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Ciesla M, Pobst J, Gomes-Osman J, Lamar M, Barnes LL, Banks R, Jannati A, Libon D, Swenson R, Tobyne S, Bates D, Showalter J, Pascual-Leone A. Estimating dementia risk in an African American population using the DCTclock. Front Aging Neurosci 2024; 15:1328333. [PMID: 38274984 PMCID: PMC10810014 DOI: 10.3389/fnagi.2023.1328333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The prevalence of Alzheimer's disease (AD) and related dementias (ADRD) is increasing. African Americans are twice as likely to develop dementia than other ethnic populations. Traditional cognitive screening solutions lack the sensitivity to independently identify individuals at risk for cognitive decline. The DCTclock is a 3-min AI-enabled adaptation of the well-established clock drawing test. The DCTclock can estimate dementia risk for both general cognitive impairment and the presence of AD pathology. Here we performed a retrospective analysis to assess the performance of the DCTclock to estimate future conversion to ADRD in African American participants from the Rush Alzheimer's Disease Research Center Minority Aging Research Study (MARS) and African American Clinical Core (AACORE). We assessed baseline DCTclock scores in 646 participants (baseline median age = 78.0 ± 6.4, median years of education = 14.0 ± 3.2, 78% female) and found significantly lower baseline DCTclock scores in those who received a dementia diagnosis within 3 years. We also found that 16.4% of participants with a baseline DCTclock score less than 60 were significantly more likely to develop dementia in 5 years vs. those with the highest DCTclock scores (75-100). This research demonstrates the DCTclock's ability to estimate the 5-year risk of developing dementia in an African American population. Early detection of elevated dementia risk using the DCTclock could provide patients, caregivers, and clinicians opportunities to plan and intervene early to improve cognitive health trajectories. Early detection of dementia risk can also enhance participant selection in clinical trials while reducing screening costs.
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Affiliation(s)
| | | | - Joyce Gomes-Osman
- Linus Health, Boston, MA, United States
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Russell Banks
- Linus Health, Boston, MA, United States
- Department of Communicative Sciences and Disorders, College of Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - Ali Jannati
- Linus Health, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - David Libon
- Linus Health, Boston, MA, United States
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States
| | - Rodney Swenson
- Linus Health, Boston, MA, United States
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | | | | | | | - Alvaro Pascual-Leone
- Linus Health, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
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2
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Wu X, Yan Y, Hu P, Wang L, Wu Y, Wu P, Geng Z, Xiao G, Zhou S, Ji G, Qiu B, Wei L, Tian Y, Liu H, Wang K. Effects of a periodic intermittent theta burst stimulation in Alzheimer's disease. Gen Psychiatr 2024; 37:e101106. [PMID: 38274292 PMCID: PMC10806514 DOI: 10.1136/gpsych-2023-101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024] Open
Abstract
Background Previous studies have demonstrated that excitatory repetitive transcranial magnetic stimulation (rTMS) can improve the cognitive function of patients with Alzheimer's disease (AD). Intermittent theta burst stimulation (iTBS) is a novel excitatory rTMS protocol for brain activity stimulation with the ability to induce long-term potentiation-like plasticity and represents a promising treatment for AD. However, the long-term effects of iTBS on cognitive decline and brain structure in patients with AD are unknown. Aims We aimed to explore whether repeating accelerated iTBS every three months could slow down the cognitive decline in patients with AD. Methods In this randomised, assessor-blinded, controlled trial, iTBS was administered to the left dorsolateral prefrontal cortex (DLPFC) of 42 patients with AD for 14 days every 13 weeks. Measurements included the Montreal Cognitive Assessment (MoCA), a comprehensive neuropsychological battery, and the grey matter volume (GMV) of the hippocampus. Patients were evaluated at baseline and after follow-up. The longitudinal pipeline of the Computational Anatomy Toolbox for SPM was used to detect significant treatment-related changes over time. Results The iTBS group maintained MoCA scores relative to the control group (t=3.26, p=0.013) and reduced hippocampal atrophy, which was significantly correlated with global degeneration scale changes. The baseline Mini-Mental State Examination (MMSE) score, apolipoprotein E genotype and Clinical Dementia Rating were indicative of MoCA scores at follow-up. Moreover, the GMV of the left (t=0.08, p=0.996) and right (t=0.19, p=0.977) hippocampus were maintained in the active group but significantly declined in the control group (left: t=4.13, p<0.001; right: t=5.31, p<0.001). GMV change in the left (r=0.35, p=0.023) and right (r=0.36, p=0.021) hippocampus across the intervention positively correlated with MoCA changes; left hippocampal GMV change was negatively correlated with global degeneration scale (r=-0.32, p=0.041) changes. Conclusions DLPFC-iTBS may be a feasible and easy-to-implement non-pharmacological intervention to slow down the progressive decline of overall cognition and quality of life in patients with AD, providing a new AD treatment option. Trial registration number NCT04754152.
