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Giebel C. A new model to understand the complexity of inequalities in dementia. Int J Equity Health 2024; 23:160. [PMID: 39138491 PMCID: PMC11323611 DOI: 10.1186/s12939-024-02245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
Many people living with dementia and unpaid carers experience inequalities in care related to challenges in receiving a correct diagnosis, care and support. Whilst complexities of the evidence are well recognised including barriers in receiving a diagnosis or post-diagnostic care, no coherent model has captured the far-reaching types and levels of inequalities to date. Building on the established Dahlgren & Whitehead Rainbow model of health determinants, this paper introduces the new Dementia Inequalities model. The Dementia Inequalities model, similar to the original general rainbow model, categorises determinants of health and well-being in dementia into three layers: (1) Individual; (2) Social and community networks; and (3) Society and infrastructure. Each layer comprises of general determinants, which have been identified in the original model but also may be different in dementia, such as age (specifically referring to young- versus late-onset dementia) and ethnicity, as well as new dementia-specific determinants, such as rare dementia subtype, having an unpaid carer, and knowledge about dementia in the health and social care workforce. Each layer and its individual determinants are discussed referring to existing research and evidence syntheses in the field, arguing for the need of this new model. A total of 48 people with lived, caring, and professional experiences of dementia have been consulted in the process of the development of this model. The Dementia Inequalities model provides a coherent, evidence-based overview of inequalities in dementia diagnosis and care and can be used in health and social care, as well as in commissioning of care services, to support people living with dementia and their unpaid carers better and try and create more equity in diagnosis and care.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK.
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Shimizu E, Goto-Hirano K, Motoi Y, Arai M, Hattori N. Symptoms and age of prodromal Alzheimer's disease in Down syndrome: a systematic review and meta-analysis. Neurol Sci 2024; 45:2445-2460. [PMID: 38228941 DOI: 10.1007/s10072-023-07292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
The diagnostic criteria for adult-onset Alzheimer's disease (AD) in patients with Down syndrome (DS) have not been standardised. This study investigated the specific symptoms of AD in the prodromal stage of DS, the mean age at diagnosis at each stage of dementia, and the relationship between intellectual disability (ID) and dementia. PubMed, Web of Science, and Embase were searched for studies on DS, AD, early-stage disease, initial symptoms, and prodromal dementia registered between January 2012 and January 2022. We also performed a meta-analysis of the differences between the mean age at prodromal symptoms and AD diagnosis and the proportion of mild cognitive impairment in patients with mild and moderately abnormal ID. We selected 14 articles reporting the behavioural and psychological symptoms of dementia (BPSD) and memory- and language-related impairments as early symptoms of AD in patients with DS. The specific symptoms of BPSD were classified into five categories: irritability (agitation), apathy, abnormal behaviour, adaptive functioning, and sleep disturbance. The mean age at the diagnosis of prodromal symptoms and AD dementia was 52.7 and 56.2 years, respectively (mean difference, + 3.11 years; 95% CI 1.82-4.40) in the meta-analysis. The diagnosis of mild dementia tended to correlate with ID severity (odds ratio [OR], 1.38; 95% CI 0.87-2.18). The features of behaviour-variant frontotemporal dementia may be clinically confirmed in diagnosing early symptoms of DS-associated AD (DSAD). Moreover, age-appropriate cognitive assessment is important. Further studies are required to evaluate DSAD using a combination of biomarkers and ID-related data.
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Affiliation(s)
- Eri Shimizu
- Department of Clinical Genetics, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Keiko Goto-Hirano
- Department of Clinical Genetics, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Yumiko Motoi
- The Medical Center for Dementia, Juntendo Hospital, Tokyo, Japan
| | - Masami Arai
- Department of Clinical Genetics, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Acton DJ, Jaydeokar S, Taylor R, Jones S. Exploring the lived experiences and care challenges of formal paid caregivers for people with intellectual disability and dementia. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024:17446295241259076. [PMID: 38816805 DOI: 10.1177/17446295241259076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
A greater number of people with intellectual disability are living into older age and are at increased risk of developing conditions such as dementia. Caring for a person with dementia presents several challenges for formal caregivers due to the progressive nature of the disease. An interpretive phenomenological analysis was used to understand the lived experiences of a purposive sample of formal caregivers in caring for people with intellectual disability and dementia. Discussions from 14 individual interviews generated data were analysed. Four key super-ordinate themes emerged which were: (1) recognising early indicators and diagnosis, (2) post diagnostic support, (3) coping with change and (4) need for future development. Themes reflected the experiences, barriers to dementia diagnosis and provide a valuable insight into the challenges faced by formal caregivers in providing aged care services.
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Affiliation(s)
- Daniel James Acton
- Cheshire and Wirral Partnership NHS Foundation Trust - Centre for Autism Neurodevelopmental Disorders and Intellectual Disability (CANDDID), UK
- University of Chester, UK
| | - Sujeet Jaydeokar
- Cheshire and Wirral Partnership NHS Foundation Trust - Centre for Autism Neurodevelopmental Disorders and Intellectual Disability (CANDDID), UK
- University of Chester, UK
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Fatemi SH, Otte ED, Folsom TD, Eschenlauer AC, Roper RJ, Aman JW, Thuras PD. Early Chronic Fluoxetine Treatment of Ts65Dn Mice Rescues Synaptic Vesicular Deficits and Prevents Aberrant Proteomic Alterations. Genes (Basel) 2024; 15:452. [PMID: 38674386 PMCID: PMC11049293 DOI: 10.3390/genes15040452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Down syndrome (DS) is the most common form of inherited intellectual disability caused by trisomy of chromosome 21, presenting with intellectual impairment, craniofacial abnormalities, cardiac defects, and gastrointestinal disorders. The Ts65Dn mouse model replicates many abnormalities of DS. We hypothesized that investigation of the cerebral cortex of fluoxetine-treated trisomic mice may provide proteomic signatures that identify therapeutic targets for DS. Subcellular fractionation of synaptosomes from cerebral cortices of age- and brain-area-matched samples from fluoxetine-treated vs. water-treated trisomic and euploid male mice were subjected to HPLC-tandem mass spectrometry. Analysis of the data revealed enrichment of trisomic risk genes that participate in regulation of synaptic vesicular traffic, pre-synaptic and post-synaptic development, and mitochondrial energy pathways during early brain development. Proteomic analysis of trisomic synaptic fractions revealed significant downregulation of proteins involved in synaptic vesicular traffic, including vesicular endocytosis (CLTA, CLTB, CLTC), synaptic assembly and maturation (EXOC1, EXOC3, EXOC8), anterograde axonal transport (EXOC1), neurotransmitter transport to PSD (SACM1L), endosomal-lysosomal acidification (ROGDI, DMXL2), and synaptic signaling (NRXN1, HIP1, ITSN1, YWHAG). Additionally, trisomic proteomes revealed upregulation of several trafficking proteins, involved in vesicular exocytosis (Rab5B), synapse elimination (UBE3A), scission of endocytosis (DBN1), transport of ER in dendritic spines (MYO5A), presynaptic activity-dependent bulk endocytosis (FMR1), and NMDA receptor activity (GRIN2A). Chronic fluoxetine treatment of Ts65Dn mice rescued synaptic vesicular abnormalities and prevented abnormal proteomic changes in adult Ts65Dn mice, pointing to therapeutic targets for potential treatment of DS.
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Affiliation(s)
- S. Hossein Fatemi
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
| | - Elysabeth D. Otte
- Department of Biology, Indiana University, Indianapolis, IN 46202, USA;
| | - Timothy D. Folsom
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
| | - Arthur C. Eschenlauer
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Randall J. Roper
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN 46202, USA;
| | - Justin W. Aman
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
| | - Paul D. Thuras
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School and VA Health Care System, One Veterans Drive, Minneapolis, MN 55417, USA
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DiProspero N, Sathishkumar M, Janecek J, Smith A, McMillan L, Petersen M, Tustison N, Keator DB, Doran E, Hom CL, Nguyen D, Andrews H, Krinsky‐McHale S, Brickman AM, Rosas HD, Lai F, Head E, Mapstone M, Silverman W, Lott IT, O'Bryant S, Yassa MA. Neurofilament light chain concentration mediates the association between regional medial temporal lobe structure and memory in adults with Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12542. [PMID: 38348178 PMCID: PMC10859879 DOI: 10.1002/dad2.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/03/2023] [Accepted: 09/26/2023] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Virtually all people with Down syndrome (DS) develop neuropathology associated with Alzheimer's disease (AD). Atrophy of the hippocampus and entorhinal cortex (EC), as well as elevated plasma concentrations of neurofilament light chain (NfL) protein, are markers of neurodegeneration associated with late-onset AD. We hypothesized that hippocampus and EC gray matter loss and increased plasma NfL concentrations are associated with memory in adults with DS. METHODS T1-weighted structural magnetic resonance imaging (MRI) data were collected from 101 participants with DS. Hippocampus and EC volume, as well as EC subregional cortical thickness, were derived. In a subset of participants, plasma NfL concentrations and modified Cued Recall Test scores were obtained. Partial correlation and mediation were used to test relationships between medial temporal lobe (MTL) atrophy, plasma NfL, and episodic memory. RESULTS Hippocampus volume, left anterolateral EC (alEC) thickness, and plasma NfL were correlated with each other and were associated with memory. Plasma NfL mediated the relationship between left alEC thickness and memory as well as hippocampus volume and memory. DISCUSSION The relationship between MTL gray matter and memory is mediated by plasma NfL levels, suggesting a link between neurodegenerative processes underlying axonal injury and frank gray matter loss in key structures supporting episodic memory in people with DS.
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Affiliation(s)
- Natalie DiProspero
- Department of Neurobiology and BehaviorSchool of Biological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Mithra Sathishkumar
- Department of Neurobiology and BehaviorSchool of Biological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
| | - John Janecek
- Department of Neurobiology and BehaviorSchool of Biological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Anna Smith
- Department of Neurobiology and BehaviorSchool of Biological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Liv McMillan
- Department of Neurobiology and BehaviorSchool of Biological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Melissa Petersen
- Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Nicholas Tustison
- Department of Neurobiology and BehaviorSchool of Biological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
- Department of RadiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David B. Keator
- Department of Psychiatry and Behavioral SciencesSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Eric Doran
- Department of PediatricsSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Christy L. Hom
- Department of PediatricsSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Dana Nguyen
- Department of PediatricsSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Howard Andrews
- Department of PsychiatryCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Sharon Krinsky‐McHale
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Adam M. Brickman
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - H. Diana Rosas
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Florence Lai
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Elizabeth Head
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
- Department of PathologySchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Mark Mapstone
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
- Department of NeurologySchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Wayne Silverman
- Department of PediatricsSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Ira T. Lott
- Department of PediatricsSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Sid O'Bryant
- Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Michael A. Yassa
- Department of Neurobiology and BehaviorSchool of Biological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
- Department of NeurologySchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
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del Hoyo Soriano L, Villarreal J, Abbeduto L. Parental Survey on Spanish‑English Bilingualism in Neurotypical Development and Neurodevelopmental Disabilities in the United States. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2023; 7:591-603. [PMID: 37997573 PMCID: PMC10664973 DOI: 10.1007/s41252-023-00325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 11/25/2023]
Abstract
Objectives The cognitive and social benefits of bilingualism for children, including those with neurodevelopmental disabilities (NDDs), have been documented. The present study was designed to characterize and compare English and Spanish use in Hispanic families with and without NDDs residing in the U.S. as well as to understand parental perceptions of their child's bilingualism and of community and professional support. Methods We conducted an online survey of 84 Spanish-speaking parents of 4- to 24-year-olds with (n = 44) and without NDDs (n = 40) who were born in and living in the U.S. Results We found that bilingualism was a desired goal for 95% of our families. We also found, however, that 17.1% of parents of children with NDDs have raised them as monolinguals English-speakers, as they thought there were reasons for that, while all families from the NT group raised their children in both languages. In addition, nearly 40% of the NDD children only speak English, compared to a 5% in the NT group. Finally, parents of children with NDDs cite a lack of support for bilingualism in the community (47.6% do not feel supported, compared to a 7.9% in the NT group) and recommendation from professionals as major factors for not raising their children as bilingual. Conclusions The results suggest a need to educate professionals from many disciplines about the benefits of bilingualism for children with NDDs and for implementation of inclusion policies that provide access to dual-language programs.
