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Wei W, Ma D, Li L, Zhang L. Cognitive impairment in cerebral small vessel disease induced by hypertension. Neural Regen Res 2024; 19:1454-1462. [PMID: 38051887 PMCID: PMC10883517 DOI: 10.4103/1673-5374.385841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease, the most common cerebrovascular disease. However, the causal relationship between hypertension and cerebral small vessel disease remains unclear. Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease. Chronic hypertension and lifestyle factors are associated with risks for stroke and dementia, and cerebral small vessel disease can cause dementia and stroke. Hypertension is the main driver of cerebral small vessel disease, which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction, leukoaraiosis, white matter lesions, and intracerebral hemorrhage, ultimately resulting in cognitive decline and demonstrating that the brain is the target organ of hypertension. This review updates our understanding of the pathogenesis of hypertension-induced cerebral small vessel disease and the resulting changes in brain structure and function and declines in cognitive ability. We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.
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Affiliation(s)
- Weipeng Wei
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Denglei Ma
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lin Li
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lan Zhang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
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2
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Glans I, Nägga K, Gustavsson AM, Stomrud E, Nilsson PM, Melander O, Hansson O, Palmqvist S. Associations of modifiable and non-modifiable risk factors with cognitive functions - a prospective, population-based, 17 years follow-up study of 3,229 individuals. Alzheimers Res Ther 2024; 16:135. [PMID: 38926747 PMCID: PMC11202373 DOI: 10.1186/s13195-024-01497-6] [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: 11/10/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Although several cardiovascular, demographic, genetic and lifestyle factors have been associated with cognitive function, little is known about what type of cognitive impairment they are associated with. The aim was to examine the associations between different risk factors and future memory and attention/executive functions, and their interaction with APOE genotype. METHODS Participants from a large, prospective, population-based, Swedish study were included (n = 3,229). Linear regression models were used to examine baseline hypertension, body mass index (BMI), long-term glucose levels (HbA1c), different lipid levels, physical activity, alcohol consumption, smoking, education, APOE genotype, age and sex. All models were adjusted for follow-up time and basic demographics, and, in a second step, all significant predictors were included to examine independent effects. Follow-up outcomes were memory and attention/executive functions. RESULTS The mean age at baseline was 56.1 (SD 5.7) years and 59.7% were women. The mean follow-up time was 17.4 (range 14.3-20.8) years. When examining independent effects, APOE ε4 genotype(p < 0.01), and higher HbA1c(p < 0.001), were associated with future low memory function. Higher BMI (p < 0.05), and HbA1c(p < 0.05), lower high-density lipoprotein cholesterol (HDL-C)(p < 0.05)and stroke(p < 0.001) were associated with future low attention/executive function. The strongest factors associated with both better memory and attention/executive functions were higher education and alcohol consumption. Further, significant interaction effects between predictors and APOE genotype were found. For memory function, the protective effects of education were greater among ɛ4-carriers(p < 0.05). For attention/executive function, the protective effects of alcohol were greater among ɛ2 or ɛ4-carriers(p < 0.05). Also, attention/executive function was lower among ɛ4-carriers with higher BMI(p < 0.05) and ɛ2-carriers with higher HbA1c-levels(p < 0.05). CONCLUSIONS Targeting cardiovascular risk factors in mid-life could have greater effect on future attention/executive functions rather than memory, whereas targeting diabetes could be beneficial for multiple cognitive domains. In addition, effects of different risk factors may vary depending on the APOE genotype. The varied cognitive profiles suggest that different mechanisms and brain regions are affected by the individual risk factors. Having detailed knowledge about the specific cognitive effects of different risk factors might be beneficial in preventive health counseling.
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Affiliation(s)
- Isabelle Glans
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Anna-Märta Gustavsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Science, Lund University, Skåne University Hospital, Malmö, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Science, Lund University, Skåne University Hospital, Malmö, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
- Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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He CYY, Zhou Z, Kan MMP, Chan DHY, Wong ACT, Mok KHY, Lam FMH, Chan SCC, Cheung CKC, Yeung MKC, Wong AYL. Modifiable risk factors for mild cognitive impairment among cognitively normal community-dwelling older adults: A systematic review and meta-analysis. Ageing Res Rev 2024; 99:102350. [PMID: 38942197 DOI: 10.1016/j.arr.2024.102350] [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: 08/21/2023] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/30/2024]
Abstract
Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.
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Affiliation(s)
- Christo Y Y He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Zhixing Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Mandy M P Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Dorothy H Y Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Athena C T Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Kenny H Y Mok
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Freddy M H Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Sam C C Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Chelsia K C Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China.
| | - Michael K C Yeung
- Department of Psychology, The Education University of Hong Kong, 999077, Hong Kong Special Administrative Region of China.
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 999077, Hong Kong Special Administrative Region of China; Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China.
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Sinclair D, Canty AJ, Ziebell JM, Woodhouse A, Collins JM, Perry S, Roccati E, Kuruvilla M, Leung J, Atkinson R, Vickers JC, Cook AL, King AE. Experimental laboratory models as tools for understanding modifiable dementia risk. Alzheimers Dement 2024; 20:4260-4289. [PMID: 38687209 PMCID: PMC11180874 DOI: 10.1002/alz.13834] [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: 12/13/2023] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024]
Abstract
Experimental laboratory research has an important role to play in dementia prevention. Mechanisms underlying modifiable risk factors for dementia are promising targets for dementia prevention but are difficult to investigate in human populations due to technological constraints and confounds. Therefore, controlled laboratory experiments in models such as transgenic rodents, invertebrates and in vitro cultured cells are increasingly used to investigate dementia risk factors and test strategies which target them to prevent dementia. This review provides an overview of experimental research into 15 established and putative modifiable dementia risk factors: less early-life education, hearing loss, depression, social isolation, life stress, hypertension, obesity, diabetes, physical inactivity, heavy alcohol use, smoking, air pollution, anesthetic exposure, traumatic brain injury, and disordered sleep. It explores how experimental models have been, and can be, used to address questions about modifiable dementia risk and prevention that cannot readily be addressed in human studies. HIGHLIGHTS: Modifiable dementia risk factors are promising targets for dementia prevention. Interrogation of mechanisms underlying dementia risk is difficult in human populations. Studies using diverse experimental models are revealing modifiable dementia risk mechanisms. We review experimental research into 15 modifiable dementia risk factors. Laboratory science can contribute uniquely to dementia prevention.
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Affiliation(s)
- Duncan Sinclair
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Alison J. Canty
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
- Global Brain Health Institute, Trinity CollegeDublinIreland
| | - Jenna M. Ziebell
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Adele Woodhouse
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Jessica M. Collins
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Sharn Perry
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Maneesh Kuruvilla
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Jacqueline Leung
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Rachel Atkinson
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - James C. Vickers
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Anthony L. Cook
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
| | - Anna E. King
- Wicking Dementia Research and Education Centre, University of TasmaniaHobartTasmaniaAustralia
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Foti K, Coresh J, Whelton PK, Matsushita K, Hardy ST, Reynolds K, Bowling CB, Walker KA, Kucharska-Newton A, Windham BG, Griswold M, Schwartz JE, Muntner P. Maintenance of Normal Blood Pressure From Middle to Older Age: Results From the Atherosclerosis Risk in Communities Study. Hypertension 2024; 81:1356-1364. [PMID: 38567509 PMCID: PMC11096029 DOI: 10.1161/hypertensionaha.123.21823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND It is unknown whether maintaining normal blood pressure (BP) from middle to older age is associated with improved health outcomes. METHODS We estimated the proportion of Atherosclerosis Risk in Communities study participants who maintained normal BP from 1987 to 1989 (visit 1) through 1996 to 1998 and 2011 to 2013 (over 4 and 5 visits, respectively). Normal BP was defined as systolic BP <120 mm Hg and diastolic BP <80 mm Hg, without antihypertensive medication. We estimated the risk of cardiovascular disease, dementia, and poor physical functioning after visit 5. In exploratory analyses, we examined participant characteristics associated with maintaining normal BP. RESULTS Among 2699 participants with normal BP at baseline (mean age 51.3 years), 47.1% and 15.0% maintained normal BP through visits 4 and 5, respectively. The hazard ratios comparing participants who maintained normal BP through visit 4 but not visit 5 and through visit 5 versus those who did not maintain normal BP through visit 4 were 0.80 (95% CI, 0.63-1.03) and 0.60 (95% CI, 0.42-0.86), respectively, for cardiovascular disease, and 0.85 (95% CI, 0.71-1.01) and 0.69 (95% CI, 0.54-0.90), respectively, for poor physical functioning. Maintaining normal BP through visit 5 was more common among participants with normal body mass index versus obesity at visit 1, those with normal body mass index at visits 1 and 5, and those with overweight at visit 1 and overweight or normal body mass index at visit 5, compared with those with obesity at visits 1 and 5. CONCLUSIONS Maintaining normal BP was associated with a lower risk of cardiovascular disease and poor physical functioning.
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Affiliation(s)
- Kathryn Foti
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shakia T. Hardy
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - C. Barrett Bowling
- Department of Veterans Affairs, Durham Geriatrics Research Education and Clinical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland, USA
| | - Anna Kucharska-Newton
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - B. Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael Griswold
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Joseph E. Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
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Dinh M, Lin CC, Whitfield C, Farhan Z, Meurer WJ, Bailey S, Skolarus LE. Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial. JMIR Form Res 2024; 8:e54010. [PMID: 38805251 PMCID: PMC11167316 DOI: 10.2196/54010] [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: 10/31/2023] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease-related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. OBJECTIVE The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. METHODS Reach Out was a randomized, controlled, mobile health-based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message-linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). RESULTS Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. CONCLUSIONS Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718.
