10513730 DOI: 10.1213/ane.0000000000006656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Cecilia Canales
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Andrea J. Ibarra
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine
| | - Brittany N. Burton
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Daniel J. Cole
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Robert Whittington
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Sehar U, Kopel J, Reddy PH. Alzheimer's disease and its related dementias in US Native Americans: A major public health concern. Ageing Res Rev 2023; 90:102027. [PMID: 37544432 PMCID: PMC10515314 DOI: 10.1016/j.arr.2023.102027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
Alzheimer's disease (AD) and Alzheimer's related dementias (ADRD) are growing public health concerns in aged populations of all ethnic and racial groups. AD and ADRD are caused by multiple factors, such as genetic mutations, modifiable and non-modifiable risk factors, and lifestyle. Studies of postmortem brains have revealed multiple cellular changes implicated in AD and ADRD, including the accumulation of amyloid beta and phosphorylated tau, synaptic damage, inflammatory responses, hormonal imbalance, mitochondrial abnormalities, and neuronal loss. These changes occur in both early-onset familial and late-onset sporadic forms. Two-thirds of women and one-third of men are at life time risk for AD. A small proportion of total AD cases are caused by genetic mutations in amyloid precursor protein, presenilin 1, and presenilin 1 genes, and the APOE4 allele is a risk factor. Tremendous research on AD/ADRD, and other comorbidities such as diabetes, obesity, hypertension, and cancer has been done on almost all ethnic groups, however, very little biomedical research done on US Native Americans. AD/ADRD prevalence is high among all ethnic groups. In addition, US Native Americans have poorer access to healthcare and medical services and are less likely to receive a diagnosis once they begin to exhibit symptoms, which presents difficulties in treating Alzheimer's and other dementias. One in five US Native American people who are 45 years of age or older report having memory issues. Further, the impact of caregivers and other healthcare aspects on US Native Americans is not yet. In the current article, we discuss the history of Native Americans of United States (US) and health disparities, occurrence, and prevalence of AD/ADRD, and shedding light on the culturally sensitive caregiving practices in US Native Americans. This article is the first to discuss biomedical research and healthcare disparities in US Native Americans with a focus on AD and ADRD, we also discuss why US Native Americans are reluctant to participate in biomedical research.
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Affiliation(s)
- Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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7
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Trumble BC, Charifson M, Kraft T, Garcia AR, Cummings DK, Hooper P, Lea AJ, Eid Rodriguez D, Koebele SV, Buetow K, Beheim B, Minocher R, Gutierrez M, Thomas GS, Gatz M, Stieglitz J, Finch CE, Kaplan H, Gurven M. Apolipoprotein-ε 4 is associated with higher fecundity in a natural fertility population. SCIENCE ADVANCES 2023; 9:eade9797. [PMID: 37556539 PMCID: PMC10411886 DOI: 10.1126/sciadv.ade9797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 07/11/2023] [Indexed: 08/11/2023]
Abstract
In many populations, the apolipoprotein-ε4 (APOE-ε4) allele increases the risk for several chronic diseases of aging, including dementia and cardiovascular disease; despite these harmful effects at later ages, the APOE-ε4 allele remains prevalent. We assess the impact of APOE-ε4 on fertility and its proximate determinants (age at first reproduction, interbirth interval) among the Tsimane, a natural fertility population of forager-horticulturalists. Among 795 women aged 13 to 90 (20% APOE-ε4 carriers), those with at least one APOE-ε4 allele had 0.3 to 0.5 more children than (ε3/ε3) homozygotes, while those with two APOE-ε4 alleles gave birth to 1.4 to 2.1 more children. APOE-ε4 carriers achieve higher fertility by beginning reproduction 0.8 years earlier and having a 0.23-year shorter interbirth interval. Our findings add to a growing body of literature suggesting a need for studies of populations living in ancestrally relevant environments to assess how alleles that are deleterious in sedentary urban environments may have been maintained by selection throughout human evolutionary history.