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Affiliation(s)
- Xingqi Wu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Yibing Yan
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Panpan Hu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Lu Wang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Yue Wu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Pan Wu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Zhi Geng
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Guixian Xiao
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shanshan Zhou
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Gongjun Ji
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Bensheng Qiu
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, Anhui, China
| | - Ling Wei
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
| | - Yanghua Tian
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, Anhui, China
| | - Hesheng Liu
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kai Wang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, Anhui, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, Anhui, China
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3
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Yulug B, Ayyıldız B, Ayyıldız S, Sayman D, Salar AB, Cankaya S, Ozdemir Oktem E, Ozsimsek A, Kurt CC, Lakadamyalı H, Akturk A, Altay Ö, Hanoglu L, Velioglu HA, Mardinoglu A. Infection with COVID-19 is no longer a public emergency: But what about degenerative dementia? J Med Virol 2023; 95:e29072. [PMID: 37724347 DOI: 10.1002/jmv.29072] [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: 05/19/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Abstract
Although no longer considered a public health threat, post-COVID cognitive syndrome continues to impact on a considerable proportion of individuals who were infected with COVID-19. Recent studies have also suggested that COVID may be represent a critical risk factor for the development of Alzheimer's disease (AD). We compared 17 COVID patients with 20 controls and evaluated the effects of COVID-19 on general cognitive performance, hippocampal volume, and connections using structural and seed-based connectivity analysis. We showed that COVID patients exhibited considerably worse cognitive functioning and increased hippocampal connectivity supported by the strong correlation between hippocampal connectivity and cognitive scores. Our findings of higher hippocampal connectivity with no observable hippocampal morphological changes even in mild COVID cases may be represent evidence of a prestructural compensatory mechanism for stimulating additional neuronal resources to combat cognitive dysfunction as recently shown for the prodromal stages of degenerative cognitive disorders. Our findings may be also important in light of recent data showing that other viral infections as well as COVID may constitute a critical risk factor for the development of AD. To our knowledge, this is the first study that investigated network differences in COVID patients, with a particular focus on compensatory hippocampal connectivity.
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Affiliation(s)
- Burak Yulug
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Behçet Ayyıldız
- Anatomy PhD Program, Graduate School of Health Sciences, Kocaeli University, Istanbul, Turkey
| | - Sevilay Ayyıldız
- Anatomy PhD Program, Graduate School of Health Sciences, Kocaeli University, Istanbul, Turkey
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dila Sayman
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Ali Behram Salar
- Department of Neuroscience, Faculty of Medicine, Istanbul Medipol University, Istanbul, Türkiye
| | - Seyda Cankaya
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Ece Ozdemir Oktem
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Ahmet Ozsimsek
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Cagla Ceren Kurt
- Department of Physiotherapy, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Hatice Lakadamyalı
- Department of Radiology, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Aynur Akturk
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Özlem Altay
- KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Lutfu Hanoglu
- Department of Neurology, Istanbul Medipol University, Istanbul, Turkey
| | - Halil Aziz Velioglu
- Department of Neuroscience, Faculty of Medicine, Istanbul Medipol University, Istanbul, Türkiye
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Adil Mardinoglu
- KTH-Royal Institute of Technology, Stockholm, Sweden
- King's College London, Faculty of Dentistry, London, UK
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4
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Lorenzetti V, McTavish E, Broyd S, van Hell H, Thomson D, Ganella E, Kottaram AR, Beale C, Martin J, Galettis P, Solowij N, Greenwood LM. Daily Cannabidiol Administration for 10 Weeks Modulates Hippocampal and Amygdalar Resting-State Functional Connectivity in Cannabis Users: A Functional Magnetic Resonance Imaging Open-Label Clinical Trial. Cannabis Cannabinoid Res 2023. [PMID: 37603080 DOI: 10.1089/can.2022.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Introduction: Cannabis use is associated with brain functional changes in regions implicated in prominent neuroscientific theories of addiction. Emerging evidence suggests that cannabidiol (CBD) is neuroprotective and may reverse structural brain changes associated with prolonged heavy cannabis use. In this study, we examine how an ∼10-week exposure of CBD in cannabis users affected resting-state functional connectivity in brain regions functionally altered by cannabis use. Materials and Methods: Eighteen people who use cannabis took part in a ∼10 weeks open-label pragmatic trial of self-administered daily 200 mg CBD in capsules. They were not required to change their cannabis exposure patterns. Participants were assessed at baseline and post-CBD exposure with structural magnetic resonance imaging (MRI) and a functional MRI resting-state task (eyes closed). Seed-based connectivity analyses were run to examine changes in the