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Affiliation(s)
- Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Chun Chieh Lin
- Division of Health Services Research, Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Zahera Farhan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Bailey
- Bridges into the Future, Flint, MI, United States
| | - Lesli E Skolarus
- Davee Department of Neurology, Northwestern University, Chicago, IL, United States
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Fu T, Yang YQ, Tang CH, He P, Lei SF. Genetic effects and causal association analyses of 14 common conditions/diseases in multimorbidity patterns. PLoS One 2024; 19:e0300740. [PMID: 38753827 PMCID: PMC11098521 DOI: 10.1371/journal.pone.0300740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Multimorbidity has become an important health challenge in the aging population. Accumulated evidence has shown that multimorbidity has complex association patterns, but the further mechanisms underlying the association patterns are largely unknown. METHODS Summary statistics of 14 conditions/diseases were available from the genome-wide association study (GWAS). Linkage disequilibrium score regression analysis (LDSC) was applied to estimate the genetic correlations. Pleiotropic SNPs between two genetically correlated traits were detected using pleiotropic analysis under the composite null hypothesis (PLACO). PLACO-identified SNPs were mapped to genes by Functional Mapping and Annotation of Genome-Wide Association Studies (FUMA), and gene set enrichment analysis and tissue differential expression were performed for the pleiotropic genes. Two-sample Mendelian randomization analyses assessed the bidirectional causality between conditions/diseases. RESULTS LDSC analyses revealed the genetic correlations for 20 pairs based on different two-disease combinations of 14 conditions/diseases, and genetic correlations for 10 pairs were significant after Bonferroni adjustment (P<0.05/91 = 5.49E-04). Significant pleiotropic SNPs were detected for 11 pairs of correlated conditions/diseases. The corresponding pleiotropic genes were differentially expressed in the brain, nerves, heart, and blood vessels and enriched in gluconeogenesis and drug metabolism, biotransformation, and neurons. Comprehensive causal analyses showed strong causality between hypertension, stroke, and high cholesterol, which drive the development of multiple diseases. CONCLUSIONS This study highlighted the complex mechanisms underlying the association patterns that include the shared genetic components and causal effects among the 14 conditions/diseases. These findings have important implications for guiding the early diagnosis, management, and treatment of comorbidities.
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Affiliation(s)
- Ting Fu
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
| | - Yi-Qun Yang
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
| | - Chang-Hua Tang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, P. R. China
| | - Pei He
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
| | - Shu-Feng Lei
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
- Changzhou Geriatric Hospital Affiliated to Soochow University, Changzhou, China
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Zhou J, Liu W, Zhou H, Lau KK, Wong GH, Chan WC, Zhang Q, Knapp M, Wong IC, Luo H. Identifying dementia from cognitive footprints in hospital records among Chinese older adults: a machine-learning study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101060. [PMID: 38638410 PMCID: PMC11025003 DOI: 10.1016/j.lanwpc.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Background By combining theory-driven and data-driven methods, this study aimed to develop dementia predictive algorithms among Chinese older adults guided by the cognitive footprint theory. Methods Electronic medical records from the Clinical Data Analysis and Reporting System in Hong Kong were employed. We included patients with dementia diagnosed at 65+ between 2010 and 2018, and 1:1 matched dementia-free controls. We identified 51 features, comprising exposures to established modifiable factors and other factors before and after 65 years old. The performances of four machine learning models, including LASSO, Multilayer perceptron (MLP), XGBoost, and LightGBM, were compared with logistic regression models, for all patients and subgroups by age. Findings A total of 159,920 individuals (40.5% male; mean age [SD]: 83.97 [7.38]) were included. Compared with the model included established modifiable factors only (area under the curve [AUC] 0.689, 95% CI [0.684, 0.694]), the predictive accuracy substantially improved for models with all factors (0.774, [0.770, 0.778]). Machine learning and logistic regression models performed similarly, with AUC ranged between 0.773 (0.768, 0.777) for LASSO and 0.780 (0.776, 0.784) for MLP. Antipsychotics, education, antidepressants, head injury, and stroke were identified as the most important predictors in the total sample. Age-specific models identified different important features, with cardiovascular and infectious diseases becoming prominent in older ages. Interpretation The models showed satisfactory performances in identifying dementia. These algorithms can be used in clinical practice to assist decision making and allow timely interventions cost-effectively. Funding The Research Grants Council of Hong Kong under the Early Career Scheme 27110519.
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Affiliation(s)
- Jiayi Zhou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Wenlong Liu
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Huiquan Zhou
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gloria H.Y. Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Qingpeng Zhang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong SAR, China
| | - Martin Knapp
- Care Policy and Evaluation Centre (CPEC), The London School of Economics and Political Science, London, UK
| | - Ian C.K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Department of Computer Science, The University of Hong Kong, Hong Kong SAR, China
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9
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Won J, Maillard P, Shan K, Ashley J, Cardim D, Zhu DC, Zhang R. Association of Blood Pressure With Brain White Matter Microstructural Integrity Assessed With MRI Diffusion Tensor Imaging in Healthy Young Adults. Hypertension 2024; 81:1145-1155. [PMID: 38487873 PMCID: PMC11023804 DOI: 10.1161/hypertensionaha.123.22337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/28/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND High blood pressure (BP) in middle-aged and older adults is associated with a brain white matter (WM) microstructural abnormality. However, little evidence is available in healthy young adults. We investigated the associations between high BP and WM microstructural integrity in young adults. METHODS This study included 1015 healthy young adults (542 women, 22-37 years) from the Human Connectome Project. Brachial systolic and diastolic BP were measured using a semiautomatic or manual sphygmomanometer. Diffusion-weighted magnetic resonance imaging was acquired to obtain diffusion tensor imaging metrics of free water (FW) content, FW-corrected WM fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity. Using whole-brain voxel-wise linear regression models and ANCOVA, we examined associations of BP and hypertension stage with diffusion tensor imaging metrics after adjusting for age, sex, education, body mass index, smoking status, alcohol consumption history, and differences in the b value used for diffusion magnetic resonance imaging. RESULTS Systolic and diastolic BP of the sample (mean±SD) were 122.8±13.0 and 76.0±9.9 mm Hg, respectively. Associations of BP with diffusion tensor imaging metrics revealed regional heterogeneity for FW-corrected fractional anisotropy. High BP and high hypertension stage were associated with higher FW and lower FW-corrected axial diffusivity, FW-corrected radial diffusivity, and FW-corrected mean diffusivity. Moreover, associations of high diastolic BP and hypertension stage with high FW were found only in men not in women. CONCLUSIONS High BP in young adults is associated with altered brain WM microstructural integrity, suggesting that high BP may have damaging effects on brain WM microstructural integrity in early adulthood, particularly in men.
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Affiliation(s)
- Junyeon Won
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, CA, USA
| | - Kevin Shan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Ashley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Danilo Cardim
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - David C. Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, Michigan, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Jalanko P, Bond B, Laukkanen JA, Brage S, Ekelund U, Laitinen T, Määttä S, Kähönen M, Haapala EA, Lakka TA. Association between arterial health and cognition in adolescents: The PANIC study. Physiol Rep 2024; 12:e16024. [PMID: 38697946 PMCID: PMC11065692 DOI: 10.14814/phy2.16024] [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: 12/13/2023] [Revised: 03/11/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024] Open
Abstract
We investigated the associations of the measures of arterial health with cognition in adolescents and whether physical activity (PA) or sedentary time (ST) confounds these associations. One hundred sixteen adolescents (71 boys) aged 15.9 ± 0.4 participated in the study. PA and ST were assessed using a combined accelerometer/heart rate monitor. Overall cognition was computed from the results of psychomotor function, attention, working memory, and paired-associate learning tests. Pulse wave velocity was measured by impedance cardiography, carotid intima-media thickness, and carotid artery distensibility by carotid ultrasonography. Systolic and diastolic blood pressure (SBP and DBP) were measured using an aneroid sphygmomanometer. SBP was inversely associated with overall cognition (standardized regression coefficient [β] = -0.216, 95% confidence interval (CI) -0.406 to -0.027, p = 0.025). Pulse wave velocity (β = -0.199, 95% CI -0.382 to -0.017, p = 0.033) was inversely associated with working memory task accuracy. SBP was directly associated with reaction time in the attention (β = 0.256, 95% CI 0.069 to 0.443, p = 0.008) and errors in the paired-associate learning tasks (β = 0.308, 95% CI 0.126 to 0.489, p = 0.001). Blood pressure was inversely associated with overall cognition. PA or ST did not confound the associations. Results suggest that preventing high blood pressure is important for promoting cognition in adolescents.
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Affiliation(s)
- Petri Jalanko
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
- Helsinki Clinic for Sports and Exercise MedicineFoundation for Sports and Exercise MedicineHelsinkiFinland
| | - Bert Bond
- Children's Health and Exercise Research Centre, Sport and Health Science, College of Life and Environmental SciencesUniversity of ExeterExeterUK
| | - Jari A. Laukkanen
- Department of Medicine, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
- Department of MedicineCentral Finland Health Care District Hospital DistrictJyväskyläFinland
| | - Soren Brage
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - Ulf Ekelund
- Department of Sports MedicineNorwegian School of Sport SciencesOsloNorway
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear ImagingUniversity of Eastern Finland and Kuopio University HospitalKuopioFinland
| | - Sara Määttä
- Department of Clinical NeurophysiologyKuopio University HospitalKuopioFinland
| | - Mika Kähönen
- Department of Clinical PhysiologyTampere University Hospital and Faculty of Medicine and Health Technology, Tampere UniversityTampereFinland
| | - Eero A. Haapala
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
| | - Timo A. Lakka
- Department of Clinical Physiology and Nuclear ImagingUniversity of Eastern Finland and Kuopio University HospitalKuopioFinland
- Institute of Biomedicine, School of MedicineUniversity of Eastern FinlandKuopioFinland
- Foundation for Research in Health Exercise and NutritionKuopio Research Institute of Exercise MedicineKuopioFinland
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11
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Alateeq K, Walsh EI, Ambikairajah A, Cherbuin N. Association between dietary magnesium intake, inflammation, and neurodegeneration. Eur J Nutr 2024:10.1007/s00394-024-03383-1. [PMID: 38597977 DOI: 10.1007/s00394-024-03383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Consistent evidence shows that magnesium (Mg) intake is associated with lower blood pressure (BP), and that lower BP is associated with improved cerebral health. However, recent findings indicate that the positive effect of dietary Mg intake on cerebral health is not mediated by a decrease in BP. As Mg's anti-inflammatory action is a plausible alternative mechanism, the objective of this study was to investigate the associations between Mg intake and inflammation to determine whether it mediates any neuroprotective effect. METHODS Participants from the UK Biobank (n = 5775, aged 40-73 years, 54.7% female) were assessed for dietary magnesium using an online food questionnaire, brain and white matter lesion (WML) volumes were segmented with FreeSurfer software, and inflammation markers including high-sensitivity C-reactive protein (hs-CRP), leukocyte, erythrocyte count, and Glycoprotein acetylation (GlycA) were measured using specific laboratory techniques such as immunoturbidimetry, automated cell counting, and nuclear magnetic resonance. Hierarchical linear regression models were performed to investigate the association between dietary Mg, and inflammatory markers and between dietary Mg, brain and WMLs volumes. Mediation analysis was performed to test a possible mediation role of inflammation on the association between dietary Mg and brain and WMLs volumes. RESULTS Higher dietary Mg intake was associated with lower inflammation: hs-CRP level (- 0.0497%; 95% confidence interval [CI] - 0.0497%, - 0.0199%) leukocytes count (- 0.0015%; 95%CI - 0.00151%, - 0.0011%), and GlycA (- 0.0519%; 95%CI - 0.1298%, - 0.0129%). Moreover, higher dietary Mg intake was associated with larger grey matter volume (0.010%; 95%CI 0.004%, 0.017%), white matter volume (0.012%; 95%CI 0.003, 0.022) and right hippocampal volume (0.002%; 95%CI 0.0007, -0.0025%). Lower hs-CRP levels mediated the positive association between higher dietary Mg intake and larger grey matter volume. CONCLUSIONS The anti-inflammatory effects of dietary Mg intake in the general population, appears to mediate its neuroprotective effect.
