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Jonson C, Levine KS, Lake J, Hertslet L, Jones L, Patel D, Kim J, Bandres-Ciga S, Terry N, Mata IF, Blauwendraat C, Singleton AB, Nalls MA, Yokoyama JS, Leonard HL. Assessing the lack of diversity in genetics research across neurodegenerative diseases: A systematic review of the GWAS Catalog and literature. Alzheimers Dement 2024. [PMID: 39030740 DOI: 10.1002/alz.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 07/22/2024]
Abstract
The under-representation of non-European cohorts in neurodegenerative disease genome-wide association studies (GWAS) hampers precision medicine efforts. Despite the inherent genetic and phenotypic diversity in these diseases, GWAS research consistently exhibits a disproportionate emphasis on participants of European ancestry. This study reviews GWAS up to 2022, focusing on non-European or multi-ancestry neurodegeneration studies. We conducted a systematic review of GWAS results and publications up to 2022, focusing on non-European or multi-ancestry neurodegeneration studies. Rigorous article inclusion and quality assessment methods were employed. Of 123 neurodegenerative disease (NDD) GWAS reviewed, 82% predominantly featured European ancestry participants. A single European study identified over 90 risk loci, compared to a total of 50 novel loci in identified in all non-European or multi-ancestry studies. Notably, only six of the loci have been replicated. The significant under-representation of non-European ancestries in NDD GWAS hinders comprehensive genetic understanding. Prioritizing genomic diversity in future research is crucial for advancing NDD therapies and understanding. HIGHLIGHTS: Eighty-two percent of neurodegenerative genome-wide association studies (GWAS) focus on Europeans. Only 6 of 50 novel neurodegenerative disease (NDD) genetic loci have been replicated. Lack of diversity significantly hampers understanding of NDDs. Increasing diversity in NDD genetic research is urgently required. New initiatives are aiming to enhance diversity in NDD research.
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Affiliation(s)
- Caroline Jonson
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- DataTecnica LLC, Washington, District of Columbia, USA
- Pharmaceutical Sciences and Pharmacogenomics Graduate Program, University of California, San Francisco, California, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Kristin S Levine
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- DataTecnica LLC, Washington, District of Columbia, USA
| | - Julie Lake
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Linnea Hertslet
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
| | - Lietsel Jones
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- DataTecnica LLC, Washington, District of Columbia, USA
| | - Dhairya Patel
- Integrative Neurogenomics Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeff Kim
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Sara Bandres-Ciga
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
| | - Nancy Terry
- Division of Library Services, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Ignacio F Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Cornelis Blauwendraat
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- Integrative Neurogenomics Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew B Singleton
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Mike A Nalls
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- DataTecnica LLC, Washington, District of Columbia, USA
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer S Yokoyama
- Pharmaceutical Sciences and Pharmacogenomics Graduate Program, University of California, San Francisco, California, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Hampton L Leonard
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, Maryland, USA
- DataTecnica LLC, Washington, District of Columbia, USA
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, Maryland, USA
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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2
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Jonson C, Levine KS, Lake J, Hertslet L, Jones L, Patel D, Kim J, Bandres-Ciga S, Terry N, Mata IF, Blauwendraat C, Singleton AB, Nalls MA, Yokoyama JS, Leonard HL. Assessing the lack of diversity in genetics research across neurodegenerative diseases: a systematic review of the GWAS Catalog and literature. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.08.24301007. [PMID: 38260595 PMCID: PMC10802650 DOI: 10.1101/2024.01.08.24301007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Importance The under-representation of participants with non-European ancestry in genome-wide association studies (GWAS) is a critical issue that has significant implications, including hindering the progress of precision medicine initiatives. This issue is particularly significant in the context of neurodegenerative diseases (NDDs), where current therapeutic approaches have shown limited success. Addressing this under-representation is crucial to harnessing the full potential of genomic medicine in underserved communities and improving outcomes for NDD patients. Objective Our primary objective was to assess the representation of non-European ancestry participants in genetic discovery efforts related to NDDs. We aimed to quantify the extent of inclusion of diverse ancestry groups in NDD studies and determine the number of associated loci identified in more inclusive studies. Specifically, we sought to highlight the disparities in research efforts and outcomes between studies predominantly involving European ancestry participants and those deliberately targeting non-European or multi-ancestry populations across NDDs. Evidence Review We conducted a systematic review utilizing existing GWAS results and publications to assess the inclusion of diverse ancestry groups in neurodegeneration and neurogenetics studies. Our search encompassed studies published up to the end of 2022, with a focus on identifying research that deliberately included non-European or multi-ancestry cohorts. We employed rigorous methods for the inclusion of identified articles and quality assessment. Findings Our review identified a total of 123 NDD GWAS. Strikingly, 82% of these studies predominantly featured participants of European ancestry. Endeavors specifically targeting non-European or multi-ancestry populations across NDDs identified only 52 risk loci. This contrasts with predominantly European studies, which reported over 90 risk loci for a single disease. Encouragingly, over 65% of these discoveries occurred in 2020 or later, indicating a recent increase in studies deliberately including non-European cohorts. Conclusions and relevance Our findings underscore the pressing need for increased diversity in neurodegenerative research. The significant under-representation of non-European ancestry participants in NDD GWAS limits our understanding of the genetic underpinnings of these diseases. To advance the field of neurodegenerative research and develop more effective therapies, it is imperative that future investigations prioritize and harness the genomic diversity present within and across global populations.