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Affiliation(s)
- Laura del Hoyo Soriano
- . MIND Institute, University of California Davis, 50Th Street, Sacramento, CA 2825, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA
| | - Jennifer Villarreal
- . MIND Institute, University of California Davis, 50Th Street, Sacramento, CA 2825, USA
- . Graduate Program in Human Development, University of California, Davis, CA, USA
| | - Leonard Abbeduto
- . MIND Institute, University of California Davis, 50Th Street, Sacramento, CA 2825, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA
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Victorino DB, Faber J, Pinheiro DJLL, Scorza FA, Almeida ACG, Costa ACS, Scorza CA. Toward the Identification of Neurophysiological Biomarkers for Alzheimer's Disease in Down Syndrome: A Potential Role for Cross-Frequency Phase-Amplitude Coupling Analysis. Aging Dis 2023; 14:428-449. [PMID: 37008053 PMCID: PMC10017148 DOI: 10.14336/ad.2022.0906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Cross-frequency coupling (CFC) mechanisms play a central role in brain activity. Pathophysiological mechanisms leading to many brain disorders, such as Alzheimer's disease (AD), may produce unique patterns of brain activity detectable by electroencephalography (EEG). Identifying biomarkers for AD diagnosis is also an ambition among research teams working in Down syndrome (DS), given the increased susceptibility of people with DS to develop early-onset AD (DS-AD). Here, we review accumulating evidence that altered theta-gamma phase-amplitude coupling (PAC) may be one of the earliest EEG signatures of AD, and therefore may serve as an adjuvant tool for detecting cognitive decline in DS-AD. We suggest that this field of research could potentially provide clues to the biophysical mechanisms underlying cognitive dysfunction in DS-AD and generate opportunities for identifying EEG-based biomarkers with diagnostic and prognostic utility in DS-AD.
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Affiliation(s)
- Daniella B Victorino
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Federal University of São Paulo / Paulista Medical School, São Paulo, SP, Brazil.
| | - Jean Faber
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Federal University of São Paulo / Paulista Medical School, São Paulo, SP, Brazil.
| | - Daniel J. L. L Pinheiro
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Federal University of São Paulo / Paulista Medical School, São Paulo, SP, Brazil.
| | - Fulvio A Scorza
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Federal University of São Paulo / Paulista Medical School, São Paulo, SP, Brazil.
| | - Antônio C. G Almeida
- Department of Biosystems Engineering, Federal University of São João Del Rei, Minas Gerais, MG, Brazil.
| | - Alberto C. S Costa
- Division of Psychiatry, Case Western Reserve University, Cleveland, OH, United States.
- Department of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, OH, United States.
| | - Carla A Scorza
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Federal University of São Paulo / Paulista Medical School, São Paulo, SP, Brazil.
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Rodríguez-Hidalgo E, García-Alba J, Novell R, Esteba-Castillo S. The Global Deterioration Scale for Down Syndrome Population (GDS-DS): A Rating Scale to Assess the Progression of Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5096. [PMID: 36982004 PMCID: PMC10049652 DOI: 10.3390/ijerph20065096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study is to adapt and validate the global deterioration scale (GDS) for the systematic tracking of Alzheimer's disease (AD) progression in a population with Down syndrome (DS). A retrospective dual-center cohort study was conducted with 83 participants with DS (46.65 ± 5.08 years) who formed the primary diagnosis (PD) group: cognitive stability (n = 48), mild cognitive impairment (n = 24), and Alzheimer's disease (n = 11). The proposed scale for adults with DS (GDS-DS) comprises six stages, from cognitive and/or behavioral stability to advanced AD. Two neuropsychologists placed the participants of the PD group in each stage of the GDS-DS according to cognitive, behavioral and daily living skills data. Inter-rater reliability in staging with the GDS-DS was excellent (ICC = 0.86; CI: 0.80-0.93), and the agreement with the diagnosis categories of the PD group ranged from substantial to excellent with κ values of 0.82 (95% CI: 0.73-0.92) and 0.85 (95% CI: 0.72, 0.99). Performance with regard to the CAMCOG-DS total score and orientation subtest of the Barcelona test for intellectual disability showed a slight progressive decline across all the GDS-DS stages. The GDS-DS scale is a sensitive tool for staging the progression of AD in the DS population, with special relevance in daily clinical practice.
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Affiliation(s)
- Emili Rodríguez-Hidalgo
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
| | - Javier García-Alba
- Research and Psychology in Education Department, Complutense University of Madrid, 28040 Madrid, Spain
| | - Ramon Novell
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
| | - Susanna Esteba-Castillo
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
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Rodríguez-Hidalgo E, García-Alba J, Buxó M, Novell R, Esteba-Castillo S. The Pictorial Screening Memory Test (P-MIS) for Adults with Moderate Intellectual Disability and Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10780. [PMID: 36078496 PMCID: PMC9518372 DOI: 10.3390/ijerph191710780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
In this study, we examined normative data and diagnostic accuracy of a pictorial screening test to detect memory impairment for mild cognitive impairment (MCI) and Alzheimer's disease (AD) in Spanish-speaking adults with intellectual disability (ID). A total of 94 volunteers with ID (60 controls, 17 MCI, and 17 AD), were evaluated by neuropsychological tests including the PMIS-ID in a cross-sectional validation study. Discriminative validity between the MCI, AD, and control group was analyzed by the area under the ROC curve. A cut-off score of 4.5 on the immediate recall trial had a sensitivity of 69% and a specificity of 80% to detect memory impairment (AUC = 0.685; 95% CI = 0.506-0.863) in the AD group. The PMIS-ID is a useful screening test to rule out a diagnosis of memory decline in people with moderate level of ID and AD, and it shows good psychometric properties.
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Affiliation(s)
- Emili Rodríguez-Hidalgo
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance, Parc Hospitalari Martí i Julià, Catalonia, 17190 Girona, Spain
| | - Javier García-Alba
- Research and Psychology in Education Department, Complutense University of Madrid, 28040 Madrid, Spain
| | - Maria Buxó
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, Catalonia, 17190 Girona, Spain
| | - Ramon Novell
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance, Parc Hospitalari Martí i Julià, Catalonia, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, Catalonia, 17190 Girona, Spain
| | - Susana Esteba-Castillo
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance, Parc Hospitalari Martí i Julià, Catalonia, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, Catalonia, 17190 Girona, Spain
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Queder N, Phelan MJ, Taylor L, Tustison N, Doran E, Hom C, Nguyen D, Lai F, Pulsifer M, Price J, Kreisl WC, Rosas HD, Krinsky‐McHale S, Brickman AM, Yassa MA, Schupf N, Silverman W, Lott IT, Head E, Mapstone M, Keator DB, Ances BM, Andrews HF, Bell K, Birn RM, Brickman AM, Bulova P, Cheema A, Chen K, Christian BT, Clare I, Clark L, Cohen AD, Constantino JN, Doran EW, Fagan A, Feingold E, Foroud TM, Handen BL, Hartley SL, Head E, Henson R, Hom C, Honig L, Ikonomovic MD, Johnson SC, Jordan C, Kamboh MI, Keator D, Klunk WE, Kofler JK, Kreisl WC, Krinsky‐McHale SJ, Lai F, Lao P, Laymon C, Lee JH, Lott IT, Lupson V, Mapstone M, Mathis CA, Minhas DS, Nadkarni N, O'Bryant S, Pang D, Petersen M, Price JC, Pulsifer M, Reiman E, Rizvi B, Rosas HD, Schupf N, Silverman WP, Tudorascu DL, Tumuluru R, Tycko B, Varadarajan B, White DA, Yassa MA, Zaman S, Zhang F. Joint-label fusion brain atlases for dementia research in Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12324. [PMID: 35634535 PMCID: PMC9131930 DOI: 10.1002/dad2.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 01/07/2023]
Abstract
Research suggests a link between Alzheimer's Disease in Down Syndrome (DS) and the overproduction of amyloid plaques. Using Positron Emission Tomography (PET) we can assess the in-vivo regional amyloid load using several available ligands. To measure amyloid distributions in specific brain regions, a brain atlas is used. A popular method of creating a brain atlas is to segment a participant's structural Magnetic Resonance Imaging (MRI) scan. Acquiring an MRI is often challenging in intellectually-imparied populations because of contraindications or data exclusion due to significant motion artifacts or incomplete sequences related to general discomfort. When an MRI cannot be acquired, it is typically replaced with a standardized brain atlas derived from neurotypical populations (i.e. healthy individuals without DS) which may be inappropriate for use in DS. In this project, we create a series of disease and diagnosis-specific (cognitively stable (CS-DS), mild cognitive impairment (MCI-DS), and dementia (DEM-DS)) probabilistic group atlases of participants with DS and evaluate their accuracy of quantifying regional amyloid load compared to the individually-based MRI segmentations. Further, we compare the diagnostic-specific atlases with a probabilistic atlas constructed from similar-aged cognitively-stable neurotypical participants. We hypothesized that regional PET signals will best match the individually-based MRI segmentations by using DS group atlases that aligns with a participant's disorder and disease status (e.g. DS and MCI-DS). Our results vary by brain region but generally show that using a disorder-specific atlas in DS better matches the individually-based MRI segmentations than using an atlas constructed from cognitively-stable neurotypical participants. We found no additional benefit of using diagnose-specific atlases matching disease status. All atlases are made publicly available for the research community. Highlight Down syndrome (DS) joint-label-fusion atlases provide accurate positron emission tomography (PET) amyloid measurements.A disorder-specific DS atlas is better than a neurotypical atlas for PET quantification.It is not necessary to use a disease-state-specific atlas for quantification in aged DS.Dorsal striatum results vary, possibly due to this region and dementia progression.
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Affiliation(s)
- Nazek Queder
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA,Department of Neurobiology and Behavior and Center for the Neurobiology of Learning and MemoryUniversity of California IrvineIrvineCaliforniaUSA
| | - Michael J. Phelan
- Institute for Memory Impairments and Neurological DisordersUniversity of California IrvineIrvineCaliforniaUSA
| | - Lisa Taylor
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Nicholas Tustison
- Department of RadiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Eric Doran
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCaliforniaUSA
| | - Christy Hom
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Dana Nguyen
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Florence Lai
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | - Margaret Pulsifer
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | - Julie Price
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | | | - Herminia D. Rosas
- Massachusetts General HospitalHarvard UniversityBostonMassachusettsUSA
| | - Sharon Krinsky‐McHale
- New York State Institute for Basic Research in Developmental DisabilitiesNew YorkNew YorkUSA
| | - Adam M. Brickman
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA,Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Michael A. Yassa
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA,Department of Neurobiology and Behavior and Center for the Neurobiology of Learning and MemoryUniversity of California IrvineIrvineCaliforniaUSA,Department of NeurologyUniversity of California IrvineIrvineCaliforniaUSA
| | - Nicole Schupf
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA,Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Wayne Silverman
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCaliforniaUSA
| | - Ira T. Lott
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCaliforniaUSA
| | - Elizabeth Head
- Department of Pathology & Laboratory MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Mark Mapstone
- Department of NeurologyUniversity of California IrvineIrvineCaliforniaUSA
| | - David B. Keator
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
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11
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Dierssen M, Herault Y, Helguera P, Martínez de Lagran M, Vazquez A, Christian B, Carmona-Iragui M, Wiseman F, Mobley W, Fisher EMC, Brault V, Esbensen A, Jacola LM, Potier MC, Hamlett ED, Abbeduto L, Del Hoyo Soriano L, Busciglio J, Iulita MF, Crispino J, Malinge S, Barone E, Perluigi M, Costanzo F, Delabar JM, Bartesaghi R, Dekker AD, De Deyn P, Fortea Ormaechea J, Shaw PA, Haydar TF, Sherman SL, Strydom A, Bhattacharyya A. Building the Future Therapies for Down Syndrome: The Third International Conference of the T21 Research Society. Mol Syndromol 2021; 12:202-218. [PMID: 34421499 DOI: 10.1159/000514437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
Research focused on Down syndrome has increased in the last several years to advance understanding of the consequences of trisomy 21 (T21) on molecular and cellular processes and, ultimately, on individuals with Down syndrome. The Trisomy 21 Research Society (T21RS) is the premier scientific organization for researchers and clinicians studying Down syndrome. The Third International Conference of T21RS, held June 6-9, 2019, in Barcelona, Spain, brought together 429 scientists, families, and industry representatives to share the latest discoveries on underlying cellular and molecular mechanisms of T21, define cognitive and behavioral challenges and better understand comorbidities associated with Down syndrome, including Alzheimer's disease and leukemia. Presentation of cutting-edge results in neuroscience, neurology, model systems, psychology, cancer, biomarkers and molecular and phar-ma-cological therapeutic approaches demonstrate the compelling interest and continuing advancement in all aspects of understanding and ameliorating conditions associated with T21.