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Affiliation(s)
- Khawlah Alateeq
- National Centre for Epidemiology and Population Health, Australian National University, 54 Mills Road, Canberra, ACT, 2601, Australia.
- Radiological Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia.
| | - Erin I Walsh
- National Centre for Epidemiology and Population Health, Australian National University, 54 Mills Road, Canberra, ACT, 2601, Australia
| | - Ananthan Ambikairajah
- National Centre for Epidemiology and Population Health, Australian National University, 54 Mills Road, Canberra, ACT, 2601, Australia
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Canberra, 2617, Australia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, Australian National University, 54 Mills Road, Canberra, ACT, 2601, Australia
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12
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Popiołek AK, Niznikiewicz MA, Borkowska A, Bieliński MK. Evaluation of Event-Related Potentials in Somatic Diseases - Systematic Review. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09642-5. [PMID: 38564137 DOI: 10.1007/s10484-024-09642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Many somatic illnesses (e.g. hypertension, diabetes, pulmonary and cardiac diseases, hepatitis C, kidney and heart failure, HIV infection, Sjogren's disease) may impact central nervous system functions resulting in emotional, sensory, cognitive or even personality impairments. Event-related potential (ERP) methodology allows for monitoring neurocognitive processes and thus can provide a valuable window into these cognitive processes that are influenced, or brought about, by somatic disorders. The current review aims to present published studies on the relationships between somatic illness and brain function as assessed with ERP methodology, with the goal to discuss where this field of study is right now and suggest future directions.
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Affiliation(s)
- Alicja K Popiołek
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Curie Sklodowskiej 9, 85-094, Bydgoszcz, Poland.
| | - Margaret A Niznikiewicz
- Medical Center, Harvard Medical School and Boston VA Healthcare System, Psychiatry 116a C/O R. McCarly 940 Belmont St, Brockton, MA, 02301, USA
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Curie Sklodowskiej 9, 85-094, Bydgoszcz, Poland
| | - Maciej K Bieliński
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Curie Sklodowskiej 9, 85-094, Bydgoszcz, Poland
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13
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Li Z, Sang F, Zhang Z, Li X. Effect of the duration of hypertension on white matter structure and its link with cognition. J Cereb Blood Flow Metab 2024; 44:580-594. [PMID: 37950676 PMCID: PMC10981405 DOI: 10.1177/0271678x231214073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/22/2023] [Accepted: 10/21/2023] [Indexed: 11/13/2023]
Abstract
The relation between hypertension (HTN) and cognition has been reported inclusive results, which may be affected by disease duration. Our study aimed to examine the influence of HTN duration on cognition and its underlying white matter (WM) changes including macrostructural WM hyperintensities (WMH) and microstructural WM integrity. A total of 1218 patients aged ≥55 years with neuropsychological assessment and a subgroup of 233 people with imaging data were recruited and divided into 3 groups (short duration: <5 years, medium duration: 5-20 years, long duration: >20 years). We found that greater HTN duration was preferentially related to worse executive function (EF), processing speed (PS), and more severe WMH, which became more significant during long duration stage. The reductions in WM integrity were evident at the early stage especially in long-range association fibers and then scattered through the whole brain. Increasing WMH and decreasing integrity of specific tracts consistently undermined EF. Furthermore, free water imaging method greatly enhanced the sensitivity in detecting HTN-related WM alterations. These findings supported that the neurological damaging effects of HTN is cumulative and neuroimaging markers of WM at macro- and microstructural level underlie the progressive effect of HTN on cognition.
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Affiliation(s)
- Zilin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Feng Sang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
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14
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AlHarkan KS, Aldhawyan AF, Bahamdan AS, Alqurashi YD, Aldulijan FA, Alsamin SI, Alotaibi JK, Alumran AK. Association between multimorbidity and cognitive decline in the elderly population of the Eastern Province, Saudi Arabia. J Family Community Med 2024; 31:99-106. [PMID: 38800794 PMCID: PMC11114873 DOI: 10.4103/jfcm.jfcm_268_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Cognitive decline affects the quality of life, and dementia affects independence in daily life activities. Multimorbidity in older adults is associated with a higher risk of cognitive impairment. This research aims to study the relationship between cognitive decline and multimorbidity in the elderly population in the Eastern Province, Saudi Arabia. MATERIALS AND METHODS This cross-sectional research was conducted from July to October 2022 among adults over 60 years. All patients with two or more comorbidities were contacted for a face-to-face interview and cognitive testing to estimate cognitive function by trained family physicians using St. Louis University Mental State Examination. ANOVA and Chi-square test were used to test for statistical significance. Binary logistic regression was used to show the odds of having cognitive impairment and multimorbidity. All tests were performed at 5% level of significance. RESULTS The study involved 343 individuals; majority (74.1%) aged 60-75 years and were males (67.9%). Hypertension, diabetes, and chronic pain were reported by 56%, 48%, and 44% participants, respectively. Thirty percent participants had 3 or more comorbidities. About 36% had mild neurocognitive disorder and 31.2% had dementia. The results showed that age, gender (female), diabetes, stroke, chronic pain, and multimorbidity were significantly associated with cognitive impairment. In our study, hypertension, coronary artery diseases, depression, and anxiety were not significantly associated with risk of cognitive decline. CONCLUSION Our study found that multimorbidity is significantly associated with cognitive decline. Controlling comorbidities and preventing risk factors in midlife could help in delaying the progression of the disease.
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Affiliation(s)
- Khalid S. AlHarkan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Adam F. Aldhawyan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed S. Bahamdan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yousef D. Alqurashi
- Department of Respiratory Care, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fajar A. Aldulijan
- Department of Family Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Sarah I. Alsamin
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jood K. Alotaibi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa K. Alumran
- Department of Health Information Management, College of Public Health, Imam Abdulrahman Bin Faisal, University, Dammam, Saudi Arabia
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15
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Canli U, Aldhahi MI, Küçük H. Association of Physiological Performance, Physical Fitness, and Academic Achievement in Secondary School Students. CHILDREN (BASEL, SWITZERLAND) 2024; 11:396. [PMID: 38671613 PMCID: PMC11049434 DOI: 10.3390/children11040396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/23/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
This study aimed to compare the physiological performance and physical fitness based on the academic achievement levels of secondary school students and to explore the effect of gender on the relationship between physiological performance, physical fitness, and academic achievement. In this cross-sectional study, 304 children aged 13-14 years were recruited. To assess physical fitness, students performed a 20 m sprint test, a pro-agility test, a one-mile endurance run/walk test, and a countermovement jump test. At the end of the one-mile endurance run/walk test, the estimated VO2peak value of the participants was calculated. The physiological performance of the students was determined by measuring their resting heart rate and blood pressure. Students were grouped into three categories based on their academic achievement levels. The assessment of academic achievement considered their scores from the previous academic year. The scores were divided into three levels: poor (average score of 69 points or less), average (scores ranging from 70 to 84 points), and good (scores of 85 points or higher). The study revealed a notable disparity among students' VO2Max measurements based on their academic achievement (F = 8.938, p < 0.001, η2 = 0.056). However, we observed that the group with poor academic achievement displayed lower diastolic blood pressure values than the groups with average and good performances. Finally, no significant gender differences were evident in the relationship between academic achievement and any of the physical and physiological parameters.
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Affiliation(s)
- Umut Canli
- Sports Science Faculty, Tekirdag Namik Kemal University, Suleymanpasa, Tekirdag 59010, Turkey;
| | - Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Hamza Küçük
- Yasar Dogu Faculty of Sport Sciences, Ondokuz Mayıs University, Samsun 55270, Turkey;
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16
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Zou X, Shi Y, Su J, Ye Q, Lin F, Cai G. Association between 2,4-dichlorophenoxyacetic acid and cognitive impairment in older adults: a cross-sectional study from NHANES 2001-2002 and 2011-2014. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:308-316. [PMID: 38129668 DOI: 10.1038/s41370-023-00628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND 2,4-Dichlorophenoxyacetic acid (2,4-D) is reported to be the most widely used herbicide in home and garden environments, rendering it commonly encountered in daily life. Despite being ubiquitous, there is a scarcity of studies that have comprehensively assessed the relationship between 2,4-D exposure and cognition using multiple models. OBJECTIVE To explore the association between 2,4-D exposure and cognition among older American people. METHODS This was a cross-sectional study that included 3 cycles of data from the National Health and Nutrition Examination Survey. Generalized linear models (GLMs), restricted cubic spline (RCS) regression, and generalized additive models (GAMs) were used to assess the relationship between exposure to 2,4-D and cognitive performance by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning sub-test, Digit Symbol Substitution Test (DSST), and Animal Fluency Test (AFT). RESULTS A total of 1364 older U.S. adults (60+ years) were included in the study. The GLMs revealed a negative association between median high levels (0.315-0.566 μg/L) of 2,4-D and cognitive impairment on the DSST and AFT, with multivariate-adjusted ORs of 0.403 (95% CI: 0.208-0.781, P = 0.009) and 0.396 (95% CI: 0.159-0.986, P = 0.047); the RCS regression and GAMs revealed a "U" shaped curve, the left part of which is consistent with the result of the GLMs. IMPACT STATEMENT There is a U-shaped relationship between human urinary 2,4-D concentrations and cognitive impairment in older U.S. adults, especially in males, so controlling 2,4-D exposure within an appropriate range is particularly important for cognitive function.