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Affiliation(s)
- Caroline Jonson
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- DataTecnica LLC, Washington, DC USA 20037
- Pharmaceutical Sciences and Pharmacogenomics, UCSF, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA USA
| | - Kristin S. Levine
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- DataTecnica LLC, Washington, DC USA 20037
| | - Julie Lake
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, MD USA 20892
| | - Linnea Hertslet
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
| | - Lietsel Jones
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- DataTecnica LLC, Washington, DC USA 20037
| | - Dhairya Patel
- Integrative Neurogenomics Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Jeff Kim
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, MD USA 20892
| | - Sara Bandres-Ciga
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
| | - Nancy Terry
- Division of Library Services, Office of Research Services, National Institutes of Health, Bethesda, Maryland, U.S.A
| | - Ignacio F. Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Cornelis Blauwendraat
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- Integrative Neurogenomics Unit, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Andrew B. Singleton
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, MD USA 20892
| | - Mike A. Nalls
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- DataTecnica LLC, Washington, DC USA 20037
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, MD USA 20892
| | - Jennifer S. Yokoyama
- Pharmaceutical Sciences and Pharmacogenomics, UCSF, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA USA
| | - Hampton L. Leonard
- Center for Alzheimer’s and Related Dementias, National Institutes of Health, Bethesda, MD USA 20892
- DataTecnica LLC, Washington, DC USA 20037
- Laboratory of Neurogenetics, National Institutes on Aging, National Institutes of Health, Bethesda, MD USA 20892
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Leow YJ, Soo SA, Kumar D, Zailan FZB, Sandhu GK, Vipin A, Lee FPHE, Ghildiyal S, Liew SY, Dang C, Tanoto P, Tan IYZ, Chong WFW, Mohammed AA, Ng KP, Kandiah N. Mild Behavioral Impairment and Cerebrovascular Profiles Are Associated with Early Cognitive Impairment in a Community-Based Southeast Asian Cohort. J Alzheimers Dis 2024; 97:1727-1735. [PMID: 38306040 PMCID: PMC10894567 DOI: 10.3233/jad-230898] [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] [Accepted: 12/01/2023] [Indexed: 02/03/2024]
Abstract
Background Mild behavioral impairment (MBI) is one of the earliest observable changes when a person experiences cognitive decline and could be an early manifestation of underlying Alzheimer's disease neuropathology. Limited attention has been given to investigating the clinical applicability of behavioral biomarkers for detection of prodromal dementia. Objective This study compared the prevalence of self-reported MBI and vascular risk factors in Southeast Asian adults to identify early indicators of cognitive impairment and dementia. Methods This cohort study utilized baseline data from the Biomarkers and Cognition Study, Singapore (BIOCIS). 607 participants were recruited and classified into three groups: cognitively normal (CN), subjective cognitive decline (SCD), and mild cognitive impairment (MCI). Group comparisons of cognitive-behavioral, neuroimaging, and blood biomarkers data were applied using univariate analyses. Multivariate logistic regression analyses were conducted to investigate the association between cerebrovascular disease, vascular profiles, and cognitive impairment. Results SCD had significantly higher depression scores and poorer quality of life (QOL) compared to CN. MCI had significantly higher depression scores; total MBI symptoms, MBI-interest, MBI-mood, and MBI-beliefs; poorer sleep quality; and poorer QOL compared to CN. Higher Staals scores, glucose levels, and systolic blood pressure were significantly associated with MCI classification. Fasting glucose levels were significantly correlated with depression, anxiety, MBI-social, and poorer sleep quality. Conclusions The results reflect current research that behavioral changes are among the first symptoms noticeable to the person themselves as they begin to experience cognitive decline. Self-reported questionnaires may aid in early diagnoses of prodromal dementia. Behavioral changes and diabetes could be potential targets for preventative healthcare for dementia.