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Affiliation(s)
- Benjamin C. Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
- Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA
| | - Mia Charifson
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, USA
| | - Tom Kraft
- Anthropology Department, University of Utah, Salt Lake City, UT, USA
| | - Angela R. Garcia
- Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA
- Scientific Research Core, Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Child Health, University of Arizona, Tucson, AZ, USA
| | - Daniel K. Cummings
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, CA, USA
| | - Paul Hooper
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, CA, USA
| | - Amanda J. Lea
- Child and Brain Development Program, Canadian Institute for Advanced Research, Toronto, Ontario, Canada
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, USA
| | | | | | - Kenneth Buetow
- Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Bret Beheim
- Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Riana Minocher
- Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | - Gregory S. Thomas
- MemorialCare Health System, Fountain Valley, CA, USA
- University of California, Irvine, CA, USA
| | - Margaret Gatz
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Jonathan Stieglitz
- Institute for Advanced Study in Toulouse, Université Toulouse 1 Capitole, Toulouse, France
| | - Caleb E. Finch
- Leonard Davis School of Gerontology and Dornsife College, University of Southern California, Los Angeles, CA, USA
| | - Hillard Kaplan
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, CA, USA
| | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA
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Boutros SW, Zimmerman B, Nagy SC, Unni VK, Raber J. Age, sex, and apolipoprotein E isoform alter contextual fear learning, neuronal activation, and baseline DNA damage in the hippocampus. Mol Psychiatry 2023; 28:3343-3354. [PMID: 36732588 PMCID: PMC10618101 DOI: 10.1038/s41380-023-01966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
Age, female sex, and apolipoprotein E4 (E4) are risk factors to develop Alzheimer's disease (AD). There are three major human apoE isoforms: E2, E3, and E4. Compared to E3, E4 increases while E2 decreases AD risk. However, E2 is associated with increased risk and severity of post-traumatic stress disorder (PTSD). In cognitively healthy adults, E4 carriers have greater brain activation during learning and memory tasks in the absence of behavioral differences. Human apoE targeted replacement (TR) mice display differences in fear extinction that parallel human data: E2 mice show impaired extinction, mirroring heightened PTSD symptoms in E2 combat veterans. Recently, an adaptive role of DNA double strand breaks (DSBs) in immediate early gene expression (IEG) has been described. Age and disease synergistically increase DNA damage and decrease DNA repair. As the mechanisms underlying the relative risks of apoE, sex, and their interactions in aging are unclear, we used young (3 months) and middle-aged (12 months) male and female TR mice to investigate the influence of these factors on DSBs and IEGs at baseline and following contextual fear conditioning. We assessed brain-wide changes in neural activation following fear conditioning using whole-brain cFos imaging in young female TR mice. E4 mice froze more during fear conditioning and had lower cFos immunoreactivity across regions important for somatosensation and contextual encoding compared to E2 mice. E4 mice also showed altered co-activation compared to E3 mice, corresponding to human MRI and cognitive data, and indicating that there are differences in brain activity and connectivity at young ages independent of fear learning. There were increased DSB markers in middle-aged animals and alterations to cFos levels dependent on sex and isoform, as well. The increase in hippocampal DSB markers in middle-aged animals and female E4 mice may play a role in the risk for developing AD.
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Affiliation(s)
- Sydney Weber Boutros
- Department of Behavioral Neuroscience, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Department of Psychological Sciences, Boise State University, 2133 W Cesar Chavez Ln, Boise, ID, 83725, USA
| | - Benjamin Zimmerman
- Department of Behavioral Neuroscience, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Advanced Imaging Research Center, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Helfgott Research Institute, NUNM, 2201 SW First Avenue, Portland, OR, 97201, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N, Matthews Avenue, Urbana, IL 61801, USA
| | - Sydney C Nagy
- Department of Behavioral Neuroscience, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Vivek K Unni
- Department of Neurology, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Jungers Center for Neurosciences Research, OHSU; and OHSU Parkinson Center, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Jacob Raber
- Department of Behavioral Neuroscience, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
- Department of Neurology, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
- Departments of Psychiatry and Radiation Medicine, OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
- Division of Neuroscience, ONPRC, 505 NW 185th Ave, Beaverton, OR, 97006, USA.