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Affiliation(s)
- Mara Dierssen
- Centre for Genomic Regulation, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Yann Herault
- Université de Strasbourg, CNRS, INSERM, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Strasbourg, France
| | - Pablo Helguera
- Instituto Ferreyra, INIMEC-CONICET-UNC, Córdoba, Argentina
| | - Maria Martínez de Lagran
- Centre for Genomic Regulation, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Anna Vazquez
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Bradley Christian
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Maria Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Frances Wiseman
- UK Dementia Research Institute, University College London, London, United Kingdom
| | - William Mobley
- University of California-San Diego, San Diego, California, USA
| | | | - Veronique Brault
- Université de Strasbourg, CNRS, INSERM, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Strasbourg, France
| | - Anna Esbensen
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa M Jacola
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Marie Claude Potier
- Brain & Spine Institute (ICM), CNRS UMR7225 - INSERM U1127 - UPMC Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Eric D Hamlett
- Medical University of South Carolina, Columbia, South Carolina, USA
| | | | | | | | | | | | - Sébastien Malinge
- Telethon Kids Institute - Cancer Centre, Nedlands, Washington, Australia
| | | | | | | | - Jean Maurice Delabar
- Brain & Spine Institute (ICM), CNRS UMR7225 - INSERM U1127 - UPMC Hôpital de la Pitié-Salpêtrière, Paris, France
| | | | - Alain D Dekker
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Peter De Deyn
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.,University of Antwerp, Antwerp, Belgium
| | - Juan Fortea Ormaechea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
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12
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Wissing MBG, Ulgiati AM, Hobbelen JSM, De Deyn PP, Waninge A, Dekker AD. The neglected puzzle of dementia in people with severe/profound intellectual disabilities: A systematic literature review of observable symptoms. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:24-45. [PMID: 34219327 PMCID: PMC9292142 DOI: 10.1111/jar.12920] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dementia is increasingly prevalent in people with severe/profound intellectual disabilities. However, early detection and diagnosis of dementia is complex in this population. This study aimed to identify observable dementia symptoms in adults with severe/profound intellectual disabilities in available literature. METHOD A systematic literature search was conducted in PubMed, PsycINFO and Web of Science with an exhaustive search string using a combination of search terms for severe/profound intellectual disabilities and dementia/ageing. RESULTS Eleven studies met inclusion criteria. Cognitive decline, behavioural and psychological alterations, decline in activities of daily living as well as neurological and physical changes were found. CONCLUSIONS Only a very limited number of studies reported symptoms ascribed to dementia in adults with severe/profound intellectual disabilities. Given the complexity of signalling and diagnosing dementia, dedicated studies are required to unravel the natural history of dementia in this population.
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Affiliation(s)
- Maureen B G Wissing
- Department of Neurology and Alzheimer Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Practice-Oriented Scientific Research (PWO), Alliade Care Group, Heerenveen, The Netherlands
| | - Aurora M Ulgiati
- Department of Neurology and Alzheimer Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Practice-Oriented Scientific Research (PWO), Alliade Care Group, Heerenveen, The Netherlands
| | - Johannes S M Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Institute Born-Bunge, University of Antwerpen, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Aly Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Royal Dutch Visio, Vries, The Netherlands
| | - Alain D Dekker
- Department of Neurology and Alzheimer Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Practice-Oriented Scientific Research (PWO), Alliade Care Group, Heerenveen, The Netherlands
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13
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Ramírez-Toraño F, García-Alba J, Bruña R, Esteba-Castillo S, Vaquero L, Pereda E, Maestú F, Fernández A. Hypersynchronized Magnetoencephalography Brain Networks in Patients with Mild Cognitive Impairment and Alzheimer's Disease in Down Syndrome. Brain Connect 2021; 11:725-733. [PMID: 33858203 DOI: 10.1089/brain.2020.0897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: The majority of individuals with Down syndrome (DS) show signs of Alzheimer's disease (AD) neuropathology in their fourth decade. However, there is a lack of specific markers for characterizing the disease stages while considering this population's differential features. Methods: Forty-one DS individuals participated in the study, and were classified into three groups according to their clinical status: Alzheimer's disease (AD-DS), mild cognitive impairment (MCI-DS), and controls (CN-DS). We performed an exhaustive neuropsychological evaluation and assessed brain functional connectivity (FC) from magnetoencephalographic recordings. Results: Compared with CN-DS, both MCI-DS and AD-DS showed a pattern of increased FC within the high alpha band. The neuropsychological assessment showed a generalized cognitive impairment, especially affecting mnestic functions, in MCI-DS and, more pronouncedly, in AD-DS. Discussion: These findings might help to characterize the AD-continuum in DS. In addition, they support the role of the excitatory/inhibitory imbalance as a key pathophysiological factor in AD. Impact statement The pattern of functional connectivity (FC) hypersynchronization found in this study resembles the largely reported Alzheimer's disease (AD) FC evolution pattern in population with typical development. This study supports the hypothesis of the excitatory/inhibitory imbalance as a key pathophysiological factor in AD, and its conclusions could help in the characterization and prediction of Down syndrome individuals with a greater likelihood of converting to dementia.
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Affiliation(s)
- Federico Ramírez-Toraño
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier García-Alba
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Research and Psychology in Education Department, Complutense University of Madrid, Madrid, Spain
| | - Ricardo Bruña
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain.,Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Susanna Esteba-Castillo
- Specialized Department in Mental Health and Intellectual Disability, Parc Hospitalari Martí i Julià-Institut 'd'Assistència Sanitària, Institut 'd'Assistència Sanitària (IAS), Girona, Spain
| | - Lucía Vaquero
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Spain
| | - Ernesto Pereda
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Electrical Engineering and Bioengineering Group, Department of Industrial Engineering and IUNE and ITB Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Fernando Maestú
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain.,Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Alberto Fernández
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain.,Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Spain.,Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
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14
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Silverman W, Krinsky-McHale SJ, Lai F, Rosas HD, Hom C, Doran E, Pulsifer M, Lott I, Schupf N. Evaluation of the National Task Group-Early Detection Screen for Dementia: Sensitivity to 'mild cognitive impairment' in adults with Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:905-915. [PMID: 33314467 PMCID: PMC8356176 DOI: 10.1111/jar.12849] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/09/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The accuracy of the National Task Group-Early Detection Screen for Dementia (NTG-EDSD) was evaluated in a sample of 185 adults with Down syndrome (DS), emphasizing 'mild cognitive impairment (MCI-DS)'. METHOD Knowledgeable informants were interviewed with the NTG-EDSD, and findings were compared to an independent dementia status rating based on consensus review of detailed assessments of cognition, functional abilities and health status (including physician examination). RESULTS Results indicated that sections of the NTG-EDSD were sensitive to MCI-DS, with one or more concerns within the 'Memory' or 'Language and Communication' domains being most informative. CONCLUSIONS The NTG-EDSD is a useful tool for evaluating dementia status, including MCI-DS. However, estimates of sensitivity and specificity, even for detecting frank dementia, indicated that NTG-EDSD findings need to be supplemented by additional sources of relevant information to achieve an acceptable level of diagnostic/screening accuracy.
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Affiliation(s)
- Wayne Silverman
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Sharon J. Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA,Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
| | - Florence Lai
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - H. Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Christy Hom
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Margaret Pulsifer
- Department of Psychiatry, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Ira Lott
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Nicole Schupf
- Sergievsky Center, Taub Institute, New York, CA, USA,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, CA, USA,Department of Epidemiology, School of Public Health, Columbia University, New York, CA, USA
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15
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Koehl L, Harp J, Van Pelt KL, Head E, Schmitt FA. Longitudinal assessment of dementia measures in Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12075. [PMID: 33225040 PMCID: PMC7666427 DOI: 10.1002/dad2.12075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Early detection of dementia symptoms is critical in Down syndrome (DS) but complicated by clinical assessment barriers. The current study aimed to characterize cognitive and behavioral impairment using longitudinal trajectories comparing several measures of cognitive and behavioral functioning. METHODS Measures included global cognitive status (Severe Impairment Battery [SIB]), motor praxis (Brief Praxis Test [BPT]), and clinical dementia informant ratings (Dementia Questionnaire for People with Learning Disabilities [DLD]). One-year reliability was assessed using a two-way mixed effect, consistency, single measurement intraclass correlation among non-demented participants. Longitudinal assessment of SIB, BPT, and DLD was completed using linear mixed effect models. RESULTS One-year reliability (n = 52; 21 male) was moderate for DLD (0.69 to 0.75) and good for SIB (0.87) and BPT (0.80). Longitudinal analysis (n = 72) revealed significant age by diagnosis interactions for SIB (F(2, 115.02) = 6.06, P = .003), BPT (F(2, 85.59) = 4.56, P = .013), and DLD (F(2, 103.56) = 4.48, P = .014). SIB progression (PR) had a faster decline in performance versus no-dementia (ND) (t(159) = -2.87; P = .013). Dementia had a faster decline in BPT performance versus ND (t(112) = -2.46; P = .041). PR showed quickly progressing scores compared to ND (t(128) = -2.86; P = .014). DISCUSSION Current measures demonstrated moderate to good reliability. Longitudinal analysis revealed that SIB, BPT, and DLD changed with age depending on diagnostic progression; no change rates were dependent on baseline cognition, indicating usefulness across a variety of severity levels in DS.
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Affiliation(s)
- Lisa Koehl
- Department of NeurologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Jordan Harp
- Department of NeurologyUniversity of KentuckyLexingtonKentuckyUSA
| | | | - Elizabeth Head
- Department of Pathology & Laboratory MedicineUniversity of California—IrvineIrvineCaliforniaUSA
| | - Frederick A. Schmitt
- Department of NeurologyUniversity of KentuckyLexingtonKentuckyUSA
- Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
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16
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Bhattacharya M, Bhaumik P, Ghosh P, Majumder P, Kumar Dey S. Telomere Length Inheritance and Shortening in Trisomy 21. Fetal Pediatr Pathol 2020; 39:390-400. [PMID: 31514556 DOI: 10.1080/15513815.2019.1661049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Trisomy 21 is a genetic disorder that shows premature aging symptoms. As an aging marker, telomere length is therefore of importance in trisomy families. Methods: We included 63 maternally originated trisomy 21 and 77 control families with infants in the first data set; 48 trisomy 21 and 60 control children in the second set; and 14 paternally originated trisomy 21 families in the third data set. We used Southern blot to measure the telomere length. Results: (1) Offsprings' telomere length increased with parents' age (p < .0001). (2) Trisomy 21 infants had longer telomere than the controls (p < .0001). (3) Post-birth, the telomere attrition rate was higher in cases than in controls (58 bps/year vs. 38 bps/year). Conclusion: (1) Our data supports the older parents-longer gamete telomere hypothesis. (2) Trisomy 21 patients are born with longer telomeres, (3) with advancing trisomy 21 age, the telomere shortens more quickly than euploids.
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Affiliation(s)
- Mandar Bhattacharya
- Human Genetics, Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Pranami Bhaumik
- Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Priyanka Ghosh
- Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Poulami Majumder
- Maulana Abul Kalam Azad University of Technology, Kolkata, India
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17
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Pulsifer MB, Evans CL, Hom C, Krinsky‐McHale SJ, Silverman W, Lai F, Lott I, Schupf N, Wen J, Rosas HD. Language skills as a predictor of cognitive decline in adults with Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12080. [PMID: 32875055 PMCID: PMC7447889 DOI: 10.1002/dad2.12080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Adults with Down syndrome (DS) are at high risk for early onset Alzheimer's disease (AD), characterized by a progressive decline in multiple cognitive domains including language, which can impact social interactions, behavior, and quality of life. This cross-sectional study examined the relationship between language skills and dementia. METHODS A total of 168 adults with DS (mean age = 51.4 years) received neuropsychological assessments, including Vineland Communication Domain, McCarthy Verbal Fluency, and Boston Naming Test, and were categorized in one of three clinical groups: cognitively stable (CS, 57.8%); mild cognitive impairment (MCI-DS, 22.6%); and probable/definite dementia (AD-DS, 19.6%). Logistic regression was used to determine how well language measures predict group status. RESULTS Vineland Communication, particularly receptive language, was a significant predictor of MCI-DS. Semantic verbal fluency was the strongest predictor of AD-DS. DISCUSSION Assessment of language skills can aid in the identification of dementia in adults with DS. Clinically, indications of emerging language problems should warrant further evaluation and monitoring.