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Affiliation(s)
- Yi Jin Leow
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - See Ann Soo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Dilip Kumar
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Gurveen Kaur Sandhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ashwati Vipin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Smriti Ghildiyal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shan Yao Liew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Chao Dang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- The First Affiliated Hospital, Sun Yat-sen University, China
| | - Pricilia Tanoto
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Adnan Azam Mohammed
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kok Pin Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Nagaendran Kandiah
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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Dulaglutide Improves Gliosis and Suppresses Apoptosis/Autophagy Through the PI3K/Akt/mTOR Signaling Pathway in Vascular Dementia Rats. Neurochem Res 2022; 48:1561-1579. [PMID: 36571662 DOI: 10.1007/s11064-022-03853-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
Dulaglutide is a new type of hypoglycemic agent that agonizes glucagon-like peptide-1 receptor (GLP-1RA). It can be concluded from previous studies that a GLP-1RA can reduce apoptosis and regulate autophagy in the nervous system, while related research on dulaglutide in vascular dementia (VD) has not been reported. In our study, the VD rat model was established by bilateral carotid artery occlusion, and the results of the Morris water maze test (MWM) and open-field test showed that the application of dulaglutide could effectively reduce the cognitive decline of VD rats without changing the behavior in the open-field test, which was used to assess an anxiety-like phenotype. We applied HE staining and immunofluorescence labeling to show that dulaglutide treatment significantly alleviated neuronal damage in the hippocampal region of VD rats, and reduced microglial and astrocyte proliferation. Western blot results showed that dulaglutide reduced VD-induced neuronal apoptosis (BCL2/BAX, c-caspase3) and autophagy (P62, LC3B, Beclin-1), and upregulated phosphorylation of PI3K/Akt/mTOR signaling pathway. KEGG pathway analysis of RNA-Sequence results showed that the differentially expressed genes in the dulaglutide treatment group were significantly enriched in the mTOR signaling pathway, and the repressor of mTOR, Deptor, was down-regulated. In conclusion, this study suggested that dulaglutide may alleviate learning and memory impairment and neuron damage in VD rats by attenuating apoptosis, regulating autophagy, and activating the PI3K/Akt/mTOR signaling pathway in neurons, which may make it a promising candidate for the simultaneous treatment of VD and diabetes.
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5
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Hossain MZ, Tarafdar SA, Kingstone T, Campbell P, Chew-Graham CA. From detection to preparing for the end-of-life: A qualitative exploration of the South Asian family carers' experiences of the journey with dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5135-e5144. [PMID: 35906825 DOI: 10.1111/hsc.13930] [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: 11/22/2021] [Revised: 06/01/2022] [Accepted: 07/09/2022] [Indexed: 06/15/2023]
Abstract
People of South Asian (SA) origin have a higher prevalence of dementia compared with the United Kingdom (UK) population as a whole. Little is known about how family carers of SA origin perceive dementia, manage access to dementia services, and how plans and preparations are made for end-of-life for loved ones with dementia. This qualitative study aimed to explore the experiences of carers of people with dementia of SA origin, living in the UK. Through semi-structured interviews, the perspective of caregivers of a person with dementia was explored from point of diagnosis to end-of-life preparation. Sixteen caregivers participated in face-to-face interviews. Four key themes are presented (i) lacking awareness at the start; (ii) living with the challenges of dementia; (iii) preparing for end-of-life; (iv) preferences for burial. Carers described difficulties in making sense of early symptoms and the behaviour changes they observed amongst their relatives with dementia. They described the tensions in trying to follow their religious and cultural identities of honouring the dignity and choices of the person with dementia. This study reports on the perspectives of SA carers of people with dementia, particularly exploring the end-of-life preparation and wishes of people with dementia in the UK. Family carers may benefit from accessing more culturally sensitive support when dementia is diagnosed, including such support when receiving formal day-to-day care. Importantly the findings suggest that planning and preparing to provide end-of-life for people with dementia should recognise and respect family and cultural contexts and religious beliefs.