functional connectivity of a priori regions-the hippocampus and the amygdala. We explored if connectivity changes were associated with cannabinoid exposure (i.e., cumulative cannabis dosage over trial, and plasma CBD concentrations and Δ9-tetrahydrocannabinol (THC) plasma metabolites postexposure), and mental health (i.e., severity of anxiety, depression, and positive psychotic symptom scores), accounting for cigarette exposure in the past month, alcohol standard drinks in the past month and cumulative CBD dose during the trial. Results: Functional connectivity significantly decreased pre-to-post the CBD trial between the anterior hippocampus and precentral gyrus, with a strong effect size (d=1.73). Functional connectivity increased between the amygdala and the lingual gyrus pre-to-post the CBD trial, with a strong effect size (d=1.19). There were no correlations with cannabinoids or mental health symptom scores. Discussion: Prolonged CBD exposure may restore/reduce functional connectivity differences reported in cannabis users. These new findings warrant replication in a larger sample, using robust methodologies-double-blind and placebo-controlled-and in the most vulnerable people who use cannabis, including those with more severe forms of Cannabis Use Disorder and experiencing worse mental health outcomes (e.g., psychosis, depression).
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Center, School of Health and Behavioral Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Eugene McTavish
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Center, School of Health and Behavioral Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Samantha Broyd
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Hendrika van Hell
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Diny Thomson
- Turner Institute for Brain and Mental Health, School of Psychological Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Eleni Ganella
- Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, Carlton South, Victoria, Australia
- Orygen, the National Center of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Akhil Raja Kottaram
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Center, School of Health and Behavioral Sciences, Australian Catholic University, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, Carlton South, Victoria, Australia
| | - Camilla Beale
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jennifer Martin
- John Hunter Hospital, Newcastle, New South Wales, Australia
- Center for Drug Repurposing and Medicines Research, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
| | - Peter Galettis
- Center for Drug Repurposing and Medicines Research, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
| | - Lisa-Marie Greenwood
- The Australian Center for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales, Australia
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
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5
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Invernizzi A, Renzetti S, van Thriel C, Rechtman E, Patrono A, Ambrosi C, Mascaro L, Cagna G, Gasparotti R, Reichenberg A, Tang CY, Lucchini RG, Wright RO, Placidi D, Horton MK. Covid-19 related cognitive, structural and functional brain changes among Italian adolescents and young adults: a multimodal longitudinal case-control study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.19.23292909. [PMID: 37503251 PMCID: PMC10371098 DOI: 10.1101/2023.07.19.23292909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with brain functional, structural, and cognitive changes that persist months after infection. Most studies of the neurologic outcomes related to COVID-19 focus on severe infection and aging populations. Here, we investigated the neural activities underlying COVID-19 related outcomes in a case-control study of mildly infected youth enrolled in a longitudinal study in Lombardy, Italy, a global hotspot of COVID-19. All participants (13 cases, 27 controls, mean age 24 years) completed resting state functional (fMRI), structural MRI, cognitive assessments (CANTAB spatial working memory) at baseline (pre-COVID) and follow-up (post-COVID). Using graph theory eigenvector centrality (EC) and data-driven statistical methods, we examined differences in ECdelta (i.e., the difference in EC values pre- and post-COVID-19) and volumetricdelta (i.e., the difference in cortical volume of cortical and subcortical areas pre- and post-COVID) between COVID-19 cases and controls. We found that ECdeltasignificantly between COVID-19 and healthy participants in five brain regions; right intracalcarine cortex, right lingual gyrus, left hippocampus, left amygdala, left frontal orbital cortex. The left hippocampus showed a significant decrease in volumetricdelta between groups (p=0.041). The reduced ECdelta in the right amygdala associated with COVID-19 status mediated the association between COVID-19 and disrupted spatial working memory. Our results show persistent structural, functional and cognitive brain changes in key brain areas associated with olfaction and cognition. These results may guide treatment efforts to assess the longevity, reversibility and impact of the observed brain and cognitive changes following COVID-19.
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Affiliation(s)
- Azzurra Invernizzi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefano Renzetti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Christoph van Thriel
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Elza Rechtman
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alessandra Patrono
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Claudia Ambrosi
- Department of Neuroscience, Neuroradiology Unit, ASST Cremona
| | | | - Giuseppa Cagna
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cheuk Y Tang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roberto G Lucchini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donatella Placidi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Megan K Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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