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Affiliation(s)
| | - Casey L. Evans
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | - Florence Lai
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ira Lott
- University of CaliforniaIrvineCaliforniaUSA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's disease and the Aging BrainColumbia UniversityNew YorkNew YorkUSA
| | - Jiyang Wen
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - H. Diana Rosas
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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18
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Krinsky‐McHale SJ, Zigman WB, Lee JH, Schupf N, Pang D, Listwan T, Kovacs C, Silverman W. Promising outcome measures of early Alzheimer's dementia in adults with Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12044. [PMID: 32647741 PMCID: PMC7335903 DOI: 10.1002/dad2.12044] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Adults with Down syndrome (DS) are at high risk for developing Alzheimer's disease (AD) and its associated dementia, warranting the development of strategies to improve early detection when prevention is possible. METHODS Using a broad battery of neuropsychological assessments, informant interviews, and clinical record review, we evaluated the psychometrics of measures in a large sample of 561 adults with DS. We tracked longitudinal stability or decline in functioning in a subsample of 269 participants over a period of 3 years, all initially without indications of clinically significant aging-related decline. RESULTS Results identified an array of objective measures that demonstrated sensitivity in distinguishing individuals with incident "mild cognitive impairment" (MCI-DS) as well as subsequent declines occurring with incident dementia. DISCUSSION Several instruments showed clear promise for use as outcome measures for future clinical trials and for informing diagnosis of individuals suspected of experiencing early signs and symptoms of a progressive dementia process.
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Affiliation(s)
- Sharon J Krinsky‐McHale
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Warren B. Zigman
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Joseph H. Lee
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversitySergievsky Center/Taub InstituteNew YorkNew YorkUSA
- Department of EpidemiologySchool of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Nicole Schupf
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversitySergievsky Center/Taub InstituteNew YorkNew YorkUSA
- Department of EpidemiologySchool of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Deborah Pang
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Tracy Listwan
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Cynthia Kovacs
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Wayne Silverman
- Department of EpidemiologySchool of Public HealthColumbia UniversityNew YorkNew YorkUSA
- University of CaliforniaIrvineCaliforniaUSA
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19
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Benejam B, Videla L, Vilaplana E, Barroeta I, Carmona‐Iragui M, Altuna M, Valldeneu S, Fernandez S, Giménez S, Iulita F, Garzón D, Bejanin A, Bartrés‐Faz D, Videla S, Alcolea D, Blesa R, Lleó A, Fortea J. Diagnosis of prodromal and Alzheimer's disease dementia in adults with Down syndrome using neuropsychological tests. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12047. [PMID: 32613076 PMCID: PMC7322242 DOI: 10.1002/dad2.12047] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION We aimed to define prodromal Alzheimer's disease (AD) and AD dementia using normative neuropsychological data in a large population-based cohort of adults with Down syndrome (DS). METHODS Cross-sectional study. DS participants were classified into asymptomatic, prodromal AD and AD dementia, based on neurologist's judgment blinded to neuropsychological data (Cambridge Cognitive Examination for Older Adults with Down's syndrome [CAMCOG-DS] and modified Cued Recall Test [mCRT]). We compared the cutoffs derived from the normative data in young adults with DS to those from receiver-operating characteristic curve (ROC) analysis. RESULTS Diagnostic performance of the CAMCOG-DS and modified Cued Recall Test (mCRT) in subjects with mild and moderate levels of intellectual disability (ID) was high, both for diagnosing prodromal AD and AD dementia (area under the curve [AUC] 0.73-0.83 and 0.90-1, respectively). The cutoffs derived from the normative data were similar to those derived from the ROC analyses. DISCUSSION Diagnosing prodromal AD and AD dementia in DS with mild and moderate ID using population norms for neuropsychological tests is possible with high diagnostic accuracy.
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Affiliation(s)
- Bessy Benejam
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
| | - Laura Videla
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Eduard Vilaplana
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Isabel Barroeta
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Maria Carmona‐Iragui
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Miren Altuna
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Silvia Valldeneu
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Susana Fernandez
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
| | - Sandra Giménez
- Multidisciplinary Sleep UnitRespiratory DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Florencia Iulita
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Diana Garzón
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Alexandre Bejanin
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - David Bartrés‐Faz
- Department of MedicineFaculty of Medicine and Health SciencesInstitute of neurosciencesUniversity of BarcelonaBarcelonaSpain
| | - Sebastià Videla
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Daniel Alcolea
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Rafael Blesa
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Alberto Lleó
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Juan Fortea
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau)Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
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O'Bryant SE, Zhang F, Silverman W, Lee JH, Krinsky‐McHale SJ, Pang D, Hall J, Schupf N. Proteomic profiles of incident mild cognitive impairment and Alzheimer's disease among adults with Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12033. [PMID: 32490140 PMCID: PMC7241058 DOI: 10.1002/dad2.12033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION We sought to determine if proteomic profiles could predict risk for incident mild cognitive impairment (MCI) and Alzheimer's disease (AD) among adults with Down syndrome (DS). METHODS In a cohort of 398 adults with DS, a total of n = 186 participants were determined to be non-demented and without MCI or AD at baseline and throughout follow-up; n = 103 had incident MCI and n = 81 had incident AD. Proteomics were conducted on banked plasma samples from a previously generated algorithm. RESULTS The proteomic profile was highly accurate in predicting incident MCI (area under the curve [AUC] = 0.92) and incident AD (AUC = 0.88). For MCI risk, the support vector machine (SVM)-based high/low cut-point yielded an adjusted hazard ratio (HR) = 6.46 (P < .001). For AD risk, the SVM-based high/low cut-point score yielded an adjusted HR = 8.4 (P < .001). DISCUSSION The current results provide support for our blood-based proteomic profile for predicting risk for MCI and AD among adults with DS.
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Affiliation(s)
- Sid E. O'Bryant
- Department of Pharmacology & Neuroscience I Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Fan Zhang
- Vermont Genetics NetworkUniversity of VermontBurlingtonVermontUSA
| | | | - Joseph H. Lee
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia UniversityNew YorkNew YorkUSA
- G.H. Sergievsky CenterColumbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyMailman School of Public Health Columbia UniversityNew YorkNew YorkUSA
| | - Sharon J. Krinsky‐McHale
- Department of PsychologyStaten IslandNYS Institute for Basic Research in Developmental DisabilitiesNew YorkNew YorkUSA
| | - Deborah Pang
- Department of PsychologyStaten IslandNYS Institute for Basic Research in Developmental DisabilitiesNew YorkNew YorkUSA
| | - James Hall
- Department of Pharmacology & Neuroscience I Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia UniversityNew YorkNew YorkUSA
- G.H. Sergievsky CenterColumbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyMailman School of Public Health Columbia UniversityNew YorkNew YorkUSA
- Departments of Neurology and PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
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21
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Keator DB, Phelan MJ, Taylor L, Doran E, Krinsky‐McHale S, Price J, Ballard EE, Kreisl WC, Hom C, Nguyen D, Pulsifer M, Lai F, Rosas DH, Brickman AM, Schupf N, Yassa MA, Silverman W, Lott IT. Down syndrome: Distribution of brain amyloid in mild cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12013. [PMID: 32435685 PMCID: PMC7233421 DOI: 10.1002/dad2.12013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Down syndrome (DS) is associated with a higher risk of dementia. We hypothesize that amyloid beta (Aβ) in specific brain regions differentiates mild cognitive impairment in DS (MCI-DS) and test these hypotheses using cross-sectional and longitudinal data. METHODS 18F-AV-45 (florbetapir) positron emission tomography (PET) data were collected to analyze amyloid burden in 58 participants clinically classified as cognitively stable (CS) or MCI-DS and 12 longitudinal CS participants. RESULTS The study confirmed our hypotheses of increased amyloid in inferior parietal, lateral occipital, and superior frontal regions as the main effects differentiating MCI-DS from the CS groups. The largest annualized amyloid increases in longitudinal CS data were in the rostral middle frontal, superior frontal, superior/middle temporal, and posterior cingulate cortices. DISCUSSION This study helps us to understand amyloid in the MCI-DS transitional state between cognitively stable aging and frank dementia in DS. The spatial distribution of Aβ may be a reliable indicator of MCI-DS in DS.
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Affiliation(s)
- David B. Keator
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | - Michael J. Phelan
- Institute for Memory Impairments and Neurological Disorders, UCIrvineCalifornia
| | - Lisa Taylor
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | - Eric Doran
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCalifornia
| | - Sharon Krinsky‐McHale
- New York State Institute for Basic Research in Developmental DisabilitiesNew YorkNew York
| | - Julie Price
- Massachusetts General HospitalHarvard UniversityBostonMassachusetts
| | - Erin E. Ballard
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | | | - Christy Hom
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | - Dana Nguyen
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
| | | | - Florence Lai
- Massachusetts General HospitalHarvard UniversityBostonMassachusetts
| | - Diana H. Rosas
- Massachusetts General HospitalHarvard UniversityBostonMassachusetts
| | - Adam M. Brickman
- Department of Neurology and of EpidemiologyColumbia UniversityNew YorkNew York
| | - Nicole Schupf
- Department of Neurology and of EpidemiologyColumbia UniversityNew YorkNew York
| | - Michael A. Yassa
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCalifornia
- Department of Neurobiology and Behavior and Center for the Neurobiology of Learning and MemoryUniversity of CaliforniaIrvineCalifornia
| | - Wayne Silverman
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCalifornia
| | - Ira T. Lott
- Department of PediatricsUniversity of CaliforniaIrvine Medical CenterOrangeCalifornia
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22
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Lu Z, Cogan L, McDermott S, Lauer E, Lindner S, Tracy K, Momany ET. Disparities in diabetes management among medicaid recipients with intellectual and developmental disabilities (IDD): Evidence from five U.S. states. Disabil Health J 2019; 13:100880. [PMID: 31870791 DOI: 10.1016/j.dhjo.2019.100880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Diabetes is one of the most common chronic conditions among adults. Little is known about the quality of diabetes care received by adults with intellectual and developmental disabilities (IDD). OBJECTIVE To determine the extent to which the diabetes care needs are met for a population with both IDD and diabetes who are solely insured by Medicaid in five states (Iowa, Massachusetts, New York, Oregon and South Carolina). METHODS Medicaid administrative data in 2012 were used to identify Medicaid members (excluding dual eligibles) with diabetes and IDD in five states. Four diabetes care measures were compared between members with and without IDD using bivariate analyses. For those with diabetes and IDD, a logistic regression model was fitted for each state with the following predictors: age, sex, IDD subgroup, and occurrence of a specialist visit in the current or past year. A meta-analysis was then conducted to synthesize cross-state results. RESULTS Across the five states, 6229 (2%) of the 308,804 non-dual adult Medicaid members 18-64 years old with diabetes in 2012 also had IDD. Comparing those with IDD to their non-IDD peers on receipt of all four diabetes care measures showed differences by state, but state rates of overall adherence were very low, ranging from 16.6% to 28.5% of the population. CONCLUSIONS Meta-analysis results identified specialist visits as a strong predictor of adults with diabetes and IDD receiving all four components of diabetes care. This important information should be considered in efforts to improve quality care for this population.
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Affiliation(s)
- Zengqi Lu
- New York State Department of Health, Empire State Plaza Corning Tower, Albany, NY, 12237, USA.
| | - Lindsay Cogan
- New York State Department of Health, Empire State Plaza Corning Tower, Albany, NY, 12237, USA; University at Albany State University of New York, School of Public Health Rensselaer, NY, 12144, USA.
| | - Suzanne McDermott
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Emily Lauer
- University of Massachusetts Medical School, Center for Developmental Disabilities Evaluation and Research, Charlestown, MA, 02129, USA.
| | - Stephan Lindner
- Oregon Health & Science University, Center for Health System Effectiveness, Portland, OR, 97239, USA.
| | - Kyle Tracy
- Oregon Health & Science University, Center for Health System Effectiveness, Portland, OR, 97239, USA.
| | - Elizabeth T Momany
- University of Iowa, Health Management and Policy, Iowa City, IA, 52242, USA.
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23
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Adaptation of the Clinical Dementia Rating Scale for adults with Down syndrome. J Neurodev Disord 2019; 11:39. [PMID: 31842726 PMCID: PMC6912998 DOI: 10.1186/s11689-019-9300-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022] Open
Abstract
Background Adults with Down syndrome (DS) are at increased risk for Alzheimer disease dementia, and there is a pressing need for the development of assessment instruments that differentiate chronic cognitive impairment, acute neuropsychiatric symptomatology, and dementia in this population of patients. Methods We adapted a widely used instrument, the Clinical Dementia Rating (CDR) Scale, which is a component of the Uniform Data Set used by all federally funded Alzheimer Disease Centers for use in adults with DS, and tested the instrument among 34 DS patients recruited from the community. The participants were assessed using two versions of the modified CDR—a caregiver questionnaire and an in-person interview involving both the caregiver and the DS adult. Assessment also included the Dementia Scale for Down Syndrome (DSDS) and the Raven’s Progressive Matrices to estimate IQ. Results Both modified questionnaire and interview instruments captured a range of cognitive impairments, a majority of which were found to be chronic when accounting for premorbid function. Two individuals in the sample were strongly suspected to have early dementia, both of whom had elevated scores on the modified CDR instruments. Among individuals rated as having no dementia based on the DSDS, about half showed subthreshold impairments on the modified CDR instruments; there was substantial agreement between caregiver questionnaire screening and in-person interview of caregivers and DS adults. Conclusions The modified questionnaire and interview instruments capture a range of impairment in DS adults, including subthreshold symptomatology, and the instruments provide complementary information relevant to the ascertainment of dementia in DS. Decline was seen across all cognitive domains and was generally positively related to age and negatively related to IQ. Most importantly, adjusting instrument scores for chronic, premorbid impairment drastically shifted the distribution toward lower (no impairment) scores.