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Affiliation(s)
- Muhammad Z Hossain
- School of Healthcare, Global Banking School (GBS), Birmingham, UK
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
- Health and Social Care, University of Wales Trinity Saint David, Birmingham, UK
- Health and Care Management, Arden University, Coventry, UK
| | - Suhail A Tarafdar
- Health Education England (HEE), West Midlands & General Practitioner, West Midlands, Birmingham, UK
| | - Tom Kingstone
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
- Research and Innovation Department, St George's Hospital, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Paul Campbell
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
- Research and Innovation Department, St George's Hospital, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
- Research and Innovation Department, St George's Hospital, Midlands Partnership NHS Foundation Trust, Stafford, UK
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Temple J, Wilson T, Brijnath B, Radford K, LoGiudice D, Utomo A, Anstey KJ. The role of demographic change in explaining the growth of Australia's older migrant population living with dementia, 2016-2051. Aust N Z J Public Health 2022; 46:661-667. [PMID: 36047851 DOI: 10.1111/1753-6405.13276] [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: 08/01/2021] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the demographic drivers contributing to the future growth in the population of older migrants in Australia living with dementia. METHODS Using birthplace-specific cohort-component projection models, we projected the number of older migrants living with dementia. ABS data on births, deaths, migration and birthplace were used, alongside Australian Institute of Health and Welfare (AIHW) estimates of dementia prevalence with birthplace dementia weights calculated from administrative data. RESULTS The number of older migrants living with dementia is projected to increase from about 134,423 in 2016 to 378,724 by 2051. Increases in populations with dementia varied considerably, from a slight decrease for those born in Southern & Eastern Europe to over 600% increases amongst the South-East Asia, Southern & Central Asia, and Sub-Saharan Africa-born populations. CONCLUSIONS Cohort flow is the primary driver increasing the number of older migrants living with dementia. This growth is largely inevitable because the cohorts are already living in Australia as part of the migrant population, but currently at ages below 60 years. IMPLICATIONS FOR PUBLIC HEALTH High relative growth and shifting birthplace composition in the number of migrants living with dementia poses implications for culturally appropriate care, health care access and workforce needs to support migrant families, carers and their communities.
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Affiliation(s)
- Jeromey Temple
- Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Tom Wilson
- Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | | | - Kylie Radford
- Neuroscience Research Australia, University of New South Wales
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria
| | - Ariane Utomo
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Victoria
| | - Kaarin J Anstey
- Neuroscience Research Australia, University of New South Wales
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7
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Sudre CH, Moriconi S, Rehwald R, Smith L, Tillin T, Barnes J, Atkinson D, Ourselin S, Chaturvedi N, Hughes AD, Jäger HR, Cardoso MJ. Accelerated vascular aging: Ethnic differences in basilar artery length and diameter, and its association with cardiovascular risk factors and cerebral small vessel disease. Front Cardiovasc Med 2022; 9:939680. [PMID: 35966566 PMCID: PMC9366336 DOI: 10.3389/fcvm.2022.939680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Risk of stroke and dementia is markedly higher in people of South Asian and African Caribbean descent than white Europeans in the UK. This is unexplained by cardiovascular risk factors (CVRF). We hypothesized this might indicate accelerated early vascular aging (EVA) and that EVA might account for stronger associations between cerebral large artery characteristics and markers of small vessel disease. Methods 360 participants in a tri-ethnic population-based study (120 per ethnic group) underwent cerebral and vertebral MRI. Length and median diameter of the basilar artery (BA) were derived from Time of Flight images, while white matter hyperintensities (WMH) volumes were obtained from T1 and FLAIR images. Associations between BA characteristics and CVRF were assessed using multivariable linear regression. Partial correlation coefficients between WMH load and BA characteristics were calculated after adjustment for CVRF and other potential confounders. Results BA diameter was strongly associated with age in South Asians (+11.3 μm/year 95% CI = [3.05; 19.62]; p = 0.008), with unconvincing relationships in African Caribbeans (3.4 μm/year [-5.26, 12.12]; p = 0.436) or Europeans (2.6 μm/year [-5.75, 10.87]; p = 0.543). BA length was associated with age in South Asians (+0.34 mm/year [0.02; 0.65]; p = 0.037) and African Caribbeans (+0.39 mm/year [0.12; 0.65]; p = 0.005) but not Europeans (+0.08 mm/year [-0.26; 0.41]; p = 0.653). BA diameter (rho = 0.210; p = 0.022) and length (rho = 0.261; p = 0.004) were associated with frontal WMH load in South Asians (persisting after multivariable adjustment for CVRF). Conclusions Compared with Europeans, the basilar artery undergoes more accelerated EVA in South Asians and in African Caribbeans, albeit to a lesser extent. Such EVA may contribute to the higher burden of CSVD observed in South Asians and excess risk of stroke, vascular cognitive impairment and dementia observed in these ethnic groups.
