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Murray-Smith H, Barker S, Barkhof F, Barnes J, Brown TM, Captur G, R E Cartlidge M, Cash DM, Coath W, Davis D, Dickson JC, Groves J, Hughes AD, James SN, Keshavan A, Keuss SE, King-Robson J, Lu K, Malone IB, Nicholas JM, Rapala A, Scott CJ, Street R, Sudre CH, Thomas DL, Wong A, Wray S, Zetterberg H, Chaturvedi N, Fox NC, Crutch SJ, Richards M, Schott JM. Updating the study protocol: Insight 46 - a longitudinal neuroscience sub-study of the MRC National Survey of Health and Development - phases 2 and 3. BMC Neurol 2024; 24:40. [PMID: 38263061 PMCID: PMC10804658 DOI: 10.1186/s12883-023-03465-3] [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: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Although age is the biggest known risk factor for dementia, there remains uncertainty about other factors over the life course that contribute to a person's risk for cognitive decline later in life. Furthermore, the pathological processes leading to dementia are not fully understood. The main goals of Insight 46-a multi-phase longitudinal observational study-are to collect detailed cognitive, neurological, physical, cardiovascular, and sensory data; to combine those data with genetic and life-course information collected from the MRC National Survey of Health and Development (NSHD; 1946 British birth cohort); and thereby contribute to a better understanding of healthy ageing and dementia. METHODS/DESIGN Phase 1 of Insight 46 (2015-2018) involved the recruitment of 502 members of the NSHD (median age = 70.7 years; 49% female) and has been described in detail by Lane and Parker et al. 2017. The present paper describes phase 2 (2018-2021) and phase 3 (2021-ongoing). Of the 502 phase 1 study members who were invited to a phase 2 research visit, 413 were willing to return for a clinic visit in London and 29 participated in a remote research assessment due to COVID-19 restrictions. Phase 3 aims to recruit 250 study members who previously participated in both phases 1 and 2 of Insight 46 (providing a third data time point) and 500 additional members of the NSHD who have not previously participated in Insight 46. DISCUSSION The NSHD is the oldest and longest continuously running British birth cohort. Members of the NSHD are now at a critical point in their lives for us to investigate successful ageing and key age-related brain morbidities. Data collected from Insight 46 have the potential to greatly contribute to and impact the field of healthy ageing and dementia by combining unique life course data with longitudinal multiparametric clinical, imaging, and biomarker measurements. Further protocol enhancements are planned, including in-home sleep measurements and the engagement of participants through remote online cognitive testing. Data collected are and will continue to be made available to the scientific community.
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Affiliation(s)
- Heidi Murray-Smith
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK.
| | - Suzie Barker
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Centre for Medical Image Computing, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Thomas M Brown
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Gabriella Captur
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Molly R E Cartlidge
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - David M Cash
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - William Coath
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - John C Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - James Groves
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Sarah E Keuss
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Josh King-Robson
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Kirsty Lu
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Ian B Malone
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Jennifer M Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Alicja Rapala
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Catherine J Scott
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Rebecca Street
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Carole H Sudre
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Centre for Medical Image Computing, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - David L Thomas
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Selina Wray
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, University College London, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Hong, Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
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Shrestha S, Zhu X, Sullivan KJ, Blackshear C, Deal JA, Sharrett AR, Kamath V, Schneider ALC, Jack CR, Huang J, Palta P, Reid RI, Knopman DS, Gottesman RF, Chen H, Windham BG, Griswold ME, Mosley TH. Association of Olfaction and Microstructural Integrity of Brain Tissue in Community-Dwelling Adults: Atherosclerosis Risk in Communities Neurocognitive Study. Neurology 2023; 101:e1328-e1340. [PMID: 37541841 PMCID: PMC10558165 DOI: 10.1212/wnl.0000000000207636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/30/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research on olfaction and brain neuropathology may help understand brain regions associated with normal olfaction and dementia pathophysiology. To identify early regional brain structures affected in poor olfaction, we examined cross-sectional associations of microstructural integrity of the brain with olfaction in the Atherosclerosis Risk in Communities Neurocognitive Study. METHODS Participants were selected from a prospective cohort study of community-dwelling adults; selection criteria included the following: evidence of cognitive impairment, participation in a previous MRI study, and a random sample of cognitively normal participants. Microstructural integrity was measured by 2 diffusion tensor imaging (DTI) measures, fractional anisotropy (FA) and mean diffusivity (MD), and olfaction by a 12-item odor identification test at the same visit. Higher FA and MD values indicate better and worse microstructural integrity, respectively, and higher odor identification scores indicate better olfaction. We used brain region-specific linear regression models to examine associations between DTI measures and olfaction, adjusting for potential confounders. RESULTS Among 1,418 participants (mean age 76 ± 5 years, 41% male, 21% Black race, 59% with normal cognition), the mean olfaction score was 9 ± 2.3. Relevant to olfaction, higher MD in the medial temporal lobe (MTL) regions, namely the hippocampus (β -0.79 [95% CI -0.94 to -0.65] units lower olfaction score per 1 SD higher MD), amygdala, entorhinal area, and some white matter (WM) tracts connecting to these regions, was associated with olfaction. We also observed associations with MD and WM FA in multiple atlas regions that were not previously implicated in olfaction. The associations between MD and olfaction were particularly stronger in the MTL regions among individuals with mild cognitive impairment (MCI) compared with those with normal cognition (e.g., βhippocampus -0.75 [95% CI -1.02 to -0.49] and -0.44 [95% CI -0.63 to -0.26] for MCI and normal cognition, respectively, p interaction = 0.004). DISCUSSION Neuronal microstructural integrity in multiple brain regions, particularly the MTL (the regions known to be affected in early Alzheimer disease), is associated with odor identification ability. Differential associations in the MTL regions among cognitively normal individuals compared with those with MCI may reflect the earlier vs later effects of the dementia pathogenesis. It is likely that some of the associated regions may not have any functional relevance to olfaction.
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Affiliation(s)
- Srishti Shrestha
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing.
| | - Xiaoqian Zhu
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Kevin J Sullivan
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Chad Blackshear
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Jennifer A Deal
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - A Richey Sharrett
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Vidyulata Kamath
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Andrea L C Schneider
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Clifford R Jack
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Juebin Huang
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Priya Palta
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Robert I Reid
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - David S Knopman
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Rebecca F Gottesman
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Honglei Chen
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - B Gwen Windham
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Michael E Griswold
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
| | - Thomas H Mosley
- From the The Memory Impairment and Neurodegenerative Dementia (MIND) Center (S.S., X.Z., K.J.S., C.B., J.H., B.G.W., M.E.G., T.H.M.), University of Mississippi Medical Center, Jackson; Department of Epidemiology (J.A.D., A.R.S.), Johns Hopkins University Bloomberg School of Public Health; Department of Psychiatry and Behavioral Sciences (V.K.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.L.C.S.), and Department of Biostatistics, Epidemiology, and Informatics (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Radiology (C.R.J., R.I.R.), Mayo Clinic, Rochester, MN; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; Department of Neurology (P.P.), University of North Carolina at Chapel Hill; Department of Neurology (D.S.K.), Mayo Clinic, Rochester, MN; Stroke Branch (R.F.G.), National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD; and Department of Epidemiology and Biostatistics (H.C.), Michigan State University, East Lansing
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