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Affiliation(s)
- Xinyang Zou
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, China
- Fujian Medical University, Fuzhou, 35001, China
| | - Yisen Shi
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, China
- Fujian Medical University, Fuzhou, 35001, China
| | - Jiaqi Su
- Fujian Medical University, Fuzhou, 35001, China
| | - Qinyong Ye
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, China
| | - Fabin Lin
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
| | - Guoen Cai
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, China.
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17
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Massengale K, Barnes VA, Williams C, Mansuri A, Norland K, Altvater M, Bailey H, Harris RA, Su S, Wang X. Nocturnal blood pressure dipping, blood pressure variability, and cognitive function in early and middle-aged adults. J Clin Hypertens (Greenwich) 2024; 26:235-240. [PMID: 38332546 PMCID: PMC10918738 DOI: 10.1111/jch.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024]
Abstract
Higher nighttime blood pressure (BP), less BP dipping, and higher BP variability have been linked with worse cognitive function in the elderly. The goal of this study is to explore whether this relationship already exists in early and middle adulthood. We further examined whether ethnic differences between African Americans and European Americans in BP parameters can explain ethnic differences in cognitive function. 24-h ambulatory BP monitoring and cognitive function were obtained from 390 participants (average age: 37.2 years with a range of 25-50; 54.9% African Americans; 63.6% females). We observed that higher nighttime BP, decreased dipping, and higher variability were significantly associated with lower scores on the Picture Sequence Memory Test. Significant negative associations between variability and overall composite scores were also observed. No significant associations between average 24-h or daytime BP and cognitive function were observed. Ethnic differences in nighttime diastolic pressures and dipping can explain 6.81% to 10.8% of the ethnicity difference in the score of the Picture Sequence Memory Test (ps < .05). This study suggests that the associations of nighttime BP, dipping, and variability with cognitive function already exist in young and middle-aged adults. Ethnic differences in nighttime BP and dipping can at least partially explain ethnic differences in cognitive function. The stronger association of these parameters with cognitive function than daytime or average BP in this age range raises the importance of using ambulatory BP monitoring for more precise detection of abnormal BP patterns in young adulthood.
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Affiliation(s)
| | - Vernon A. Barnes
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Celestin Williams
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Asifhusen Mansuri
- Division of Pediatric Nephrology and HypertensionChildren's Hospital of GeorgiaMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Kimberly Norland
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Michelle Altvater
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Hallie Bailey
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Ryan A. Harris
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Shaoyong Su
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
| | - Xiaoling Wang
- Georgia Prevention InstituteMedical College of GeorgiaAugusta UniversityAugustaGeorgiaUSA
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18
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Jamka M, Chrobot M, Jaworska N, Brylak J, Makarewicz-Bukowska A, Popek J, Janicka A, Walkowiak J. Comparison of Eating Habits, Body Composition and Densitometric Parameters between Subjects with Normal Cognitive Function and Mild Cognitive Impairment: An Observational Study. Nutrients 2024; 16:644. [PMID: 38474772 PMCID: PMC10934958 DOI: 10.3390/nu16050644] [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: 01/13/2024] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
The role of nutrition in the ageing process of the brain is pivotal. Therefore, the study aimed to compare eating habits, body composition and densitometric parameters between subjects with normal cognitive function (NCF) and mild cognitive impairment (MCI). A total of 95 subjects with NCF (74% of women) and 95 individuals with MCI (77% of women) aged 50-70 years were studied. Densitometric parameters were evaluated using dual-energy X-ray absorptiometry methods. Eating habits were assessed using the food frequency questionnaire and 3-day diary records, and advanced glycation end products (AGEs) intake was calculated. Significant differences between groups were detected for the %fat in the right arm (NCF vs. MCI: 38.4 (30.4-46.8) vs. 43.5 (35.5-49.2)%, p = 0.0407). Moreover, the MCI group had a significantly lower intake of calcium (p = 0.0010), phosphor (p = 0.0411), vitamins B2 (p = 0.0138) and B12 (p = 0.0024) compared to the NCF group, with both groups also differing in the frequency of butter (p = 0.0191) and fermented milk beverages (p = 0.0398) intake. Analysis restricted to women showed significant differences between groups in right arm %fat, VAT mass, calcium, vitamins B2, B12, butter and fermented milk products intake, while in men, differences were detected in the intake of calcium, iodine, vitamin B1, water and AGEs. In conclusion, subjects with NCF and MCI have comparable densitometric variables but differ significantly in some body composition parameters and the intake of some food groups and nutrients.
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Affiliation(s)
| | | | | | | | | | | | | | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572 Poznań, Poland; (M.J.); (M.C.); (N.J.); (J.B.); (A.M.-B.); (J.P.); (A.J.)
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Hung TH, Chen VCH, Chuang YC, Hsu YH, Wu WC, Tsai YH, McIntyre RS, Weng JC. Investigating the effect of hypertension on vascular cognitive impairment by using the resting-state functional connectome. Sci Rep 2024; 14:4580. [PMID: 38403657 PMCID: PMC10894879 DOI: 10.1038/s41598-024-54996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
Hypertension (HTN) affects over 1.2 billion individuals worldwide and is defined as systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. Hypertension is also considered a high risk factor for cerebrovascular diseases, which may lead to vascular cognitive impairment (VCI). VCI is associated with executive dysfunction and is also a transitional stage between hypertension and vascular dementia. Hence, it is essential to establish a reliable approach to diagnosing the severity of VCI. In 28 HTN (51-83 yrs; 18 males, 10 females) and 28 healthy controls (HC) (51-75 yrs; 7 males, 21 females), we investigated which regions demonstrate alterations in the resting-state functional connectome due to vascular cognitive impairment in HTN by using the amplitude of the low-frequency fluctuations (ALFF), regional homogeneity (ReHo), graph theoretical analysis (GTA), and network-based statistic (NBS) methods. In the group comparison between ALFF/ReHo, HTN showed reduced spontaneous activity in the regions corresponding to vascular or metabolic dysfunction and enhanced brain activity, mainly in the primary somatosensory cortex and prefrontal areas. We also observed cognitive dysfunction in HTN, such as executive function, processing speed, and memory. Both the GTA and NBS analyses indicated that the HTN demonstrated complex local segregation, worse global integration, and weak functional connectivity. Our findings show that resting-state functional connectivity was altered, particularly in the frontal and parietal regions, by hypertensive individuals with potential vascular cognitive impairment.
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Affiliation(s)
- Tai-Hsin Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Chen Chuang
- Institute of Medical Device and Imaging, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Wen-Chau Wu
- Institute of Medical Device and Imaging, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan.
- Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.
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20
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AlHarkan K, Sultana N, Al Mulhim N, AlAbdulKader AM, Alsafwani N, Barnawi M, Alasqah K, Bazuhair A, Alhalwah Z, Bokhamseen D, Aljameel SS, Alamri S, Alqurashi Y, Ghamdi KA. Artificial intelligence approaches for early detection of neurocognitive disorders among older adults. Front Comput Neurosci 2024; 18:1307305. [PMID: 38444404 PMCID: PMC10913197 DOI: 10.3389/fncom.2024.1307305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Dementia is one of the major global health issues among the aging population, characterized clinically by a progressive decline in higher cognitive functions. This paper aims to apply various artificial intelligence (AI) approaches to detect patients with mild cognitive impairment (MCI) or dementia accurately. Methods Quantitative research was conducted to address the objective of this study using randomly selected 343 Saudi patients. The Chi-square test was conducted to determine the association of the patient's cognitive function with various features, including demographical and medical history. Two widely used AI algorithms, logistic regression and support vector machine (SVM), were used for detecting cognitive decline. This study also assessed patients' cognitive function based on gender and developed the predicting models for males and females separately. Results Fifty four percent of patients have normal cognitive function, 34% have MCI, and 12% have dementia. The prediction accuracies for all the developed models are greater than 71%, indicating good prediction capability. However, the developed SVM models performed the best, with an accuracy of 93.3% for all patients, 94.4% for males only, and 95.5% for females only. The top 10 significant predictors based on the developed SVM model are education, bedtime, taking pills for chronic pain, diabetes, stroke, gender, chronic pains, coronary artery diseases, and wake-up time. Conclusion The results of this study emphasize the higher accuracy and reliability of the proposed methods in cognitive decline prediction that health practitioners can use for the early detection of dementia. This research can also stipulate substantial direction and supportive intuitions for scholars to enhance their understanding of crucial research, emerging trends, and new developments in future cognitive decline studies.
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Affiliation(s)
- Khalid AlHarkan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nahid Sultana
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noura Al Mulhim
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Assim M. AlAbdulKader
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor Alsafwani
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwah Barnawi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khulud Alasqah
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Anhar Bazuhair
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zainab Alhalwah
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dina Bokhamseen
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sumayh S. Aljameel
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sultan Alamri
- Department of Family Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yousef Alqurashi
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Kholoud Al Ghamdi
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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21
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Li QY, Hu HY, Zhang GW, Hu H, Ou YN, Huang LY, Wang AY, Gao PY, Ma LY, Tan L, Yu JT. Associations between cardiometabolic multimorbidity and cerebrospinal fluid biomarkers of Alzheimer's disease pathology in cognitively intact adults: the CABLE study. Alzheimers Res Ther 2024; 16:28. [PMID: 38321520 PMCID: PMC10848421 DOI: 10.1186/s13195-024-01396-w] [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: 08/08/2023] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Cardiometabolic multimorbidity is associated with an increased risk of dementia, but the pathogenic mechanisms linking them remain largely undefined. We aimed to assess the associations of cardiometabolic multimorbidity with cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) pathology to enhance our understanding of the underlying mechanisms linking cardiometabolic multimorbidity and AD. METHODS This study included 1464 cognitively intact participants from the Chinese Alzheimer's Biomarker and LifestylE (CABLE) database. Cardiometabolic diseases (CMD) are a group of interrelated disorders such as hypertension, diabetes, heart diseases (HD), and stroke. Based on the CMD status, participants were categorized as CMD-free, single CMD, or CMD multimorbidity. CMD multimorbidity is defined as the coexistence of two or more CMDs. The associations of cardiometabolic multimorbidity and CSF biomarkers were examined using multivariable linear regression models with demographic characteristics, the APOE ε4 allele, and lifestyle factors as covariates. Subgroup analyses stratified by age, sex, and APOE ε4 status were also performed. RESULTS A total of 1464 individuals (mean age, 61.80 years; age range, 40-89 years) were included. The markers of phosphorylated tau-related processes (CSF P-tau181: β = 0.165, P = 0.037) and neuronal injury (CSF T-tau: β = 0.065, P = 0.033) were significantly increased in subjects with CMD multimorbidity (versus CMD-free), but not in those with single CMD. The association between CMD multimorbidity with CSF T-tau levels remained significant after controlling for Aβ42 levels. Additionally, significantly elevated tau-related biomarkers were observed in patients with specific CMD combinations (i.e., hypertension and diabetes, hypertension and HD), especially in long disease courses. CONCLUSIONS The presence of cardiometabolic multimorbidity was associated with tau phosphorylation and neuronal injury in cognitively normal populations. CMD multimorbidity might be a potential independent target to alleviate tau-related pathologies that can cause cognitive impairment.