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Affiliation(s)
- Carole H. Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom,Department of Computer Science, Centre for Medical Image Computing, University College London, London, United Kingdom,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom,*Correspondence: Carole H. Sudre
| | - Stefano Moriconi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Rafael Rehwald
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom,Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lorna Smith
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Josephine Barnes
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Sébastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - H. Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - M. Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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8
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Zhang J, Zhu Q, Wang X, Wang J. Effect of Donepezil on Vascular Dementia in Rats via PI3K/AKT Pathway. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Previous studies have shown that Donepezil has therapeutic effects on vascular dementia (VD). PI3K/AKT involves in oxidative stress injury and cell apoptosis. This study investigated whether Donepezil affects the neurological function and apoptosis of VD mice via
PI3K/AKT signaling. Methods: Mice were assigned into Sham group, VD group, VD+Donepezil groupfollowed by analysis of mice learning and memory ability by Water maze test, p-AKT expression by Western blot, Caspase-3 activity, MDA content, SOD activity and GSH-Px in hippocampus. HT22 cells
were cultured and separated into control group, I-R group and I-R+Donepezil group followed by measuring p-AKT level, ROS content and apoptosis. Results: Learning and memory abilities of VD group mice were significantly decreased, Caspase-3 activity and MDA in brain tissue were significantly
increased, along with decreased SOD activity, GSH-Px and p-AKT level. Donepezil treatment can significantly improve VD mice learning and memory ability, reduce Caspase-3 activity and MDA in brain tissue, increase SOD activity, GSH-Px and p-AKT level. In vitro, I-R treatment significantly
induced apoptosis of HT22 cells, increased ROS production and decreased p-AKT level. Donepezil treatment could up-regulate p-AKT in HT22 cells and reduce apoptosis and ROS production in HT22 cells. Conclusion: Donepezil improves the function of brain nerve in VD mice through regulating
PI3K/AKT pathway, thus reducing oxidative stress injury and apoptosis of brain nerve cells.
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Affiliation(s)
- Jianmin Zhang
- Department of Neurology, The First People’s Hospital of Fuyang District, Hangzhou, 311400, Zhejiang, China
| | - Qianwen Zhu
- Department of Neurology, The First People’s Hospital of Fuyang District, Hangzhou, 311400, Zhejiang, China
| | - Xingnan Wang
- Department of Neurology, The First People’s Hospital of Fuyang District, Hangzhou, 311400, Zhejiang, China
| | - Jian Wang
- Department of Neurology, The First People’s Hospital of Fuyang District, Hangzhou, 311400, Zhejiang, China
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Kokorelias KM, Nelson MLA, Cameron JI, Colquhoun H, Munce S, Hitzig SL, Salbach NM, Martyniuk J, Steele Gray C, Tang T, Wang RH, Lindsay P, Bayley M, Kaur N, Singh H. Exploring the poststroke experiences and unmet needs of South Asian communities in high-income countries: a scoping review protocol. BMJ Open 2022; 12:e059017. [PMID: 35477869 PMCID: PMC9047763 DOI: 10.1136/bmjopen-2021-059017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION South Asian groups experience a higher burden of stroke and poorer functional outcomes after stroke than their White counterparts. However, within the stroke literature, there has been little focus on the unique poststroke needs of the South Asian community and opportunities for community-based services to address these needs. RESEARCH QUESTION What is the current knowledge base related to the experiences and needs, including unmet needs of people living with stroke and their caregivers from South Asian communities living in high-income countries? AIMS This is a protocol for a review that intends to synthesise existing studies of the poststroke experiences and needs of individuals from South Asian communities to uncover opportunities for community-based resources to address these needs. METHODS AND ANALYSIS This scoping review methodology will be guided by modified Arksey and O'Malley (2005) and Joanna Briggs Institute frameworks. A search on OVID Medline, OVID Embase, OVID PsycINFO, EBSCO CINAHL, the Cochrane Library, Scopus and Global Index Medicus will be conducted to synthesise existing peer-reviewed literature (all study designs). Grey literature will be searched through detailed hand searching. Literature focusing on the poststroke experiences and needs of South Asian groups impacted by stroke residing in high-income countries will be included. Study descriptors will be extracted (eg, study location, type, methodology). Data will be analysed descriptively and thematically. Team meetings will provide opportunities for peer debriefing, thereby enhancing analytic rigour. CONCLUSION AND IMPLICATIONS Findings will enhance knowledge of the poststroke experiences and needs of South Asian communities living in high-income countries and identify actionable opportunities for community-based resources to address needs. ETHICS AND DISSEMINATION Ethics approval was not required for this scoping review protocol. Community-based organisations will be consulted to provide insights into the analysis and assist with dissemination. Dissemination of findings will also occur through a publication and academic presentations.