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Laxative use among older adults with intellectual disability: a cross-sectional observational study. Int J Clin Pharm 2019; 42:89-99. [PMID: 31792735 DOI: 10.1007/s11096-019-00942-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/16/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Chronic constipation is a prevalent issue in older people with intellectual disabilities and may have a significant negative impact on quality of life. The use of laxatives have not been adequately studied in this population. OBJECTIVE To examine laxatives in relation to prevalence, pattern, dosage, reported indication and correlates. SETTING Older people with intellectual disabilities who live independently, in community group homes or residential care in Ireland. METHOD Data was extracted from wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Descriptive statistics, bivariate analyses and multiple logistic regression were carried out. Laxative use was analysed using two indicators for chronic constipation, reported doctor's diagnosis of constipation and Rome III criteria. MAIN OUTCOME MEASURE Laxative use. RESULTS Among the cohort n = 677, chronic constipation was reported by 38.5% (n = 257). In total 41.5% (n = 281) reported 431 laxatives (mean ± 1.53 ± 0.74), with 74.3% (n = 209) of those with laxative use reporting chronic constipation. There were 40% (n = 113) who took 2 + laxatives, within which, 60% (n = 67) were using a combination from same laxative class. Reporting chronic constipation, living in residential care, exposure to anticholinergics and receiving soft/liquidized food were significantly associated with laxative use. CONCLUSION Chronic constipation and laxative use were highly prevalent in this study of older adults with intellectual disabilities. The treatment of constipation appeared to be unsystematic. Intra-class laxative use was frequent. There is a need for evidence-based treatment guidelines developed especially for people with intellectual disabilities to provide effective, quality care.
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Fleming KK, Brady NC. Task and Participant Variables Predict Communication Complexity Scale (CCS) Scores: Closer Examination of the CCS. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:483-496. [PMID: 31756140 PMCID: PMC7384712 DOI: 10.1352/1944-7558-124.6.483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Communication Complexity Scale (CCS) scores for 269 minimally verbal participants were examined to determine if communicator behavior and task and communicator characteristics were related to scores in a manner consistent with theoretical and research evidence expectations. Each participant completed an interactive assessment with 6 joint attention tasks and 6 behavior regulation tasks. Caregivers completed the Vineland Adaptive Behavior Scales II. Results indicated (a) joint attention tasks yielded lower scores than behavior regulation tasks, (b) older participants had lower scores, (c) individuals with autism spectrum disorder scored more similarly than those without, (d) the difference between joint attention and behavior regulation scores was greater for the autism spectrum disorder group, and (e) adaptive behavior was significantly positively related to complexity scores.
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Affiliation(s)
- Kandace K. Fleming
- Research Design and Analysis Unit, The University of Kansas, The Schiefelbusch Institute for Life Span Studies, Lawrence
| | - Nancy C. Brady
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, The Schiefelbusch Institute for Life Span, Studies, Lawrence
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26
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García-Alba J, Ramírez-Toraño F, Esteba-Castillo S, Bruña R, Moldenhauer F, Novell R, Romero-Medina V, Maestú F, Fernández A. Neuropsychological and neurophysiological characterization of mild cognitive impairment and Alzheimer's disease in Down syndrome. Neurobiol Aging 2019; 84:70-79. [PMID: 31518951 DOI: 10.1016/j.neurobiolaging.2019.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
Down syndrome (DS) has been considered a unique model for the investigation of Alzheimer's disease (AD) but intermediate stages in the continuum are poorly defined. Considering this, we investigated the neurophysiological (i.e., magnetoencephalography [MEG]) and neuropsychological patterns of mild cognitive impairment (MCI) and AD in middle-aged adults with DS. The sample was composed of four groups: Control-DS (n = 14, mean age 44.64 ± 3.30 years), MCI-DS (n = 14, 51.64 ± 3.95 years), AD-DS (n = 13, 53.54 ± 6.58 years), and Control-no-DS (healthy controls, n = 14, 45.21 ± 4.39 years). DS individuals were studied with neuropsychological tests and MEG, whereas the Control-no-DS group completed only the MEG session. Our results showed that the AD-DS group exhibited a significantly poorer performance as compared with the Control-DS group in all tests. Furthermore, this effect was crucially evident in AD-DS individuals when compared with the MCI-DS group in verbal and working memory abilities. In the neurophysiological domain, the Control-DS group showed a widespread increase of theta activity when compared with the Control-no-DS group. With disease progression, this increased theta was substituted by an augmented delta, accompanied with a reduction of alpha activity. Such spectral pattern-specifically observed in occipital, posterior temporal, cuneus, and precuneus regions-correlated with the performance in cognitive tests. This is the first MEG study in the field incorporating both neuropsychological and neurophysiological information, and demonstrating that this combination of markers is sensitive enough to characterize different stages along the AD continuum in DS.
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Affiliation(s)
- Javier García-Alba
- Research and Psychology in Education Department, Complutense University of Madrid, Madrid, Spain; Center for Biomedical Technology, Laboratory of Cognitive and Computational Neuroscience, Technical University of Madrid, Campus Montegancedo, Madrid, Spain.
| | - Federico Ramírez-Toraño
- Center for Biomedical Technology, Laboratory of Cognitive and Computational Neuroscience, Technical University of Madrid, Campus Montegancedo, Madrid, Spain; Department of Experimental Psychology, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Madrid, Spain
| | - Susanna Esteba-Castillo
- Specialized Department in Mental Health and Intellectual Disability, Parc Hospitalari Martí i Julià - Institut d'Assistència Sanitària, Institut d'Assistència Sanitària (IAS), Girona, Spain; Neurodevelopment group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, Girona, Spain
| | - Ricardo Bruña
- Center for Biomedical Technology, Laboratory of Cognitive and Computational Neuroscience, Technical University of Madrid, Campus Montegancedo, Madrid, Spain; Department of Experimental Psychology, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Fernando Moldenhauer
- Internal Medicine Department, Adult Down Syndrome Unit, La Princesa University Hospital, Health Research Institute, Madrid, Spain
| | - Ramón Novell
- Specialized Department in Mental Health and Intellectual Disability, Parc Hospitalari Martí i Julià - Institut d'Assistència Sanitària, Institut d'Assistència Sanitària (IAS), Girona, Spain; Neurodevelopment group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, Girona, Spain
| | - Verónica Romero-Medina
- Center for Biomedical Technology, Laboratory of Cognitive and Computational Neuroscience, Technical University of Madrid, Campus Montegancedo, Madrid, Spain
| | - Fernando Maestú
- Center for Biomedical Technology, Laboratory of Cognitive and Computational Neuroscience, Technical University of Madrid, Campus Montegancedo, Madrid, Spain; Department of Experimental Psychology, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Alberto Fernández
- Center for Biomedical Technology, Laboratory of Cognitive and Computational Neuroscience, Technical University of Madrid, Campus Montegancedo, Madrid, Spain; Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Spain, Madrid, Spain
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27
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Fonseca LM, Mattar GP, Haddad GG, Gonçalves AS, Miguel ADQC, Guilhoto LM, Zaman S, Holland AJ, Bottino CMDC, Hoexter MQ. Frontal-subcortical behaviors during Alzheimer's disease in individuals with Down syndrome. Neurobiol Aging 2019; 78:186-194. [PMID: 30947114 DOI: 10.1016/j.neurobiolaging.2019.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/08/2019] [Accepted: 02/28/2019] [Indexed: 11/25/2022]
Abstract
There is evidence that frontal-subcortical circuits play an important role in the initial presentation of dementia in Down syndrome (DS), including changes in behavior, a decline in working memory and executive dysfunction. We evaluated 92 individuals with DS (≥30 years of age), divided into 3 groups by diagnosis-stable cognition, prodromal dementia, and Alzheimer's disease. Each individual was evaluated with an executive protocol developed for people with intellectual disabilities and was rated for behaviors related to frontal lobe dysfunction (disinhibition, executive dysfunction, and apathy) by an informant using the Frontal Systems Behavior Scale. Informant-reported behaviors related to frontal lobe dysfunction were found to correlate negatively with executive function performance. Disinhibition and executive dysfunction were associated with the clinical stage of dementia. The odds of having Alzheimer's disease increased in parallel with increases in the domain and total Frontal Systems Behavior Scale scores (p ≤ 0.5). Disinhibition, executive dysfunction and apathy should be taken into consideration during the clinical evaluation of adults with DS, and future studies should consider the intersection of neuropathology, brain connectivity, and behavior.
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Affiliation(s)
- Luciana Mascarenhas Fonseca
- Old Age Research Group, PROTER, Department and Institute of Psychiatry, University of São Paulo School of Medicine, FMUSP, São Paulo, Brazil; Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Guilherme Prado Mattar
- Old Age Research Group, PROTER, Department and Institute of Psychiatry, University of São Paulo School of Medicine, FMUSP, São Paulo, Brazil
| | - Glenda Guerra Haddad
- Old Age Research Group, PROTER, Department and Institute of Psychiatry, University of São Paulo School of Medicine, FMUSP, São Paulo, Brazil
| | - Aline Souza Gonçalves
- Laboratory of Neuroscience, LIM27, Department and Institute of Psychiatry, University of São Paulo School of Medicine, FMUSP, São Paulo, Brazil
| | | | - Laura Maria Guilhoto
- Association of Parents and Friends of Individuals with Intellectual Disability of São Paulo, São Paulo, Brazil; Department of Neurology and Neurosurgery, Federal University of Sao Paulo, São Paulo, Brazil
| | - Shahid Zaman
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anthony J Holland
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Cassio Machado de Campos Bottino
- Old Age Research Group, PROTER, Department and Institute of Psychiatry, University of São Paulo School of Medicine, FMUSP, São Paulo, Brazil
| | - Marcelo Queiroz Hoexter
- Obsessive-Compulsive Spectrum Disorders Program, PROTOC, Department and Institute of Psychiatry, University of São Paulo School of Medicine, FMUSP, São Paulo, Brazil
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28
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Down syndrome: Neurobiological alterations and therapeutic targets. Neurosci Biobehav Rev 2019; 98:234-255. [DOI: 10.1016/j.neubiorev.2019.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/12/2022]
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Abstract
Virtually all adults with Down syndrome (DS) show the neuropathological changes of Alzheimer disease (AD) by the age of 40 years. This association is partially due to overexpression of amyloid precursor protein, encoded by APP, as a result of the location of this gene on chromosome 21. Amyloid-β accumulates in the brain across the lifespan of people with DS, which provides a unique opportunity to understand the temporal progression of AD and the epigenetic factors that contribute to the age of dementia onset. This age dependency in the development of AD in DS can inform research into the presentation of AD in the general population, in whom a longitudinal perspective of the disease is not often available. Comparison of the risk profiles, biomarker profiles and genetic profiles of adults with DS with those of individuals with AD in the general population can help to determine common and distinct pathways as well as mechanisms underlying increased risk of dementia. This Review evaluates the similarities and differences between the pathological cascades and genetics underpinning DS and AD with the aim of providing a platform for common exploration of these disorders.
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Affiliation(s)
- Ira T Lott
- Department of Pediatrics and Neurology, School of Medicine, University of California, Irvine, CA, USA.
| | - Elizabeth Head
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
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Startin CM, Hamburg S, Hithersay R, Al-Janabi T, Mok KY, Hardy J, Strydom A. Cognitive markers of preclinical and prodromal Alzheimer's disease in Down syndrome. Alzheimers Dement 2019; 15:245-257. [PMID: 30503169 PMCID: PMC6374283 DOI: 10.1016/j.jalz.2018.08.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/01/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Down syndrome (DS) is associated with an almost universal development of Alzheimer's disease. Individuals with DS are therefore an important population for randomized controlled trials to prevent or delay cognitive decline, though it is essential to understand the time course of early cognitive changes. METHODS We conducted the largest cognitive study to date with 312 adults with DS to assess age-related and Alzheimer's disease-related cognitive changes during progression from preclinical to prodromal dementia, and prodromal to clinical dementia. RESULTS Changes in memory and attention measures were most sensitive to early decline. Resulting sample size calculations for randomized controlled trials to detect significant treatment effects to delay decline were modest. DISCUSSION Our findings address uncertainties around the development of randomized controlled trials to delay cognitive decline in DS. Such trials are essential to reduce the high burden of dementia in people with DS and could serve as proof-of-principle trials for some drug targets.