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Affiliation(s)
- Qiong-Yao Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - He-Ying Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - Gao-Wen Zhang
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Hao Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - Liang-Yu Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - An-Yi Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - Pei-Yang Gao
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - Li-Yun Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No.5 Donghai Middle Road, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, China.
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22
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Valsdóttir V, Jónsdóttir MK, Magnúsdóttir BB, Chang M, Hu YH, Gudnason V, Launer LJ, Stefánsson H. Comparative study of machine learning methods for modeling associations between risk factors and future dementia cases. GeroScience 2024; 46:737-750. [PMID: 38135769 PMCID: PMC10828447 DOI: 10.1007/s11357-023-01040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
A substantial portion of dementia risk can be attributed to modifiable risk factors that can be affected by lifestyle changes. Identifying the contributors to dementia risk could prove valuable. Recently, machine learning methods have been increasingly applied to healthcare data. Several studies have attempted to predict dementia progression by using such techniques. This study aimed to compare the performance of different machine-learning methods in modeling associations between known cognitive risk factors and future dementia cases. A subset of the AGES-Reykjavik Study dataset was analyzed using three machine-learning methods: logistic regression, random forest, and neural networks. Data were collected twice, approximately five years apart. The dataset included information from 1,491 older adults who underwent a cognitive screening process and were considered to have healthy cognition at baseline. Cognitive risk factors included in the models were based on demographics, MRI data, and other health-related data. At follow-up, participants were re-evaluated for dementia using the same cognitive screening process. Various performance metrics for all three machine learning algorithms were assessed. The study results indicate that a random forest algorithm performed better than neural networks and logistic regression in predicting the association between cognitive risk factors and dementia. Compared to more traditional statistical analyses, machine-learning methods have the potential to provide more accurate predictions about which individuals are more likely to develop dementia than others.
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Affiliation(s)
- Vaka Valsdóttir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.
- RHLÖ - Icelandic Gerontological Research Center, Landspítali University Hospital, Reykjavik, Iceland.
| | - María K Jónsdóttir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Mental Health Services, Landspitali University Hospital, Reykjavik, Iceland
| | - Brynja Björk Magnúsdóttir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Mental Health Services, Landspitali University Hospital, Reykjavik, Iceland
| | - Milan Chang
- RHLÖ - Icelandic Gerontological Research Center, Landspítali University Hospital, Reykjavik, Iceland
| | - Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, National Institutes of Health (NIH), Bethesda, MD, USA
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23
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Lamar M, Arfanakis K, Evia A, Makkinejad N, Capuano AW, Kim N, Leurgans SE, Fleischman DA, Duke Han S, Poole V, Barnes LL. Changes in an in-vivo classifier of ARTerioloSclerosis (ARTS) with simultaneous change in cognition for older African Americans. Neurobiol Aging 2024; 134:21-27. [PMID: 37979249 PMCID: PMC10845033 DOI: 10.1016/j.neurobiolaging.2023.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
At autopsy, African American decedents often have mixed Alzheimer's and cerebrovascular brain pathologies including arteriolosclerosis. We applied a novel in-vivo classifier of ARTerioloSclerosis (ARTS) in 167 older African Americans (∼75y of age) with > 2 biennial 3 T MRI scans and > 3 years of associated cognitive follow-up to determine if ARTS scores (higher score=higher likelihood of arteriolosclerosis) changed over time and if this change associated with changes in cognition in the same individuals. Mixed effects regression models tested whether ARTS scores increased over time, while simultaneous mixed effects regression models estimated the simultaneous rates of change in both ARTS and cognition and the correlation of these changes. ARTS scores increased over time (estimate=0.030, SE=0.002, p < 0.0001). Faster increases in ARTS were associated with faster rates of global cognitive decline (r = -0.447, p = 0.006) and domain-specific cognitive functions. Applying an in-vivo marker of arteriolosclerosis in an African American cohort revealed that the likelihood of arteriolosclerosis increases over time, and participants whose ARTS scores increased more rapidly tended to have faster than average rates of cognitive decline.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, USA; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA; Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Nazanin Makkinejad
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Namhee Kim
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - S Duke Han
- Rush Alzheimer's Disease Center, USA; Department of Family Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Victoria Poole
- Rush Alzheimer's Disease Center, USA; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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24
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Ruck JM, Chu NM, Liu Y, Li Y, Chen Y, Mathur A, Carlson MC, Crews DC, Chodosh J, Segev DL, McAdams-DeMarco M. Association of Postoperative Delirium With Incident Dementia and Graft Outcomes Among Kidney Transplant Recipients. Transplantation 2024; 108:530-538. [PMID: 37643030 PMCID: PMC10840878 DOI: 10.1097/tp.0000000000004779] [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] [Indexed: 08/31/2023]
Abstract
BACKGROUND Kidney transplant (KT) recipients have numerous risk factors for delirium, including those shared with the general surgical population (eg, age and major surgery) and transplant-specific factors (eg, neurotoxic immunosuppression medications). Evidence has linked delirium to long-term dementia risk in older adults undergoing major surgery. We sought to characterize dementia risk associated with post-KT delirium. METHODS Using the United States Renal Data System datasets, we identified 35 800 adult first-time KT recipients ≥55 y. We evaluated risk factors for delirium using logistic regression. We evaluated the association between delirium and incident dementia (overall and by subtype: Alzheimer's, vascular, and other/mixed-type), graft loss, and death using Fine and Gray's subhazards models and Cox regression. RESULTS During the KT hospitalization, 0.9% of recipients were diagnosed with delirium. Delirium risk factors included age (OR = 1.40, 95% CI, 1.28-1.52) and diabetes (OR = 1.38, 95% CI, 1.10-1.73). Delirium was associated with higher risk of death-censored graft loss (aHR = 1.52, 95% CI, 1.12-2.05) and all-cause mortality (aHR = 1.53, 95% CI, 1.25-1.89) at 5 y post-KT. Delirium was also associated with higher risk of dementia (adjusted subhazard ratio [aSHR] = 4.59, 95% CI, 3.48-6.06), particularly vascular dementia (aSHR = 2.51, 95% CI, 1.01-6.25) and other/mixed-type dementia (aSHR = 5.58, 95% CI, 4.24-7.62) subtypes. The risk of all-type dementia associated with delirium was higher for younger recipients aged between 55 and 64 y ( Pinteraction = 0.01). CONCLUSIONS Delirium is a strong risk factor for subsequent diagnosis of dementia among KT recipients, particularly those aged between 55 and 64 y at the time of transplant. Patients experiencing posttransplant delirium might benefit from early interventions to enhance cognitive health and surveillance for cognitive impairment to enable early referral for dementia care.
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Affiliation(s)
- Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yi Liu
- Department of Surgery, New York University Grossman School of Medicine and Langone Health, New York, NY
| | - Yiting Li
- Department of Surgery, New York University Grossman School of Medicine and Langone Health, New York, NY
| | - Yusi Chen
- Department of Surgery, New York University Grossman School of Medicine and Langone Health, New York, NY
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua Chodosh
- Department of Population Health, New York University Grossman School of Medicine and Langone Health, New York, NY
- Department of Medicine, New York University Grossman School of Medicine and Langone Health, New York, NY
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine and Langone Health, New York, NY
- Department of Population Health, New York University Grossman School of Medicine and Langone Health, New York, NY
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine and Langone Health, New York, NY
- Department of Population Health, New York University Grossman School of Medicine and Langone Health, New York, NY
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25
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Joyce OC, McHugh C, Mockler D, Wilson F, Kelly ÁM. Midlife hypertension is a risk factor for some, but not all, domains of cognitive decline in later life: a systematic review and meta-analysis. J Hypertens 2024; 42:205-223. [PMID: 37937515 PMCID: PMC10763710 DOI: 10.1097/hjh.0000000000003614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Management of midlife blood pressure and hypertension status may provide a window of intervention to mitigate cognitive decline with advancing age. The aim of this review was to investigate the relationship between midlife hypertension and cognition in midlife and later life. METHODS Online electronic databases were searched from their inception to May 2022. Studies assessing midlife (40-65 years) hypertension and cognition at mid and/or later-life were included. A random effects meta-analysis was deemed appropriate. RESULTS One hundred forty-nine studies across 26 countries were included. Qualitative synthesis found negative relationships between midlife hypertension and later life cognition in the domains of memory, executive function, and global cognition. Metanalytical evidence revealed midlife hypertension negatively impacts memory, executive function, and global cognition but had no observed effect on attention at midlife. DISCUSSION Hypertension at midlife has a significant negative impact on cognition in mid-life and later life, namely memory, executive function, and global cognition.