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Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrice Lindsay
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - Mark Bayley
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Navaldeep Kaur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Hardeep Singh
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Tian D, Gao Q, Chang Z, Lin J, Ma D, Han Z. Network pharmacology and in vitro studies reveal the pharmacological effects and molecular mechanisms of Shenzhi Jiannao prescription against vascular dementia. BMC Complement Med Ther 2022; 22:33. [PMID: 35109845 PMCID: PMC8812053 DOI: 10.1186/s12906-021-03465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Shenzhi Jiannao (SZJN) prescription is a type of herbal formula adopted in the management of cognitive impairment and related disorders. However, its effects and related regulatory mechanisms on vascular dementia (VD) are elusive. Herein, network pharmacology prediction was employed to explore the pharmacological effects and molecular mechanisms of SZJN prescription on VD using network pharmacology prediction, and validated the results through in vitro experiments. Methods Through a search in the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database, chemical composition and targets for SZJN prescription were retrieved. The potential targets for VD were then obtained from the GeneCards and DisGeNET databases. The network was constructed that depicted the interactions between putative SZJN prescription and known therapeutic targets for VD using Cytoscape 3.7.1. Analysis of protein-protein interaction was achieved via STRING 11.0 software, followed by Gene Ontology (GO) functional enrichment and Kyoto Gene and Genome Encyclopedia (KEGG) pathway analyses. To validate the computer-predicted results, in vitro experiments based on an excitotoxic injury model were designed using glutamate-exposed PC12 cells, and treated with varying concentrations (low, 0.05; medium, 0.1 and high, 0.2 mg/mL) of SZJN prescription. Cell viability and cell death were detected using the IncuCyte imaging system. Moreover, the expression profiles of Caspase-3 were analyzed through qRT-PCR. Results Twenty-eight potentially active ingredients for SZJN prescription, including stigmasterol, beta-sitosterol, and kaempferol, plus 21 therapeutic targets for VD, including PTGS2, PTGS1, and PGR were revealed. The protein-protein interaction network was employed for the analysis of 20 target proteins, including CASP3, JUN, and AChE. The enrichment analysis demonstrated candidate targets of SZJN prescription were more frequently involved in neuroactive ligand-receptor interaction, calcium, apoptosis, and cholinergic synaptic signaling pathways. In vitro experiments revealed that SZJN prescription could significantly reverse glutamate-induced cell viability loss and cell death, and lower the levels of Caspase-3 mRNA in glutamate-induced PC12 cells. Conclusions Collectively, this study demonstrated that SZJN prescription exerted the effect of treating VD by regulating multi-targets and multi-channels with multi-components through the method of network pharmacology. Furthermore, in vitro results confirmed that SZJN prescription attenuated glutamate-induced neurotoxicity.