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Affiliation(s)
- Carla M Startin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Psychiatry, University College London, London, UK; The LonDownS Consortium, London, UK.
| | - Sarah Hamburg
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Psychiatry, University College London, London, UK; The LonDownS Consortium, London, UK
| | - Rosalyn Hithersay
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Psychiatry, University College London, London, UK; The LonDownS Consortium, London, UK
| | - Tamara Al-Janabi
- Division of Psychiatry, University College London, London, UK; The LonDownS Consortium, London, UK
| | - Kin Y Mok
- The LonDownS Consortium, London, UK; Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK; Division of Life Science, Hong Kong University of Science and Technology, Hong Kong SAR, People's Republic of China
| | - John Hardy
- The LonDownS Consortium, London, UK; Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK; Reta Lila Weston Institute, Institute of Neurology, University College London, London, UK
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Psychiatry, University College London, London, UK; The LonDownS Consortium, London, UK
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Zhu B, Jin LN, Shen JQ, Liu JF, Jiang RY, Yang L, Zhang J, Luo AL, Miao LY, Yang C. Differential expression of serum biomarkers in hemodialysis patients with mild cognitive decline: A prospective single-center cohort study. Sci Rep 2018; 8:12250. [PMID: 30115946 PMCID: PMC6095882 DOI: 10.1038/s41598-018-29760-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/18/2018] [Indexed: 12/21/2022] Open
Abstract
Studies suggest that hemodialysis patients are at a higher risk for cognitive decline than healthy individuals; however, underlying mechanisms have not been fully elucidated. We aimed to investigate the roles of serum biomarkers, such as brain-derived neurotrophic factor (BDNF), inflammatory cytokines, fibroblast growth factor (FGF)-23 and its co-receptor α-klotho and platelet (PLT) count in mild cognitive decline (MCD) of patients undergoing hemodialysis in this prospective cohort study. Serum levels of BDNF, tumour necrosis factor (TNF)-α, interleukin (IL)-6 and the number of PLT were significantly altered in the MCD group compared with those in healthy controls (HCs) or those with normal cognitive function (NCF). Although serum α-klotho and FGF-23 levels were significantly altered in the MCD group, there were no statistical differences between the MCD and NCF groups. Serum BDNF levels and PLT counts were significantly correlated with cognitive test scores. Receiver operating characteristic (ROC) curves demonstrated that BDNF and PLT were potential biomarkers for improved MCD diagnosis in patients with hemodialysis. These findings suggest that hemodialysis-related MCD is associated with altered BDNF, TNF-α and IL-6 levels as well as PLT counts and that serum BDNF levels and PLT counts are potential biomarkers for hemodialysis-related MCD diagnosis.
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Affiliation(s)
- Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Li-Na Jin
- The Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jian-Qin Shen
- The Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jin-Feng Liu
- The Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ri-Yue Jiang
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ling Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jie Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ai-Lin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li-Ying Miao
- The Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Chun Yang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Carvalho CL, Belan AFR, Castro LRD, Radanovic M. Analysis of the linguistic profile in down syndrome using the arizona battery for communication disorders of dementia - a pilot study. Codas 2018. [PMID: 29538492 DOI: 10.1590/2317-1782/20182017164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To characterize the linguistic profile of adults and elderly with Down Syndrome (DS) using the Arizona Battery for Communication Disorders of Dementia (ABCD). METHODS Thirty adult individuals with DS were evaluated through the MoCA cognitive battery, four functional scales (Pfeffer, Lawton-IADL, Katz-IADL and IQCODE) and the ABCD battery, which evaluates Mental State, Episodic Memory, Linguistic Expression, Linguistic Comprehension and Visuospatial Construction. The scores obtained by the individuals in the ABCD were correlated to those obtained on the Lawton-IADL scale. RESULTS Individuals with DS had significantly lower performance than cognitively normal adults and elderly as described in Brazilian studies. Due to the lack of similar studies in our country, we compared our results to those of elderly with Alzheimer's Disease (AD), verifying that the performance of the DS population is similar to that of AD patients, although the former presented better scores on episodic immediate memory tests. There was a significant positive correlation between the scores obtained in the Lawton-IADL and those on the constructs Mental State, Episodic Memory, Linguistic Comprehension and Total ABCD. CONCLUSION The ABCD battery is a useful tool in the evaluation of adults and elderly with DS and the performance of individuals in this battery correlates with indices of functionality. This is a pioneer study in Brazil, and it points to the need for a better characterization of the linguistic abilities of individuals with DS, in order to allow the elaboration of strategies that stimulate their communicative abilities as to promote greater social insertion for this population.
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Affiliation(s)
- Cláudia Lopes Carvalho
- Departamento de Envelhecimento, Associação de Pais e Amigos dos Excepcionais - APAE - São Paulo (SP), Brazil
| | | | - Leila Regina de Castro
- Departamento de Envelhecimento, Associação de Pais e Amigos dos Excepcionais - APAE - São Paulo (SP), Brazil
| | - Márcia Radanovic
- Departamento de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo - USP - São Paulo (SP), Brazil
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Fenoll R, Pujol J, Esteba-Castillo S, de Sola S, Ribas-Vidal N, García-Alba J, Sánchez-Benavides G, Martínez-Vilavella G, Deus J, Dierssen M, Novell-Alsina R, de la Torre R. Anomalous White Matter Structure and the Effect of Age in Down Syndrome Patients. J Alzheimers Dis 2018; 57:61-70. [PMID: 28222523 DOI: 10.3233/jad-161112] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Neural tissue alterations in Down syndrome are fully expressed at relatively late developmental stages. In addition, there is an early presence of neurodegenerative changes in the late life stages. OBJECTIVE The aims of this study were both to characterize white matter abnormalities in the brain of adult Down syndrome patients using diffusion tensor imaging (DTI) and to investigate whether degenerative alterations in white matter structure are detectable before dementia is clinically evident. METHODS Forty-five adult non-demented Down syndrome patients showing a wide age range (18-52 years) and a matched 45-subject control group were assessed. DTI fractional anisotropy (FA) brain maps were generated and selected cognitive tests were administered. RESULTS Compared with healthy controls, non-demented Down syndrome patients showed lower DTI FA in white matter involving the major pathways, but with more severe alterations in the frontal-subcortical circuits. White matter FA decreased with age at a similar rate in both DS and control groups. CONCLUSIONS Our results contribute to characterizing the expression of white matter structural alterations in adult Down syndrome. However, an accelerated aging effect was not demonstrated, which may suggest that the FA measurements used are not sufficiently sensitive or, alternatively, age-related white matter neurodegeneration is not obvious prior to overt clinical dementia.
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Affiliation(s)
- Raquel Fenoll
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | - Susanna Esteba-Castillo
- Specialized Department in Mental Health and Intellectual Disability, Institut d'Assistència Sanitària (IAS), Girona, Catalonia, Spain
| | - Susana de Sola
- Integrative Pharmacology and Neuroscience Systems Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Cellular & Systems Neurobiology, Centre for Genomic Regulation (CRG), Barcelona, Spain
| | - Núria Ribas-Vidal
- Specialized Department in Mental Health and Intellectual Disability, Institut d'Assistència Sanitària (IAS), Girona, Catalonia, Spain
| | - Javier García-Alba
- Specialized Department in Mental Health and Intellectual Disability, Institut d'Assistència Sanitària (IAS), Girona, Catalonia, Spain
| | - Gonzalo Sánchez-Benavides
- Integrative Pharmacology and Neuroscience Systems Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Gerard Martínez-Vilavella
- Integrative Pharmacology and Neuroscience Systems Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Department of Clinical and Health Psychology, Autonomous University of Barcelona, Spain
| | - Mara Dierssen
- Cellular & Systems Neurobiology, Centre for Genomic Regulation (CRG), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Ramón Novell-Alsina
- Cellular & Systems Neurobiology, Centre for Genomic Regulation (CRG), Barcelona, Spain
| | - Rafael de la Torre
- Integrative Pharmacology and Neuroscience Systems Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department de Ciències Experimentals i de la Salut Universitat Pompeu Fabra (CEXS-UPF), Barcelona, Spain
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A longitudinal study of brain anatomy changes preceding dementia in Down syndrome. NEUROIMAGE-CLINICAL 2018; 18:160-166. [PMID: 29868444 PMCID: PMC5984600 DOI: 10.1016/j.nicl.2018.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/18/2017] [Accepted: 01/18/2018] [Indexed: 12/21/2022]
Abstract
Background We longitudinally assessed Down syndrome individuals at the age of risk of developing dementia to measure changes in brain anatomy and their relationship to cognitive impairment progression. Methods Forty-two Down syndrome individuals were initially included, of whom 27 (mean age 46.8 years) were evaluable on the basis of completing the 2-year follow-up and success in obtaining good quality MRI exams. Voxel-based morphometry was used to estimate regional brain volumes at baseline and follow-up on 3D anatomical images. Longitudinal volume changes for the group and their relationship with change in general cognitive status and specific cognitive domains were mapped. Results As a group, significant volume reduction was identified in the substantia innominata region of the basal forebrain, hippocampus, lateral temporal cortex and left arcuate fasciculus. Volume reduction in the substantia innominata and hippocampus was more prominent in individuals whose clinical status changed from cognitively stable to mild cognitive impairment or dementia during the follow-up. Relevantly, longitudinal memory score change was specifically associated with volume change in the hippocampus, prospective memory with prefrontal lobe and verbal comprehension with language-related brain areas. Conclusions Results are notably concordant with the well-established anatomical changes signaling the progression to dementia in Alzheimer's disease, despite the dense baseline pathology that developmentally accumulates in Down syndrome. This commonality supports the potential value of Down syndrome as a genetic model of Alzheimer's neurodegeneration and may serve to further support the view that Down syndrome patients are best candidates to benefit from treatment research in Alzheimer's disease.
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Hamlett ED, Ledreux A, Potter H, Chial HJ, Patterson D, Espinosa JM, Bettcher BM, Granholm AC. Exosomal biomarkers in Down syndrome and Alzheimer's disease. Free Radic Biol Med 2018; 114:110-121. [PMID: 28882786 PMCID: PMC6135098 DOI: 10.1016/j.freeradbiomed.2017.08.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
Every person with Down syndrome (DS) has the characteristic features of Alzheimer's disease (AD) neuropathology in their brain by the age of forty, and most go on to develop AD dementia. Since people with DS show highly variable levels of baseline function, it is often difficult to identify early signs of dementia in this population. The discovery of blood biomarkers predictive of dementia onset and/or progression in DS is critical for developing effective clinical diagnostics. Our recent studies show that neuron-derived exosomes, which are small extracellular vesicles secreted by most cells in the body, contain elevated levels of amyloid-beta peptides and phosphorylated-Tau that could indicate a preclinical AD phase in people with DS starting in childhood. We also found that the relative levels of these biomarkers were altered following dementia onset. Exosome release and signaling are dependent on cellular redox homeostasis as well as on inflammatory processes, and exosomes may be involved in the immune response, suggesting a dual role as both triggers of inflammation in the brain and propagators of inflammatory signals between brain regions. Based on recently reported connections between inflammatory processes and exosome release, the elevated neuroinflammatory state observed in people with DS may affect exosomal AD biomarkers. Herein, we discuss findings from studies of people with DS, people with DS and AD (DS-AD), and mouse models of DS showing new connections between neuroinflammatory pathways, oxidative stress, exosomes, and exosome-mediated signaling, which may inform future AD diagnostics, preventions, and treatments in the DS population as well as in the general population.
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Affiliation(s)
- Eric D Hamlett
- Knoebel Institute for Healthy Aging and the Department of Biological Sciences, University of Denver, Denver, CO, USA; Medical University of South Carolina, Charleston, SC, USA
| | - Aurélie Ledreux
- Knoebel Institute for Healthy Aging and the Department of Biological Sciences, University of Denver, Denver, CO, USA
| | - Huntington Potter
- Rocky Mountain Alzheimer's Disease Center, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Heidi J Chial
- Rocky Mountain Alzheimer's Disease Center, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - David Patterson
- Knoebel Institute for Healthy Aging and the Department of Biological Sciences, University of Denver, Denver, CO, USA
| | - Joaquin M Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Department of Pharmacology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Brianne M Bettcher
- Rocky Mountain Alzheimer's Disease Center, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Denver, CO, USA; Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Ann-Charlotte Granholm
- Knoebel Institute for Healthy Aging and the Department of Biological Sciences, University of Denver, Denver, CO, USA; Medical University of South Carolina, Charleston, SC, USA.