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Affiliation(s)
- Oisín Cormac Joyce
- Department of Physiology, School of Medicine, Level 2, Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Clíodhna McHugh
- Department of Physiology, School of Medicine, Level 2, Trinity Biomedical Sciences Institute, Trinity College Dublin
| | | | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Áine M. Kelly
- Department of Physiology, School of Medicine, Level 2, Trinity Biomedical Sciences Institute, Trinity College Dublin
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26
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Santillo E, Balietti M, Fabbietti P, Antolini MS, Paoloni C, Piacenza F, Giuli C. Association between low values of mean arterial pressure and impaired cognitive performance in older patients with mild cognitive impairment: cross-sectional preliminary findings from the STRENGTH Project. Aging Clin Exp Res 2024; 36:9. [PMID: 38281243 PMCID: PMC10822812 DOI: 10.1007/s40520-023-02668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/17/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Uncontrolled blood pressure (BP) is a risk factor for Mild Cognitive Impairment (MCI) and dementia. AIMS This study examined the relationship between BP and clinical/cognitive/neuropsychological aspects in MCI individuals. METHODS MCI patients underwent clinical, functional, cognitive and metacognitive, as well as psychological assessments. Social network, lifestyle characteristics, and medication prescriptions were also evaluated. Each patient underwent BP measurements. RESULTS Lower values of systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were associated with poorer cognitive performance. Notably, MAP showed greater capability in detecting impairments in attention and visuospatial abilities compared to SBP and DBP. DISCUSSION These findings support the notion that in older individuals with MCI excessively low BP values, particularly MAP, might represent a risk and suggest that cerebral hypoperfusion may play a key role. CONCLUSIONS Routine assessment of MAP could aid clinicians in adjusting antihypertensive treatment and closely monitoring cognitive function in MCI patients.
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Affiliation(s)
| | - Marta Balietti
- Center for Neurobiology of Aging, IRCCS INRCA, Via Birarelli 8, 60121, Ancona, Italy.
| | - Paolo Fabbietti
- Centre for Biostatistic and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Ancona, Italy
| | | | | | - Francesco Piacenza
- Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy
| | - Cinzia Giuli
- Geriatric Operative Unit, IRCCS INRCA, Fermo, Italy
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27
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Cheong SM, Gaynanova I. Sensing the impact of extreme heat on physical activity and sleep. Digit Health 2024; 10:20552076241241509. [PMID: 38528970 PMCID: PMC10962040 DOI: 10.1177/20552076241241509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction This study assesses the person-specific impact of extreme heat on low-income households using wearable sensors. The focus is on the intensive and longitudinal assessment of physical activity and sleep with the rising person-specific ambient temperature. Methods This study recruited 30 participants in a low-income and predominantly Black community in Houston, Texas in August and September of 2022. Each participant wore on his/her wrist an accelerometer that recorded person-specific ambient temperature, sedentary behavior, physical activity intensity (low and moderate to vigorous), and sleep efficiency 24 h over 14 days. Mixed effects models were used to analyze associations among physical activity, sleep, and person-specific ambient temperature. Results The main findings include increased sedentary time, sleep impairment with the rise of person-level ambient temperature, and the mitigating role of AC. Conclusions Extreme heat negatively affects physical activity and sleep. The negative consequences are especially critical for those with limited use of AC in lower-income neighborhoods of color. Staying home with a high indoor temperature during hot days can lead to various adverse health outcomes including accelerated cognitive decline, higher cancer risk, and social isolation.
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Affiliation(s)
- So-Min Cheong
- Department of Public Service & Administration, Texas A&M University, College Station, TX, USA
| | - Irina Gaynanova
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
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28
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Liu YH, Ma LL, Hu LK, Cui L, Li YL, Chen N, Yang K, Zhang Y, Yan YX. The joint effects of sarcopenia and cardiometabolic risk factors on declined cognitive function: Evidence from a 7-year cohort study. J Affect Disord 2024; 344:644-652. [PMID: 37852588 DOI: 10.1016/j.jad.2023.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Sarcopenia and cardiometabolic risk factors are very common in the middle-aged and older population. This study aimed to explore the joint effect of sarcopenia and cardiometabolic risk factors on cognitive performance and cognitive decline. METHODS The definition of sarcopenia status was referenced in the AWGS 2019 algorithm. Linear regression models were used to explore the association of sarcopenia status with cognitive performance at baseline. Mixed effect models and multinomial logistic regression models were used to evaluate the long-term effect of sarcopenia status. The additive interaction between the effects of sarcopenia and cardiometabolic risk factors on cognitive performance was also evaluated. RESULTS In the cross-sectional analysis, sarcopenia and possible sarcopenia were associated with worse cognitive performance. In the longitudinal analysis, the participant with sarcopenia had a 0.34 [95 % CI (-0.43, -0.24)] lower global cognition score, and those with possible sarcopenia had a 0.20 [95 % CI (-0.27, -0.14)] lower global cognition score, compared with participants with no-sarcopenia. Sarcopenia and possible sarcopenia were identified as significant risk factors for cognitive decline. Sarcopenia combined with hypertension, type 2 diabetes, dyslipidemia, or abdominal obesity was associated with worse cognitive function. LIMITATIONS The assessment of cognitive function was not diagnosed accurately. CONCLUSIONS Sarcopenia and possible sarcopenia had adverse effects on cognitive performance and cognitive decline, sarcopenia combined with cardiometabolic risk factors can significantly enhance these effects. Therefore, the prevention of sarcopenia in the older population is crucial.
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Affiliation(s)
- Yu-Hong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China; Nanchang Center for Disease Control and Prevention, Nanchang 330038, China
| | - Lin-Lin Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Li-Kun Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Lu Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yan-Ling Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Ning Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Kun Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yu-Xiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China; Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
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Hsu YH, Lee M, Pan KL, Chen CY, Hung TH, Chen VCH. Neuropsychiatric and cognitive symptoms in people with hypertension: An examination with the NINDS-CSN consensus protocol. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:39-47. [PMID: 34658278 DOI: 10.1080/23279095.2021.1986826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypertension has been associated with risk of cognitive impairments. The American Heart Association recommended the use of the harmonized neuropsychological protocol suggested by the National Institute of Neurologic Disorders and Stroke and the Canadian Stroke Network (NINDS-CSN) for studying related cognitive impairments. Initially designed for vascular cognitive impairment, empirical data of results from NINDS-CSN protocol has not been well-established in hypertension. The present study recruited 58 adults diagnosed with hypertension and 44 normotensive controls. Tests from the NINDS-CSN protocol were given in three lengths, including neuropsychological tests and neuropsychiatric inventories. The results showed higher proportions of hypertensive adults with impairments on tests of memory and executive functions and that they performed worse as a group on several tests from the 30-minute protocol, but not on the other additional tests in the full-length version, nor on cognitive screening test in the 5-minute protocol such as the Mini-Mental State Examination or the Montreal Cognitive Assessment. There was no significant group difference on neuropsychiatric symptoms. These findings suggested that the 30-minute version of the NINDS-CSN protocol with the two supplemental tests was able to reveal selective cognitive deficits in hypertensive adults and provide a practical solution for related studies, balancing between the requirement of sensitivity, domain variety, and brevity.
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Affiliation(s)
- Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Heart Failure Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chen-Yu Chen
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Tai-Hsin Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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Dhami P, Alagiakrishnan K, Senthilselvan A. Association between use of antihypertensives and cognitive decline in the elderly-A retrospective observational study. PLoS One 2023; 18:e0295658. [PMID: 38117779 PMCID: PMC10732389 DOI: 10.1371/journal.pone.0295658] [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: 09/12/2023] [Accepted: 11/24/2023] [Indexed: 12/22/2023] Open
Abstract
AIM Mild cognitive impairment (MCI) is the prodromal phase of dementia. The objective of this study was to determine whether specific antihypertensives were associated with conversion from MCI to dementia. METHODS In this retrospective study, a chart review was conducted on 335 older adults seen at the University of Alberta Hospital, Kaye Edmonton Seniors Clinic who were diagnosed with MCI. At the point of diagnosis, data was collected on demographic and lifestyle characteristics, measures of cognitive function, blood pressure measurements, use of antihypertensives, and other known or suspected risk factors for cognitive decline. Patients were followed for 5.5 years for dementia diagnoses. A logistic regression analysis was then conducted to determine the factors associated with conversion from MCI to dementia. RESULTS Mean age (± standard deviation) of the study participants was 76.5 ± 7.3 years. Patients who converted from MCI to dementia were significantly older and were more likely to have a family history of dementia. After controlling for potential confounders including age, sex, Mini Mental Status Exam scores and family history of dementia, patients who were on beta-blockers (BBs) had a 57% reduction in the odds of converting to dementia (OR: 0.43, 95% CI: 0.23, 0.81). CONCLUSIONS In this study, BB use was protective against conversion from MCI to dementia. Further studies are required to confirm the findings of our study and to elucidate the effect of BBs on cognitive decline.
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Affiliation(s)
- Prabhpaul Dhami
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kannayiram Alagiakrishnan
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Xu J, Xu W, Chen G, Hu Q, Jiang J. Association of TyG index with prehypertension or hypertension: a retrospective study in Japanese normoglycemia subjects. Front Endocrinol (Lausanne) 2023; 14:1288693. [PMID: 37964964 PMCID: PMC10642169 DOI: 10.3389/fendo.2023.1288693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Aim The objective of our study was to investigate the potential association between the triglyceride and glucose (TyG) index and the occurrence of prehypertension or hypertension in a cohort of normoglycemic Japanese subjects. Methods The NAGALA physical examination program was conducted in 1994 at Murakami Memorial Hospital in Gifu City, Japan. For our retrospective study, we selected 15,450 participants who had taken part in this program. Our aim was to explore the potential link between the TyG index, a surrogate marker for insulin resistance, and the presence of prehypertension (pre-HTN) or hypertension (HTN). Our analysis included adjustments for clinical demographic attributes and serum biomarkers. Logistic regression was employed to assess the relationship between the TyG index and the likelihood of pre-HTN or HTN. Results A total of 15,450 study subjects were included in our analysis. Notably, the prevalence of both pre-HTN and HTN displayed an ascending trend with increasing quartiles of the TyG index. In our comprehensive multivariable logistic regression analysis, when evaluating TyG as a continuous variable, the adjusted odds ratio (OR) for pre-HTN was OR 1.31 [95% CI 1.11-1.56], while for HTN, it was OR 1.76 [95% CI 1.24-2.5] within the fully adjusted model (model 3). When TyG was stratified into quartiles within model 3, the adjusted ORs for pre-HTN were OR 1.16 [95% CI 1.02-1.31], OR 1.22 [95% CI 1.06-1.41], and OR 1.31 [95% CI 1.08-1.59], respectively, using quartile 1 as the reference. The adjusted ORs for HTN in quartiles 2, 3, and 4 were OR 1.22 [95% CI 0.89-1.66], OR 1.4 [95% CI 1.02-1.91], and OR 1.48 [95% CI 1.02-2.15], respectively, within the same model and analysis, with quartile 1 as the reference. Subgroup analysis indicated that the TyG index exhibited a significant positive correlation with the risk of hypertension or prehypertension, except in the subgroup aged ≥65 years. Conclusion Our study highlights a robust correlation between the TyG index and the likelihood of pre-HTN or HTN in normoglycemic Japanese subjects. This underscores the potential clinical relevance of the TyG index in refining early hypertension management strategies. Nonetheless, the validation of these findings necessitates larger studies with extended follow-up periods.