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Affiliation(s)
- Danfeng Tian
- Beijing University of Chinese Medicine, No.11 East road, North 3rd Ring Road, Beijing, 100029, China
| | - Qiang Gao
- Beijing University of Chinese Medicine, No.11 East road, North 3rd Ring Road, Beijing, 100029, China
| | - Ze Chang
- Beijing University of Chinese Medicine, No.11 East road, North 3rd Ring Road, Beijing, 100029, China
| | - Jingfeng Lin
- Beijing University of Chinese Medicine, No.11 East road, North 3rd Ring Road, Beijing, 100029, China
| | - Dayong Ma
- Neurology Department of Dongzhimen Hospital, Beijing University of Chinese Medicine, No.5 Haiyuncang, Dongcheng District, Beijing, 100700, China
| | - Zhenyun Han
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), No.1 Dayun road, Sports New City Road, Shenzhen, 518172, China.
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11
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Anterior Cervical Discectomy and Fusion in patients with Preexisting Dementia: Increased Medical Complications, Costs, and 90-Day Readmissions. Clin Neurol Neurosurg 2022; 215:107182. [DOI: 10.1016/j.clineuro.2022.107182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/03/2022]
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12
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Manca R, De Marco M, Colston A, Raymont V, Amin J, Davies R, Kumar P, Russell G, Blackburn DJ, Venneri A. The Impact of Social Isolation Due to COVID-19 on Symptom Progression in People With Dementia: Findings of the SOLITUDE Study. Front Psychiatry 2022; 13:877595. [PMID: 35619615 PMCID: PMC9127264 DOI: 10.3389/fpsyt.2022.877595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD's symptoms and carers' burden. METHODS Forty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD's health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0. RESULTS No significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0. CONCLUSION PWD's symptoms and carers' burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer's disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients' carers.
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Affiliation(s)
- Riccardo Manca
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Matteo De Marco
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Amanda Colston
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jay Amin
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Memory Assessment and Research Centre, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Pramod Kumar
- Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
| | - Daniel J Blackburn
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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13
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Mossanen Parsi M, Duval C, Ariëns RAS. Vascular Dementia and Crosstalk Between the Complement and Coagulation Systems. Front Cardiovasc Med 2021; 8:803169. [PMID: 35004913 PMCID: PMC8733168 DOI: 10.3389/fcvm.2021.803169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 01/12/2023] Open
Abstract
Vascular Dementia (VaD) is a neurocognitive disorder caused by reduced blood flow to the brain tissue, resulting in infarction, and is the second most common type of dementia. The complement and coagulation systems are evolutionary host defence mechanisms activated by acute tissue injury to induce inflammation, clot formation and lysis; recent studies have revealed that these systems are closely interlinked. Overactivation of these systems has been recognised to play a key role in the pathogenesis of neurological disorders such as Alzheimer's disease and multiple sclerosis, however their role in VaD has not yet been extensively reviewed. This review aims to bridge the gap in knowledge by collating current understanding of VaD to enable identification of complement and coagulation components involved in the pathogenesis of this disorder that may have their effects amplified or supressed by crosstalk. Exploration of these mechanisms may unveil novel therapeutic targets or biomarkers that would improve current treatment strategies for VaD.
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Affiliation(s)
| | | | - Robert A. S. Ariëns
- Discovery and Translational Science Department, School of Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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Arshad F, MM S, Paplikar A, Rajendran S, Kalkonde Y, Alladi S. Vascular cognitive impairment in India: Challenges and opportunities for prevention and treatment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 3:100034. [PMID: 36324418 PMCID: PMC9616277 DOI: 10.1016/j.cccb.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/22/2021] [Accepted: 11/23/2021] [Indexed: 06/16/2023]
Abstract
The burden of vascular contribution to cognitive impairment and dementia is substantially high in India. There are approximately 5.3 million dementia patients in India and nearly 40% are estimated to be due to vascular dementia. Several factors pose unique challenges to reducing the burden of vascular dementia and vascular cognitive impairment (VCI) in India. Wide heterogeneity in vascular risk factor profile, diversity in socioeconomic, ethnic and dietary factors, as well as regional and rural-urban differences impact uniform implementation of preventive and therapeutic strategies. There is limited evidence on the natural history of vascular disease from longitudinal cohorts in India. Additionally, the lack of advanced brain imaging and genetic information pose challenges to understanding pathophysiology and treatment response to VCI in India. Efforts are now being made to implement programmes to reduce cardiovascular risk and VCI at the population level. Cognitive and functional measures appropriate to the diverse linguistic and educational context have been developed to diagnose VCI across India. Multicentric clinical and research cohorts of stroke are also being established. Filling research gaps and developing intervention strategies for the Indian context are crucial to address the growing burden of VCI.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Samim MM