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9
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Deming Y, Vasiljevic E, Morrow A, Miao J, Van Hulle C, Jonaitis E, Ma Y, Whitenack V, Kollmorgen G, Wild N, Suridjan I, Shaw LM, Asthana S, Carlsson CM, Johnson SC, Zetterberg H, Blennow K, Bendlin BB, Lu Q, Engelman CD. Neuropathology-based APOE genetic risk score better quantifies Alzheimer's risk. Alzheimers Dement 2023; 19:3406-3416. [PMID: 36795776 PMCID: PMC10427737 DOI: 10.1002/alz.12990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Apolipoprotein E (APOE) ε4-carrier status or ε4 allele count are included in analyses to account for the APOE genetic effect on Alzheimer's disease (AD); however, this does not account for protective effects of APOE ε2 or heterogeneous effect of ε2, ε3, and ε4 haplotypes. METHODS We leveraged results from an autopsy-confirmed AD study to generate a weighted risk score for APOE (APOE-npscore). We regressed cerebrospinal fluid (CSF) amyloid and tau biomarkers on APOE variables from the Wisconsin Registry for Alzheimer's Prevention (WRAP), Wisconsin Alzheimer's Disease Research Center (WADRC), and Alzheimer's Disease Neuroimaging Initiative (ADNI). RESULTS The APOE-npscore explained more variance and provided a better model fit for all three CSF measures than APOE ε4-carrier status and ε4 allele count. These findings were replicated in ADNI and observed in subsets of cognitively unimpaired (CU) participants. DISCUSSION The APOE-npscore reflects the genetic effect on neuropathology and provides an improved method to account for APOE in AD-related analyses.
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Affiliation(s)
- Yuetiva Deming
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Eva Vasiljevic
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Autumn Morrow
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jiacheng Miao
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Carol Van Hulle
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin Jonaitis
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yue Ma
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Vanessa Whitenack
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | | | | | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Asthana
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, Wisconsin, USA
| | - Cynthia M Carlsson
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, Wisconsin, USA
| | - Sterling C Johnson
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, Wisconsin, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Barbara B Bendlin
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Qiongshi Lu
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Corinne D Engelman
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
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10
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Lim AC, Barnes LL, Weissberger GH, Lamar M, Nguyen AL, Fenton L, Herrera J, Han SD. Quantification of race/ethnicity representation in Alzheimer's disease neuroimaging research in the USA: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:101. [PMID: 37491471 PMCID: PMC10368705 DOI: 10.1038/s43856-023-00333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Racial and ethnic minoritized groups are disproportionately at risk for Alzheimer's Disease (AD), but are not sufficiently recruited in AD neuroimaging research in the United States. This is important as sample composition impacts generalizability of findings, biomarker cutoffs, and treatment effects. No studies have quantified the breadth of race/ethnicity representation in the AD literature. METHODS This review identified median race/ethnicity composition of AD neuroimaging US-based research samples available as free full-text articles on PubMed. Two types of published studies were analyzed: studies that directly report race/ethnicity data (i.e., direct studies), and studies that do not report race/ethnicity but used data from a cohort study/database that does report this information (i.e., indirect studies). RESULTS Direct studies (n = 719) have median representation of 88.9% white or 87.4% Non-Hispanic white, 7.3% Black/African American, and 3.4% Hispanic/Latino ethnicity, with 0% Asian American, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native, Multiracial, and Other Race participants. Cohort studies/databases (n = 44) from which indirect studies (n = 1745) derived are more diverse, with median representation of 84.2% white, 83.7% Non-Hispanic white, 11.6% Black/African American, 4.7% Hispanic/Latino, and 1.75% Asian American participants. Notably, 94% of indirect studies derive from just 10 cohort studies/databases. Comparisons of two time periods using a median split for publication year, 1994-2017 and 2018-2022, indicate that sample diversity has improved recently, particularly for Black/African American participants (3.39% from 1994-2017 and 8.29% from 2018-2022). CONCLUSIONS There is still underrepresentation of all minoritized groups relative to Census data, especially for Hispanic/Latino and Asian American individuals. The AD neuroimaging literature will benefit from increased representative recruitment of ethnic/racial minorities. More transparent reporting of race/ethnicity data is needed.
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Affiliation(s)
- Aaron C Lim
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gali H Weissberger
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Raman Gat, Israel
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Laura Fenton
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - Jennifer Herrera
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA.
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA.