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Affiliation(s)
- Jingtao Xu
- Department of Emergency, First People’s Hospital of Foshan, Foshan, China
- The Poison Treatment Centre of Foshan, First People’s Hospital of Foshan, Foshan, China
| | - Weigan Xu
- Department of Emergency, First People’s Hospital of Foshan, Foshan, China
- The Poison Treatment Centre of Foshan, First People’s Hospital of Foshan, Foshan, China
| | - Guojun Chen
- Department of Emergency, First People’s Hospital of Foshan, Foshan, China
- The Poison Treatment Centre of Foshan, First People’s Hospital of Foshan, Foshan, China
| | - Qiaohua Hu
- Department of Emergency, First People’s Hospital of Foshan, Foshan, China
- The Poison Treatment Centre of Foshan, First People’s Hospital of Foshan, Foshan, China
| | - Jun Jiang
- The Poison Treatment Centre of Foshan, First People’s Hospital of Foshan, Foshan, China
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Davidson CG, Woodford SJ, Mathur S, Valle DB, Foster D, Kioutchoukova I, Mahmood A, Lucke-Wold B. Investigation into the vascular contributors to dementia and the associated treatments. EXPLORATION OF NEUROSCIENCE 2023; 2:224-237. [PMID: 37981945 PMCID: PMC10655228 DOI: 10.37349/en.2023.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/20/2023] [Indexed: 11/21/2023]
Abstract
As the average lifespan has increased, memory disorders have become a more pressing public health concern. However, dementia in the elderly population is often neglected in light of other health priorities. Therefore, expanding the knowledge surrounding the pathology of dementia will allow more informed decision-making regarding treatment within elderly and older adult populations. An important emerging avenue in dementia research is understanding the vascular contributors to dementia. This review summarizes potential causes of vascular cognitive impairment like stroke, microinfarction, hypertension, atherosclerosis, blood-brain-barrier dysfunction, and cerebral amyloid angiopathy. Also, this review address treatments that target these vascular impairments that also show promising results in reducing patient's risk for and experience of dementia.
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Affiliation(s)
| | | | - Shreya Mathur
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Devon Foster
- University of Central Florida, Orlando, FL 32816, USA
| | | | - Arman Mahmood
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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Fituri S, Shi Z. Association between Dietary Patterns and Cognitive Function among Qatari Adults: A Cross-Sectional Analysis of the Qatar Biobank Study. Nutrients 2023; 15:4053. [PMID: 37764836 PMCID: PMC10537779 DOI: 10.3390/nu15184053] [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: 08/27/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to assess the association between dietary patterns and cognitive function among Qatari adults. In a cross-sectional analysis, data on 1000 Qatari adults attending the Qatar Biobank Study (QBB) aged ≥18 years were obtained. Using factor analysis, dietary patterns were constructed based on habitual dietary intake assessed by food frequency questionnaires (FFQs). The mean reaction time (MRT) derived from self-administered touch screen tests was used as an indicator of cognitive function. The association between dietary patterns and MRT was investigated using linear regression. The mean age of the participants was 35.8 (SD 10.3) years, and the mean MRT was 715.3 (SD 204.1) milliseconds. Three dietary patterns were identified. The "traditional" dietary pattern, characterized by high intakes of white rice, mixed dishes and soups/starters possibly high in saturated fat and sodium, was positively associated with MRT. In the multivariable model, comparing the highest to lowest quartiles of the traditional pattern, the regression coefficient for MRT was 50.0 (95% CI 16.9, 83.1; p for trend 0.001). There was an effect modification of diabetes and age on the association between the "modern" dietary pattern and MRT. The "convenient" dietary pattern was not associated with cognition. In conclusion, the traditional rice-based dietary pattern may be associated with poor cognitive function.
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Affiliation(s)
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
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Müller JDA, Giacobe LJ, Grassi V, Palmeira ALR. The use of angiotensin receptor blockers in dementia prevention. Dement Neuropsychol 2023; 17:e20233006. [PMID: 37681194 PMCID: PMC10481907 DOI: 10.1590/1980-5764-dn-2023-3006] [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: 01/22/2023] [Accepted: 03/14/2023] [Indexed: 09/09/2023] Open
Abstract
Alzheimer's disease (AD) and dementia are preventable and highly prevalent diseases, as is systemic arterial hypertension. Thus, it is speculated that angiotensin receptor blockers (ARBs) may be neuroprotective against AD. Objective The aim of this study was to evaluate if the use of ARBs confers a neuroprotective effect on AD, through a systematic review. Methods Studies published on Embase, LILACS, SciELO, and PubMed were evaluated. The selection of the studies included those that evaluated the use of antihypertensive drugs in individuals with a previous diagnosis of mild cognitive impairment. The data were extracted with the Cochrane Effective Practice and Organization of Care (EPOC) form. The risk of bias was evaluated by the EPOC "Risk of bias tool." Results A total of 12 articles were identified, and 3 articles were selected. Two of them analyzed the use of ARB/ACEI versus other antihypertensives and the development of dementia. Conclusion There is a tendency for ARBs to be superior to other antihypertensives in preventing dementia.
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Affiliation(s)
| | | | - Vanise Grassi
- Universidade do Vale do Taquari, Centro de Ciências Médicas, Lajeado RS, Brazil
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Shields KL, Jarrett CL, Bisconti AV, Park SH, Craig JC, Broxterman RM, Richardson RS. Preserved endothelium-independent vascular function with aging in men and women: evidence from the peripheral and cerebral vasculature. J Appl Physiol (1985) 2023; 135:559-571. [PMID: 37391885 PMCID: PMC10538978 DOI: 10.1152/japplphysiol.00571.2022] [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: 09/27/2022] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
In the peripheral and cerebral vasculature, the impact of aging and sex on the endothelial-independent functional capacity of vascular smooth muscle cells (VSMCs) is not well understood, nor is it known whether such VSMC functions in these vascular beds reflect one another. Therefore, endothelium-independent dilation, at both the conduit (Δ diameter) and microvascular (Δ vascular conductance, VC) level, elicited by sublingual nitroglycerin (NTG, 0.8 mg of Nitrostat), compared with sham-delivery (control), was assessed using Doppler ultrasound in the popliteal (PA) and middle cerebral (MCA) artery of 20 young [23 ± 4 yr, 10 males (YM)/10 females (YF)] and 21 old [69 ± 5 yr, 11 males (OM)/10 females (OF)] relatively healthy adults. In the PA, compared with zero, NTG significantly increased diameter in all groups (YM: 0.29 ± 0.13, YF: 0.35 ± 0.26, OM: 0.30 ± 0.18, OF: 0.31 ± 0.14 mm), while control did not. The increase in VC only achieved significance in the OF (0.22 ± 0.31 mL/min/mmHg). In the MCA, compared with zero, NTG significantly increased diameter and VC in all groups (YM: 0.89 ± 0.30, 1.06 ± 1.28; YF: 0.97 ± 0.31, 1.84 ± 1.07; OM: 0.90 ± 0.42, 0.72 ± 0.99; OF: 0.74 ± 0.32, 1.19 ± 1.18, mm and mL/min/mmHg, respectively), while control did not. There were no age or sex differences or age-by-sex interactions for both the NTG-induced PA and MCA dilation and VC. In addition, PA and MCA dilation and VC responses to NTG were not related when grouped by age, sex, or as all subjects (r = 0.04-0.44, P > 0.05). Thus, peripheral and cerebral endothelial-independent VSMC function appears to be unaffected by age or sex, and variations in such VSMC function in one of these vascular beds are not reflected in the other.NEW & NOTEWORTHY To confidently explain peripheral and cerebral vascular dysfunction, it is essential to have a clear understanding of the endothelial-independent function of VSMCs across age and sex. By assessing endothelium-independent dilation using sublingual nitroglycerin, endothelial-independent VSMC function in the periphery (popliteal artery), and in the cerebral circulation (middle cerebral artery), was not different due to age or sex. In addition, endothelial-independent VSMC function in one of these vascular beds is not reflected in the other.
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Affiliation(s)
- Katherine L Shields
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
| | - Catherine L Jarrett
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Angela V Bisconti
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Soung Hun Park
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
| | - Jesse C Craig
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Ryan M Broxterman
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
- Center on Aging, University of Utah, Salt Lake City, Utah, United States
| | - Russell S Richardson
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, United States
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
- Center on Aging, University of Utah, Salt Lake City, Utah, United States
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Kubota H, Kunisawa K, Wulaer B, Hasegawa M, Kurahashi H, Sakata T, Tezuka H, Kugita M, Nagao S, Nagai T, Furuyashiki T, Narumiya S, Saito K, Nabeshima T, Mouri A. High salt induces cognitive impairment via the interaction of the angiotensin II-AT 1 and prostaglandin E2-EP 1 systems. Br J Pharmacol 2023; 180:2393-2411. [PMID: 37076133 DOI: 10.1111/bph.16093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND PURPOSE High salt (HS) intake has been associated with hypertension and cognitive impairment. It is well known that the angiotensin II (Ang II)-AT1 receptor and prostaglandin E2 (PGE2)-EP1 receptor systems are involved in hypertension and neurotoxicity. However, the involvement of these systems in HS-mediated hypertension and emotional and cognitive impairments remains unclear. EXPERIMENTAL APPROACH Mice were loaded with HS solution (2% NaCl drinking water) for 12 weeks, and blood pressure was monitored. Subsequently, effects of HS intake on emotional and cognitive function and tau phosphorylation in the prefrontal cortex (PFC) and hippocampus (HIP) were investigated. The involvement of Ang II-AT1 and PGE2-EP1 systems in HS-induced hypertension and neuronal and behavioural impairments was examined by treatment with losartan, an AT1 receptor blocker (ARB), or EP1 gene knockout. KEY RESULTS We demonstrate that hypertension and impaired social behaviour and object recognition memory following HS intake may be associated with tau hyperphosphorylation, decreased phosphorylation of Ca2+ /calmodulin-dependent protein kinase II (CaMKII), and postsynaptic density protein 95 (PSD95) expression in the PFC and HIP of mice. These changes were blocked by pharmacological treatment with losartan or EP1 receptor gene knockout. CONCLUSIONS AND IMPLICATIONS Our findings suggest that the interaction of Ang II-AT1 receptor and PGE2-EP1 receptor systems could be novel therapeutic targets for hypertension-induced cognitive impairment.