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Jenkins EC, Marchi EJ, Velinov MT, Ye L, Krinsky-McHale SJ, Zigman WB, Schupf N, Silverman WP. Longitudinal telomere shortening and early Alzheimer's disease progression in adults with down syndrome. Am J Med Genet B Neuropsychiatr Genet 2017; 174:772-778. [PMID: 28856789 DOI: 10.1002/ajmg.b.32575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Abstract
Telomere shortening was shown to parallel Alzheimer's disease (AD) associated dementia. By using a dual PNA Probe system we have developed a practical method for comparing telomere length in T-lymphocyte interphases from individuals with Down syndrome (DS) with and without "mild cognitive impairment" (MCI-DS) and demonstrated that telomere length can serve as a valid biomarker for the onset of MCI-DS in this high-risk population. To verify progressive cognitive decline we have now examined sequential changes in telomere length in 10 adults with DS (N = 4 Female, N = 6 Male) developing MCI-DS. Cases were selected blind to telomere length from a sample of adults with DS previously enrolled in a prospective longitudinal study at 18-month intervals with clinical and telomere assessments: (1) MCI-DS group data were collected approximately three years prior to development of MCI-DS; (2) 18 months later; (3) when MCI-DS was first observed. These telomere measures were compared to those from another 10 adults with DS matched by sex and approximate age but without indications of MCI-DS (Controls). PNA (peptide nucleic acid) probes for telomeres together with a chromosome two centromere probe were used. Findings indicated telomere shortening over time for both Cases and Controls. Group differences emerged by 18-months prior to recognition of MCI-DS onset and completely non-overlapping distributions of telomere measures were observed by the time of MCI-DS onset. This study adds to accumulating evidence of the value of telomere length, as an early biomarker of AD progression in adults with Down syndrome.
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Affiliation(s)
- Edmund C Jenkins
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Elaine J Marchi
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Milen T Velinov
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Lingling Ye
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Sharon J Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York.,Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, New York
| | - Warren B Zigman
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Nicole Schupf
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York.,Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, New York
| | - Wayne P Silverman
- The Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland
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Janicki MP, McCallion P, Splaine M, Santos FH, Keller SM, Watchman K. Consensus Statement of the International Summit on Intellectual Disability and Dementia Related to Nomenclature. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 55:338-346. [PMID: 28972868 DOI: 10.1352/1934-9556-55.5.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A working group of the 2016 International Summit on Intellectual Disability and Dementia was charged to examine the terminology used to define and report on dementia in publications related to intellectual disability (ID). A review of related publications showed mixed uses of terms associated with dementia or causative diseases. As with dementia research in the non-ID population, language related to dementia in the ID field often lacks precision and could lead to a misunderstanding of the condition(s) under discussion, an increasingly crucial issue given the increased global attention dementia is receiving in that field. Most articles related to ID and dementia reporting clinical or medical research generally provide a structured definition of dementia or related terms; social care articles tend toward term use without definition. Toward terminology standardization within studies/reports on dementia and ID, the Summit recommended that a consistent approach is taken that ensures (a) growing familiarity with dementia-related diagnostic, condition-specific, and social care terms (as identified in the working group's report); (b) creating a guidance document on accurately defining and presenting information about individuals or groups referenced; and
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Affiliation(s)
| | | | | | | | - Seth M Keller
- Seth M. Keller, American Academy of Developmental Medicine and Dentistry, Lumberton, NJ; and
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Esbensen AJ, Hooper SR, Fidler D, Hartley S, Edgin J, d’Ardhuy XL, Capone G, Conners F, Mervis CB, Abbeduto L, Rafii M, Krinsky-McHale SJ, Urv T. Outcome Measures for Clinical Trials in Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:247-281. [PMID: 28452584 PMCID: PMC5424621 DOI: 10.1352/1944-7558-122.3.247] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard Abbeduto
- MIND Institute, University of California, Davis School of Medicine
| | | | | | - Tiina Urv
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
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Jenkins EC, Ye L, Marchi E, Krinsky-McHale SJ, Zigman WB, Schupf N, Silverman WP. An improved method for detecting telomere size differences in T-lymphocyte interphases from older people with Down syndrome with and without mild cognitive impairment. Biol Methods Protoc 2017; 2:bpx005. [PMID: 32161788 PMCID: PMC6994080 DOI: 10.1093/biomethods/bpx005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/13/2017] [Accepted: 03/28/2017] [Indexed: 11/12/2022] Open
Abstract
Telomere size (quantified by fluorescence intensity and physical lengths) in short-term T-lymphocyte cultures from adults with Down syndrome (DS) with and without mild cognitive impairment (MCI-DS) or dementia was compared. For these studies, dementia status was determined based on longitudinal assessments employing a battery of cognitive and functional assessments developed to distinguish adult-onset impairment from preexisting developmental disability. In the course of our studies using a MetaSystems Image Analyzer in combination with ISIS software and a Zeiss Axioskop 2, we found that Fluorescein isothiocyanate (FITC) telomere fluorescence referenced to chromosome 2-identified FITC probe fluorescence as a nontelomere standard (telomere/cen2 ratio) showed great promise as a biomarker of early decline associated with Alzheimer's disease (AD) in this high-risk population. We have now obtained a cen (2) CY3 probe that can clearly be distinguished from the blue-green FITC interphase telomere probe, providing a clear distinction between telomere and centromere fluorescence in both interphase and metaphase. We used FITC/CY3 light intensity ratios to compare telomere length in interphases in adults with DS with and without MCI-DS or dementia. Five age-matched female and five age-matched male pairs (n = 10) all showed clear evidence of telomere shortening associated with clinical progression of AD (P < 0.002 - P < 0.000001), with distributions of mean values for cases and controls showing no overlap. We also examined the time needed for microscopy using interphase versus metaphase fluorescence preparations. With interphase preparations, examination time was reduced by an order of magnitude compared with metaphase preparations, indicating that the methods employed herein have considerable practical promise for translation into broad diagnostic practice.
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Affiliation(s)
- E. C. Jenkins
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, 10314 NY, USA
| | - L. Ye
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, 10314 NY, USA
| | - E. Marchi
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, 10314 NY, USA
| | - S. J. Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, 10314 NY, USA
| | - W. B. Zigman
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, 10314 NY, USA
| | - N. Schupf
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, 10314 NY, USA
- Taub Institute for Alzheimer’s Disease and Aging Research, Columbia University, New York, 10032 NY, USA
| | - W. P. Silverman
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, 21205 MD, USA
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Axmon A, Karlsson B, Ahlström G. Health care utilisation among older persons with intellectual disability and dementia: a registry study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:1165-1177. [PMID: 27730719 DOI: 10.1111/jir.12338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/18/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Both persons with intellectual disability (ID) and persons with dementia have high disease burdens, and consequently also high health care needs. As life expectancy increases for persons with ID, the group of persons with the dual diagnosis of ID and dementia will become larger. METHOD Through national registries, we identified 7936 persons who had received support directed to persons with ID during 2012, and an age- and gender-matched sample from the general population. A national registry was also used to collect information on health care utilisation (excluding primary care) for the period 2002-2012. Health care utilisation was measured as presence and number of planned and unplanned in-patient and out-patient visits, as well as length of stay. RESULTS In comparison with persons with ID but without dementia, persons with ID and dementia were more likely to have at least one planned out-patient visit (odds ratio [OR] 8.07), unplanned out-patient visit (OR 2.41), planned in-patient visit (OR 2.76) or unplanned in-patient visit (OR 4.19). However, among those with at least one of each respective outcome, the average number of visits did not differ between those with and without dementia. Persons with ID and dementia were less likely to have at least one planned out-patient visit than persons with dementia in the general population sample (OR 0.40), but more likely to have at least one unplanned in-patient visit (OR 1.90). No statistically significant differences were found for having at least one unplanned out-patient or planned in-patient visit. Nevertheless, among those with at least one unplanned out-patient visit, the number of visits was higher in the general population sample. CONCLUSIONS Persons with ID and dementia are less likely to receive planned health care than persons with dementia in the general population. They have, however, higher levels of unplanned health care utilisation. This may be an indication that the current support system is not sufficient to meet the challenges of increased longevity among persons with ID.
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Affiliation(s)
- A Axmon
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - B Karlsson
- Healthcare and medical services, County Council, Uppsala, Sweden
| | - G Ahlström
- Department of Health Sciences, Lund University, Lund, Sweden
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Elliott-King J, Shaw S, Bandelow S, Devshi R, Kassam S, Hogervorst E. A critical literature review of the effectiveness of various instruments in the diagnosis of dementia in adults with intellectual disabilities. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 4:126-148. [PMID: 27752536 PMCID: PMC5061450 DOI: 10.1016/j.dadm.2016.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Currently, there is no consensus on dementia diagnostics in adults with intellectual disabilities (ID). There are three types of assessments available: direct cognitive tests, test batteries, and informant reports. Methods A systematic literature search was conducted in four databases yielding 9840 records. Relevant studies were identified and selected using predefined inclusion and exclusion criteria and then coded and classified according to assessment type. This was completed by two independent researchers, with a third consulted when discrepancies arose. The review collates diagnostic instruments and presents strengths and weaknesses. Results Overall 47 studies met the search criteria, and 43 instruments were extracted from the selected studies. Of which, 10 instruments were classified as test batteries, 23 were classified as direct cognitive tests, and the remaining 10 were informant reports. Discussion This review can recommend that cognitive test batteries can offer the most practical and efficient method for dementia diagnosis in individuals with ID.
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Affiliation(s)
- Jordan Elliott-King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Sarah Shaw
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Stephan Bandelow
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rajal Devshi
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Shelina Kassam
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Eef Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Jenkins EC, Ye L, Krinsky-McHale SJ, Zigman WB, Schupf N, Silverman WP. Telomere longitudinal shortening as a biomarker for dementia status of adults with Down syndrome. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:169-74. [PMID: 26593971 DOI: 10.1002/ajmg.b.32389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/28/2015] [Indexed: 01/22/2023]
Abstract
Previous studies have suggested that Alzheimer's disease (AD) causes an accelerated shortening of telomeres, the ends of chromosomes consisting of highly conserved TTAGGG repeats that, because of unidirectional 5'-3' DNA synthesis, lose end point material with each cell division. Our own previous work suggested that telomere length of T-lymphocytes might be a remarkably accurate biomarker for "mild cognitive impairment" in adults with Down syndrome (MCI-DS), a population at dramatically high risk for AD. To verify that the progression of cognitive and functional losses due to AD produced this observed telomere shortening, we have now examined sequential changes in telomere length in five individuals with Down syndrome (3F, 2M) as they transitioned from preclinical AD to MCI-DS (N = 4) or dementia (N = 1). As in our previous studies, we used PNA (peptide nucleic acid) probes for telomeres and the chromosome 2 centromere (as an "internal standard" expected to be unaffected by aging or dementia status), with samples from the same individuals now collected prior to and following development of MCI-DS or dementia. Consistent shortening of telomere length was observed over time. Further comparisons with our previous cross-sectional findings indicated that telomere lengths prior to clinical decline were similar to those of other adults with Down syndrome (DS) who have not experienced clinical decline while telomere lengths following transition to MCI-DS or dementia in the current study were comparable to those of other adults with DS who have developed MCI-DS or dementia. Taken together, findings indicate that telomere length has significant promise as a biomarker of clinical progression of AD for adults with DS, and further longitudinal studies of a larger sample of individuals with DS are clearly warranted to validate these findings and determine if and how factors affecting AD risk also influence these measures of telomere length.