- USC School of Gerontology, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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11
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Yang LG, March ZM, Stephenson RA, Narayan PS. Apolipoprotein E in lipid metabolism and neurodegenerative disease. Trends Endocrinol Metab 2023:S1043-2760(23)00092-9. [PMID: 37357100 PMCID: PMC10365028 DOI: 10.1016/j.tem.2023.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/27/2023]
Abstract
Dysregulation of lipid metabolism has emerged as a central component of many neurodegenerative diseases. Variants of the lipid transport protein, apolipoprotein E (APOE), modulate risk and resilience in several neurodegenerative diseases including late-onset Alzheimer's disease (LOAD). Allelic variants of the gene, APOE, alter the lipid metabolism of cells and tissues and have been broadly associated with several other cellular and systemic phenotypes. Targeting APOE-associated metabolic pathways may offer opportunities to alter disease-related phenotypes and consequently, attenuate disease risk and impart resilience to multiple neurodegenerative diseases. We review the molecular, cellular, and tissue-level alterations to lipid metabolism that arise from different APOE isoforms. These changes in lipid metabolism could help to elucidate disease mechanisms and tune neurodegenerative disease risk and resilience.
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Affiliation(s)
- Linda G Yang
- Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Zachary M March
- Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Roxan A Stephenson
- Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Priyanka S Narayan
- Genetics and Biochemistry Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA.; National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD, USA; Center for Alzheimer's and Related Dementias (CARD), National Institutes of Health, Bethesda, MD, USA.
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12
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Suchy-Dicey A, Su Y, Buchwald DS, Manson SM, Reiman EM. Volume atrophy in medial temporal cortex and verbal memory scores in American Indians: Data from the Strong Heart Study. Alzheimers Dement 2023; 19:2298-2306. [PMID: 36453775 PMCID: PMC10232670 DOI: 10.1002/alz.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Distinguishing Alzheimer's disease (AD) patient subgroups may optimize positive clinical outcomes. Cortical atrophy is correlated with memory deficits, but these associations are understudied in American Indians. METHODS We collected imaging and cognition data in the Strong Heart Study (SHS), a cohort of 11 tribes across three regions. We processed 1.5T MRI using FreeSurfer and iterative principal component analysis. Linear mixed models estimated volumetric associations with diabetes. RESULTS Over mean 7 years follow-up (N = 818 age 65-89 years), overall volume loss was 0.5% per year. Significant losses associated with diabetes were especially strong in the right hemisphere. Annualized hippocampal, parahippocampal, entorhinal atrophy were worse for men, older age, diabetes, hypertension, stroke; and associated with both encoding and retrieval memory losses. DISCUSSION Our findings suggest that diabetes is an important risk factor in American Indians for cortical atrophy and memory loss. Future research should examine opportunities for primary prevention in this underserved population.
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Affiliation(s)
- Astrid Suchy-Dicey
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Yi Su
- Banner Alzheimer's Institute, Phoenix, Arizona, USA
| | - Dedra S Buchwald
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Spero M Manson
- Colorado School of Public Health, University of Colorado Anschutz, Aurora, Colorado, USA
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13
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Caldwell JZ, Isenberg N. The aging brain: risk factors and interventions for long term brain health in women. Curr Opin Obstet Gynecol 2023; 35:169-175. [PMID: 36912325 PMCID: PMC10023345 DOI: 10.1097/gco.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Poor cognitive aging and dementia pose a significant public health burden, and women face unique risks compared to men. Recent research highlights the role of genetics, menopause, chronic disease, and lifestyle in risk and resilience in women's cognitive aging. This work suggests avenues for clinical action at midlife that may change the course of brain health in aging. RECENT FINDINGS Studies indicate women's risk for poor cognitive aging relates in part to hormone changes at menopause, a time when memory, brain structure and function, and Alzheimer's pathology may be observed in women and not men. Medical and lifestyle risks including diabetes, hypertension, and low physical activity also contribute to women's unique risks. At the same time, literature on resilience suggests women may benefit from lifestyle and chronic disease intervention, possibly more than men. Current studies emphasize the importance of interacting genetic and lifestyle risks, and effects of social determinants of health. SUMMARY Women have greater risk than men for poor cognitive aging; however, by treating the whole person, including genetics, lifestyle, and social environment, clinicians have an opportunity to support healthy cognitive aging in women and reduce the future public health burden of dementia.