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srijithesh Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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15
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Ahmed Burq HSI, Karimi H, Ahmad A, Gilani SA, Hanif A. Effect of whole-body vibration on obstacle clearance and stair negotiation time in chronic stroke patients; A randomized controlled trial. J Bodyw Mov Ther 2021; 27:698-704. [PMID: 34391309 DOI: 10.1016/j.jbmt.2021.05.012] [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: 08/09/2020] [Revised: 03/19/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the effect of Whole-Body Vibration (WBV) and Routine Physiotherapy (RP) on obstacle crossing and stair negotiation time in chronic stroke patients. METHODS The current study was randomized, parallel-group, assessor-blinded, clinical trial conducted in Physiotherapy Department of Lahore General Hospital, involving 64 patients with chronic stroke. Patients were randomly allocated to 2 groups, i.e., the WBV group (n = 32) and the RP group (n = 32). The WBV group was given additional twelve sessions of vibration therapy (amplitude of 3 mm and frequency of 20 Hz), 6 days/week for 2 weeks. The outcome measures were change in score of height and depth of obstacles cleared, i.e., 6, 8, 10 & 12 inches height and 6, 8, 10 & 12 inches depth and stair negotiation time, i.e., Stair-Climb Test. Chi square test, Independent sample t-test and Paired sample t-test were used to analyze the data. RESULTS Results show that higher number of patients improved in crossing the maximum height and maximum depth of obstacles in the WBV group but improvement was significant only in height, i.e., (p < 0.05). In the WBV group, Stair Negotiation Time decreased significantly as compared to the RP group, i.e., (p < 0.05). CONCLUSIONS The present study concluded that both study groups, i.e., RP and WBV, improved despite better results for the latter. Speed of stair climbing and capacity to cross obstacles improved with the WBV therapy in chronic stroke survivors. TRIAL REGISTRATION IRCT, IRCT20190328043131N1. Registered 03 august 2019 - Retrospectively registered, https://www.irct.ir/user/trial/38832/view.
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Affiliation(s)
- Hafiz Syed Ijaz Ahmed Burq
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Hossein Karimi
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Ashfaq Ahmad
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Syed Amir Gilani
- Dean Faculty of Allied Health Sciences, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Asif Hanif
- University Institute of Public Health, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
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16
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Shiekh SI, Forbes H, Mathur R, Smeeth L, Pearce N, Warren-Gash C. Ethnicity and risk of diagnosed dementia after stroke: a cohort study using the Clinical Practice Research Datalink. J Epidemiol Community Health 2020; 74:114-119. [PMID: 31699799 PMCID: PMC6993022 DOI: 10.1136/jech-2019-212825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/20/2019] [Accepted: 10/09/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The UK has over 1.2 million stroke survivors. Stroke is a major risk factor for dementia, and along with other risk factors such as hypertension and diabetes, is more common among Black, Asian and other ethnic minorities (BAME). We aimed to explore whether diagnosed dementia differed by ethnicity among adult stroke survivors. METHODOLOGY Using the UK Clinical Practice Research Datalink and linked hospital data, we conducted a cohort study among patients aged ≥40 years who had an incident stroke between 2005 and 2016. We fitted multivariable Cox proportional hazard models to estimate ethnic differences in the risk of poststroke dementia, adjusting for major clinical and social confounders. RESULTS Our cohort comprised 45 474 stroke survivors (mean age 72.6 years, 49% female), of whom 95.7% were White, 2.0% South Asian, 1.2% Black and 1.1% of Mixed/Other ethnicity. Of these, 4624 (10.2%) were diagnosed with poststroke dementia over a median follow-up of 3.26 years. Compared with the White ethnic group, those of Black ethnicity were 42% more likely to be diagnosed with dementia (adjusted HR 1.42, 95% CI 1.05 to 1.93). There was no association between any other ethnic group and poststroke dementia diagnosis. DISCUSSION There was good evidence that those of Black ethnicity had higher risk of diagnosed dementia poststroke. Further understanding of the mechanisms of this relationship could help target interventions at communities most at risk of dementia poststroke.
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Affiliation(s)
- Suhail Ismail Shiekh
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Harriet Forbes
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Charlotte Warren-Gash
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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