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Affiliation(s)
- Edmund C Jenkins
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Lingling Ye
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Sharon J Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Warren B Zigman
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Nicole Schupf
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York
| | - Wayne P Silverman
- The Kennedy Krieger Institute and The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cerebrovascular contributions to aging and Alzheimer's disease in Down syndrome. Biochim Biophys Acta Mol Basis Dis 2015; 1862:909-14. [PMID: 26593849 DOI: 10.1016/j.bbadis.2015.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/22/2022]
Abstract
Down syndrome (DS) is a common cause of intellectual disability and is also associated with early age of onset of Alzheimer's disease (AD). Due to an extra copy of chromosome 21, most adults over 40years old with DS have beta-amyloid plaques as a result of overexpression of the amyloid precursor protein. Cerebrovascular pathology may also be a significant contributor to neuropathology observed in the brains of adults with DS. This review describes the features of cardiovascular dysfunction and cerebrovascular pathology in DS that may be modifiable risk factors and thus targets for interventions. We will describe cerebrovascular pathology, the role of co-morbidities, imaging studies indicating vascular pathology and the possible consequences. It is clear that our understanding of aging and AD in people with DS will benefit from further studies to determine the role that cerebrovascular dysfunction contributes to cognitive health. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Walsh DM, Doran E, Silverman W, Tournay A, Movsesyan N, Lott IT. Rapid assessment of cognitive function in down syndrome across intellectual level and dementia status. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:1071-9. [PMID: 26031550 PMCID: PMC4623954 DOI: 10.1111/jir.12200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 03/10/2015] [Accepted: 04/14/2015] [Indexed: 05/13/2023]
Abstract
BACKGROUND Adults with Down syndrome (DS) are at risk of developing dementia and cognitive assessment is a fundamental part of the diagnostic process. Previously, we developed a Rapid Assessment for Developmental Disabilities (RADD), a brief, broadly focused direct test of cognition. In the current report, we assess whether the RADD is sensitive to dementia in DS and the degree to which it compares with other cognitive measures of dementia in this population. METHODS In a sample of 114 individuals with DS, with dementia diagnosed in 62%, the RADD was compared with the Dementia Questionnaire for Mentally Retarded Persons (DMR), the Bristol Activities of Daily Living Scale, Severe Impairment Battery (SIB), and the Brief Praxis Test (BPT). RESULTS The RADD showed predicted effects across intellectual disability (ID) levels and dementia status (p < 0.001). Six-month test-retest reliability for the subset of individuals without dementia was high (r(41) = 0.95, p < 0.001). Criterion-referenced validity was demonstrated by correlations between RADD scores and ID levels based upon prior intelligence testing and clinical diagnoses (rs (114) = 0.67, p = 0.001) and with other measures of cognitive skills, such as the BPT, SIB, and DMR-Sum of Cognitive scores (range 0.84 through 0.92). Using receiver operating characteristic curves for groups varying in pre-morbid severity of ID, the RADD exhibited high sensitivity (0.87) and specificity (0.81) in discriminating among individuals with and without dementia, although sensitivity was somewhat lower (0.73) for the subsample of dementia cases diagnosed no more than 2 years prior to their RADD assessment. CONCLUSION Taken together, findings indicated that the RADD, a relatively brief, easy-to-administer test for cognitive function assessment across ID levels and dementia status, would be a useful component of cognitive assessments for adults with DS, including assessments explicitly focused on dementia.
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Affiliation(s)
- D M Walsh
- Departments of Psychiatry and Human Behavior, University of California - Irvine, Irvine, CA, USA
| | - E Doran
- Pediatrics, University of California - Irvine, Irvine, CA, USA
| | - W Silverman
- Kennedy-Krieger Institute, School of Medicine, John Hopkins University, Baltimore, MD, USA
| | - A Tournay
- Pediatrics, University of California - Irvine, Irvine, CA, USA
| | - N Movsesyan
- Pediatrics, University of California - Irvine, Irvine, CA, USA
| | - I T Lott
- Pediatrics, University of California - Irvine, Irvine, CA, USA
- Neurology, School of Medicine, University of California - Irvine, Irvine, CA, USA
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Benejam B, Fortea J, Molina-López R, Videla S. Patterns of Performance on the Modified Cued Recall Test in Spanish Adults With Down Syndrome With and Without Dementia. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015; 120:481-489. [PMID: 26505869 DOI: 10.1352/1944-7558-120.6.481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The assessment of memory decline in people with intellectual disability (ID) is more difficult than in the general population, due to a lack of appropriate instruments and to preexisting cognitive impairment. The aim of this study was to describe performance of healthy adults with Down syndrome (healthy-DS; prospectively cohort) on a Spanish version of the modified Cued Recall Test (mCRT). We also recruited retrospectively a cohort of DS subjects with Dementia of the Alzheimer's Type (DS-DAT). Healthy-DS obtained higher scores on free recall and total score than DS-DAT. Age was the main factor associated with decreasing mCRT scores. The mCRT was useful in DS subjects with ID at the upper end of the spectrum or ID in the middle range of the spectrum, and discriminated well between DS subjects with and without DAT.
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Affiliation(s)
- Bessy Benejam
- Bessy Benejam, Down Medical Centre (CMD), Catalan Down Syndrome Foundation (FCSD), Barcelona, Spain
| | - Juan Fortea
- Juan Fortea, Down Medical Centre (CMD), Catalan Down Syndrome Foundation (FCSD), Barcelona, Spain; Memory Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona
| | - Rafael Molina-López
- Rafael Molina-López, Clinical Research, Catalan Down Syndrome Foundation, Barcelona, Spain; and
| | - Sebastià Videla
- Sebastià Videla, Clinical Research, Catalan Down Syndrome Foundation (FCSD), Barcelona, Spain; Department of Experimental and Health Sciences, Faculty of Health and Life Sciences, Universitat Pompeu Fabra
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Salem LC, Sabers A, Kjaer TW, Musaeus C, Nielsen MN, Nielsen AG, Waldemar G. Quantitative Electroencephalography as a Diagnostic Tool for Alzheimer's Dementia in Adults with Down Syndrome. Dement Geriatr Cogn Dis Extra 2015; 5:404-13. [PMID: 26628899 PMCID: PMC4662295 DOI: 10.1159/000438857] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/20/2015] [Indexed: 12/29/2022] Open
Abstract
Background Assessment of dementia in individuals with intellectual disability is complex due to great inter-individual variability in cognitive function prior to dementia and a lack of standardized instruments. Studies have indicated that quantitative electroencephalography (qEEG) results may be used as a diagnostic marker for dementia. The aim of this study was to examine the value of qEEG in the diagnostic evaluation of dementia in patients with Down syndrome (DS). Method The study included 21 patients with DS and mild-to-moderate dementia due to Alzheimer's disease (DS-AD) and 16 age-matched adults with DS without cognitive deterioration assessed by the informant-based Dementia Screening Questionnaire in Intellectual Disability (DSQIID). Conventional EEG was performed and analysed quantitatively using fast Fourier transformation. Outcomes were centroid frequency, peak frequency, absolute power, and relative power. Results In several regions of the brain, a significant decrease in the theta-1 band (4-7 Hz) was identified for the centroid frequency. A significant negative correlation was demonstrated between the mean of the centroid frequency of the theta-1 band and the total DSQIID score. Conclusion We found that qEEG can detect a significant decrease in centroid frequency in a sample of patients with DS-AD as compared to a sample of adults with DS and no cognitive deterioration.
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Affiliation(s)
- Lise Cronberg Salem
- Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Anne Sabers
- Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Troels W Kjaer
- Neurophysiology Center, Roskilde University Hospital, Roskilde, Denmark
| | - Christian Musaeus
- Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin N Nielsen
- Department of Clinical Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Gunhild Waldemar
- Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
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Makary AT, Testa R, Tonge BJ, Einfeld SL, Mohr C, Gray KM. Association between adaptive behaviour and age in adults with Down syndrome without dementia: examining the range and severity of adaptive behaviour problems. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:689-702. [PMID: 25414060 DOI: 10.1111/jir.12172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Studies on adaptive behaviour and ageing in adults with Down syndrome (DS) (without dementia) have typically analysed age-related change in terms of the total item scores on questionnaires. This research extends the literature by investigating whether the age-related changes in adaptive abilities could be differentially attributed to changes in the number or severity (intensity) of behavioural questionnaire items endorsed. METHODS The Adaptive Behaviour Assessment System-II Adult (ABAS-II Adult) was completed by parents and caregivers of 53 adults with DS aged between 16 and 56 years. Twenty adults with DS and their parents/caregivers were a part of a longitudinal study, which provided two time points of data. In addition 33 adults with DS and their parents/caregivers from a cross-sectional study were included. Random effects regression analyses were used to examine the patterns in item scores associated with ageing. RESULTS Increasing age was found to be significantly associated with lower adaptive behaviour abilities for all the adaptive behaviour composite scores, expect for the practical composite. These associations were entirely related to fewer ABAS-II Adult items being selected as present for the older participants, as opposed to the scores being attributable to lower item severity. CONCLUSIONS This study provides evidence for a differential pattern of age-related change for various adaptive behaviour skills in terms of range, but not severity. Possible reasons for this pattern will be discussed. Overall, these findings suggest that adults with DS may benefit from additional support in terms of their social and conceptual abilities as they age.
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Affiliation(s)
- A T Makary
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - R Testa
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - B J Tonge
- Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia
| | - S L Einfeld
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - C Mohr
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - K M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
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Grieco J, Pulsifer M, Seligsohn K, Skotko B, Schwartz A. Down syndrome: Cognitive and behavioral functioning across the lifespan. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2015; 169:135-49. [DOI: 10.1002/ajmg.c.31439] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
OBJECTIVE The main aim of this case series report is to alert physicians to the occurrence of catatonia in Down syndrome (DS). A second aim is to stimulate the study of regression in DS and of catatonia. A subset of individuals with DS is noted to experience unexplained regression in behavior, mood, activities of daily living, motor activities, and intellectual functioning during adolescence or young adulthood. Depression, early onset Alzheimer's, or just "the Down syndrome" are often blamed after general medical causes have been ruled out. Clinicians are generally unaware that catatonia, which can cause these symptoms, may occur in DS. STUDY DESIGN Four DS adolescents who experienced regression are reported. Laboratory tests intended to rule out causes of motor and cognitive regression were within normal limits. Based on the presence of multiple motor disturbances (slowing and/or increased motor activity, grimacing, posturing), the individuals were diagnosed with unspecified catatonia and treated with anti-catatonic treatments (benzodiazepines and electroconvulsive therapy [ECT]). RESULTS All four cases were treated with a benzodiazepine combined with ECT and recovered their baseline functioning. CONCLUSION We suspect catatonia is a common cause of unexplained deterioration in adolescents and young adults with DS. Moreover, pediatricians and others who care for individuals with DS are generally unfamiliar with the catatonia diagnosis outside schizophrenia, resulting in misdiagnosis and years of morbidity. Alerting physicians to catatonia in DS is essential to prompt diagnosis, appropriate treatment, and identification of the frequency and course of this disorder.
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Affiliation(s)
- Neera Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Armin Nassiri
- Community Psychiatry, San Jose, California, University of Missouri, Columbia, Missouri, USA
| | - Judith H Miles
- Thompson Center for Autism and Neurodevelopmental Disorders and Department of Child Health, University of Missouri, Columbia, Missouri, USA
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Gruszecka A, Kopczyński P, Cudziło D, Lipińska N, Romaniuk A, Barczak W, Rozwadowska N, Totoń E, Rubiś B. Telomere shortening in Down syndrome patients--when does it start? DNA Cell Biol 2015; 34:412-7. [PMID: 25786194 DOI: 10.1089/dna.2014.2746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Down syndrome (DS) is one of the most common aneuploidy. In general population, its prevalence is 1:600-1:800 live births. It is caused by a trisomy of chromosome 21. DS is phenotypically manifested by premature aging, upward slant to the eyes, epicanthus, flattened face, and poor muscle tone. In addition to physical changes, this syndrome is characterized by early onset of diseases specific to old age, such as Alzheimer's disease, vision and hearing problems, and precocious menopause. Since DS symptoms include premature aging, the shortening of telomeres might be one of the markers of cellular aging. Consequently, the aim of the study was to determine the length of the telomeres in leukocytes from the blood of juvenile patients with DS (n=68) compared to an age-matched control group (n=56) and also to determine the diagnostic or predictive value for this parameter. We show that, for the first time, in juveniles, the average relative telomere length in studied subjects is significantly longer than in the control group (50.46 vs. 40.56, respectively arbitrary units [AU]; p=0.0026). The results provide interesting basis for further research to determine the causes and consequences of telomere maintaining and the dynamics of this process in patients with DS.
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Affiliation(s)
- Aleksandra Gruszecka
- 1Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemysław Kopczyński
- 2Centre for Orthodontic Mini-implants at the Department and Clinic of Maxillofacial Orthopedics and Orthodontics, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Cudziło
- 3Orthodontic Department, Institute of Mother and Child, Warsaw, Poland
| | - Natalia Lipińska
- 1Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Romaniuk
- 1Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Barczak
- 4Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland.,5Radiobiology Laboratory, Department of Medical Physics, The Greater Poland Cancer Centre, Poznan, Poland
| | | | - Ewa Totoń
- 1Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, Poznan, Poland
| | - Błażej Rubiś
- 1Department of Clinical Chemistry and Molecular Diagnostics, Poznan University of Medical Sciences, Poznan, Poland
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