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Affiliation(s)
- Jessica Z.K. Caldwell
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Ave., Las Vegas, NV 89106
| | - Nancy Isenberg
- Providence Swedish Center for Healthy Aging, Swedish Neuroscience Institute, 1600 E. Jefferson St. A Level, Seattle, WA 98122
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14
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Mascarenhas Fonseca L, Sage Chaytor N, Olufadi Y, Buchwald D, Galvin JE, Schmitter-Edgecombe M, Suchy-Dicey A. Intraindividual Cognitive Variability and Magnetic Resonance Imaging in Aging American Indians: Data from the Strong Heart Study. J Alzheimers Dis 2023; 91:1395-1407. [PMID: 36641671 PMCID: PMC9974814 DOI: 10.3233/jad-220825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND American Indians have high prevalence of risk factors for Alzheimer's disease and related dementias (ADRD) compared to the general population, yet dementia onset and frequency in this population are understudied. Intraindividual cognitive variability (IICV), a measure of variability in neuropsychological test performance within a person at a single timepoint, may be a novel, noninvasive biomarker of neurodegeneration and early dementia. OBJECTIVE To characterize the cross-sectional associations between IICV and hippocampal, total brain volume, and white matter disease measured by magnetic resonance imaging (MRI) among older American Indians. METHODS IICV measures for memory, executive function, and processing speed, and multidomain cognition were calculated for 746 American Indians (aged 64-95) who underwent MRI. Regression models were used to examine the associations of IICV score with hippocampal volume, total brain volume, and graded white matter disease, adjusting for age, sex, education, body mass index, intracranial volume, diabetes, stroke, hypertension, hypercholesterolemia, alcohol use, and smoking. RESULTS Higher memory IICV measure was associated with lower hippocampal volume (Beta = -0.076; 95% CI -0.499, -0.023; p = 0.031). After adjustment for Bonferroni or IICV mean scores in the same tests, the associations were no longer significant. No IICV measures were associated with white matter disease or total brain volume. CONCLUSION These findings suggest that the IICV measures used in this research cannot be robustly associated with cross-sectional neuroimaging features; nonetheless, the results encourage future studies investigating the associations between IICV and other brain regions, as well as its utility in the prediction of neurodegeneration and dementia in American Indians.
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Affiliation(s)
- Luciana Mascarenhas Fonseca
- Elson S Floyd College of Medicine, Washington State University, United States
- Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Naomi Sage Chaytor
- Elson S Floyd College of Medicine, Washington State University, United States
| | - Yunusa Olufadi
- Elson S Floyd College of Medicine, Washington State University, United States
| | - Dedra Buchwald
- Elson S Floyd College of Medicine, Washington State University, United States
- Institute for Research and Education to Advance Community Health, Washington State University, United States
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, United States
| | | | - Astrid Suchy-Dicey
- Elson S Floyd College of Medicine, Washington State University, United States
- Institute for Research and Education to Advance Community Health, Washington State University, United States
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15
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Turknett J, Wood TR. Demand Coupling Drives Neurodegeneration: A Model of Age-Related Cognitive Decline and Dementia. Cells 2022; 11:2789. [PMID: 36139364 PMCID: PMC9496827 DOI: 10.3390/cells11182789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/27/2022] [Accepted: 09/05/2022] [Indexed: 12/12/2022] Open
Abstract
The societal burden of Alzheimer's Disease (AD) and other major forms of dementia continues to grow, and multiple pharmacological agents directed towards modifying the pathological "hallmarks" of AD have yielded disappointing results. Though efforts continue towards broadening and deepening our knowledge and understanding of the mechanistic and neuropathological underpinnings of AD, our previous failures motivate a re-examination of how we conceptualize AD pathology and progression. In addition to not yielding effective treatments, the phenotypically heterogeneous biological processes that have been the primary area of focus to date have not been adequately shown to be necessary or sufficient to explain the risk and progression of AD. On the other hand, a growing body of evidence indicates that lifestyle and environment represent the ultimate level of causation for AD and age-related cognitive decline. Specifically, the decline in cognitive demands over the lifespan plays a central role in driving the structural and functional deteriorations of the brain. In the absence of adequate cognitive stimulus, physiological demand-function coupling leads to downregulation of growth, repair, and homeostatic processes, resulting in deteriorating brain tissue health, function, and capacity. In this setting, the heterogeneity of associated neuropathological tissue hallmarks then occurs as a consequence of an individual's genetic and environmental background and are best considered downstream markers of the disease process rather than specific targets for direct intervention. In this manuscript we outline the evidence for a demand-driven model of age-related cognitive decline and dementia and why it mandates a holistic approach to dementia treatment and prevention that incorporates the primary upstream role of cognitive demand.
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Affiliation(s)
- Josh Turknett
- Brainjo Center for Neurology and Cognitive Enhancement, Atlanta, GA 30076, USA
| | - Thomas R. Wood
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Institute for Human and Machine Cognition, Pensacola, FL 32502, USA
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