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Affiliation(s)
- Hisayoshi Kubota
- Department of Regulatory Science for Evaluation & Development of Pharmaceuticals & Devices, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
| | - Kazuo Kunisawa
- Department of Regulatory Science for Evaluation & Development of Pharmaceuticals & Devices, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
| | - Bolati Wulaer
- Laboratory of Health and Medical Science Innovation (HMSI), Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
| | - Masaya Hasegawa
- Department of Regulatory Science for Evaluation & Development of Pharmaceuticals & Devices, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
| | - Hitomi Kurahashi
- Department of Regulatory Science for Evaluation & Development of Pharmaceuticals & Devices, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
| | - Takatoshi Sakata
- Department of Regulatory Science for Evaluation & Development of Pharmaceuticals & Devices, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
| | - Hiroyuki Tezuka
- Department of Cellular Function Analysis, Research Promotion and Support Headquarters, Fujita Health University, Toyoake, Aichi, Japan
| | - Masanori Kugita
- Education and Research Facility of Animal Models for Human Diseases, Center for Research Promotion and Support, Fujita Health University, Toyoake, Aichi, Japan
| | - Shizuko Nagao
- Education and Research Facility of Animal Models for Human Diseases, Center for Research Promotion and Support, Fujita Health University, Toyoake, Aichi, Japan
| | - Taku Nagai
- Division of Behavioral Neuropharmacology International Center for Brain Science (ICBS), Fujita Health University, Toyoake, Aichi, Japan
| | - Tomoyuki Furuyashiki
- Division of Pharmacology, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Shuh Narumiya
- Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Kuniaki Saito
- Laboratory of Health and Medical Science Innovation (HMSI), Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
- Department of Disease Control and Prevention, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
- Japanese Drug Organization of Appropriate Use and Research, Nagoya, Aichi, Japan
| | - Toshitaka Nabeshima
- Laboratory of Health and Medical Science Innovation (HMSI), Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
- Japanese Drug Organization of Appropriate Use and Research, Nagoya, Aichi, Japan
| | - Akihiro Mouri
- Department of Regulatory Science for Evaluation & Development of Pharmaceuticals & Devices, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, Japan
- Japanese Drug Organization of Appropriate Use and Research, Nagoya, Aichi, Japan
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Cutrell S, Alhomoud IS, Mehta A, Talasaz AH, Van Tassell B, Dixon DL. ACE-Inhibitors in Hypertension: A Historical Perspective and Current Insights. Curr Hypertens Rep 2023; 25:243-250. [PMID: 37284934 DOI: 10.1007/s11906-023-01248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW This review describes the discovery and development of ACE inhibitors as antihypertensive agents, compares their efficacy, tolerability, and safety to ARBs, and highlights the contemporary issues surrounding ACE inhibitor use for HTN. RECENT FINDINGS Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed medications for the management of hypertension (HTN) and other chronic conditions including heart failure and chronic kidney disease. These agents inhibit ACE, the enzyme that is responsible for converting angiotensin (AT) I to AT II. Inhibiting the synthesis of AT II causes arterial and venous vasodilation, natriuresis, and a decrease in sympathetic activity, resulting in the reduction of blood pressure. ACE inhibitors are first-line therapy in HTN management along with thiazide diuretics, calcium channel blockers, and angiotensin receptor blockers (ARB). Along with inhibiting AT II synthesis, inhibition of ACE causes accumulation of bradykinin, increasing the risk of bradykinin-mediated side effects like angioedema and cough. Since ARBs do not work on ACE in the renin-angiotensin system, the risk of angioedema and cough are lower with ARBs. Recent evidence has also suggested ARBs may have neuroprotective effects compared to other antihypertensives, including ACE inhibitors; however, this warrants further study. Currently, ACE inhibitors and ARBs have an equal class of recommendation for first-line treatment for the management of HTN. Recent evidence has shown ARBs to be just as effective as ACE inhibitors for HTN but with improved tolerability.
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Affiliation(s)
- Stacey Cutrell
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., Smith Building, 6th floor, Room 660, Richmond, VA, USA
| | - Ibrahim S Alhomoud
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., Smith Building, 6th floor, Room 660, Richmond, VA, USA
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - Anurag Mehta
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Azita H Talasaz
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., Smith Building, 6th floor, Room 660, Richmond, VA, USA
| | - Benjamin Van Tassell
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., Smith Building, 6th floor, Room 660, Richmond, VA, USA
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N. 12th St., Smith Building, 6th floor, Room 660, Richmond, VA, USA.
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Hong N, Kim KJ, Yu MH, Jeong SH, Lee S, Lim JS, Rhee Y. Risk of dementia in primary aldosteronism compared with essential hypertension: a nationwide cohort study. Alzheimers Res Ther 2023; 15:136. [PMID: 37568223 PMCID: PMC10416485 DOI: 10.1186/s13195-023-01274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/12/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Although hypertension is a critical risk factor for dementia, the association between primary aldosteronism (PA) and dementia has been scarcely reported. We aimed to investigate whether the risk of dementia in patients with PA was elevated compared with patients with essential hypertension (EH). METHODS From the National Health Insurance Claim database in Korea (2003-2017), 3,687 patients with PA (adrenalectomy [ADX], n = 1,339, mineralocorticoid receptor antagonist [MRA] n = 2,348) with no prior dementia were age- and sex-matched at a 1:4 ratio to patients with EH (n = 14,741). The primary outcomes were all-cause dementia events, including Alzheimer's disease, vascular dementia, or other dementia combined with a prescription of one or more medications for dementia (donepezil, galantamine, memantine, or rivastigmine). Multivariable Cox regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals for the outcome incidence rates between patients with PA and their EH matches. RESULTS During a median follow-up of 5.2 years, there were 156 cases of all-cause dementia (4.2%), 140 cases of Alzheimer's disease (3.8%), and 65 cases of vascular dementia (1.8%). Compared with EH, the risk of all-cause dementia was increased in treated PA (unadjusted hazard ratio [HR] 1.26; p < 0.011). Among PA, MRA group had higher risks of all-cause dementia, especially vascular dementia, adjusted for age, sex, income, comorbidities, and concurrent medication (adjusted HR 1.31; p = 0.027 and adjusted HR 1.62; p = 0.020, respectively) compared to EH. ADX group seemed to have a lower dementia risk than the EH group, but there was no statistical significance after full adjustment. This trend became more prominent when the dementia risks were evaluated from the time of hypertension diagnosis rather than treatment initiation for PA. CONCLUSION The findings of this cohort study suggest that PA, especially the MRA group, is associated with an increased risk of dementia. Monitoring cognitive function in PA patients even after treatment initiation might be warranted to prevent dementia.
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Affiliation(s)
- Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyoung Jin Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Heui Yu
- SENTINEL Team, Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20, Ilsan-Ro, Wonju-Si, Gangwon-Do, 26426, Republic of Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20, Ilsan-Ro, Wonju-Si, Gangwon-Do, 26426, Republic of Korea.
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Smith JR, Sharrett AR, Pike JR, Gottesman RF, Knopman DS, Lee M, Lutsey PL, Palta P, Windham BG, Coresh J, Deal JA. Dementia occurring over a 32-year follow-up attributable to hypertension observed at different ages: Implications for dementia prevention. Alzheimers Dement 2023; 19:3435-3447. [PMID: 36808817 PMCID: PMC10435664 DOI: 10.1002/alz.12984] [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: 10/13/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/20/2023]
Abstract
INTRODUCTION The fraction of dementia attributable to hypertension might vary depending on the age of the population considered and the age through which dementia occurs. METHODS In the Atherosclerosis Risk in Communities study, we quantified population attributable fractions (PAF) of dementia by age 80 and 90 from hypertension assessed at ages of 45-54 (n = 7572), 55-64 (n = 12,033), 65-74 (n = 6561), and 75-84 (n = 2086). RESULTS The PAF for dementia by age 80 from all non-normal blood pressure at ages 45-54 was 15.3% (95% confidence interval [CI] = 6.9%-22.3%), 19.1% (95% CI = 9.9%-26.9%) at ages 55-64, and 19.9% (95% CI = -4.4%-38.5%) at ages 65-74. The strongest PAFs were from stage 2 hypertension (11.9%-21.3%). For dementia by age 90, PAFs from non-normal blood pressure up through age 75 were smaller (10.9%-13.8%), and non-significant by age 75-84. DISCUSSION Interventions targeting hypertension even in early late life might reduce a sizeable proportion of dementia. HIGHLIGHTS We estimated prospective population attributable risks of dementia for hypertension. 15%-20% of dementia cases by age 80 are from non-normal blood pressure (BP). Associations between hypertension and dementia persisted through age 75. Midlife to early late-life BP control might reduce a large proportion of dementia.
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Affiliation(s)
- Jason R. Smith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James Russel Pike
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD, USA
| | | | - Mark Lee
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Priya Palta
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - B. Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Li F, Miao M, Li N, Zhou J, Sun M, Zhang J. Prevalence of preoperative cognitive impairment among elderly thoracic surgery patients and association with postoperative delirium: a prospective observational study. Front Hum Neurosci 2023; 17:1234018. [PMID: 37545595 PMCID: PMC10397730 DOI: 10.3389/fnhum.2023.1234018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Preoperative cognitive impairment (PCI) may increase the incidence of postoperative delirium (POD), yet screening for cognitive impairment is rarely performed. This study hypothesized that Mini-Cog for preoperative cognitive impairment screening predicts postoperative delirium. Methods The prospective observational study recruited 153 elderly patients presenting for elective thoracic surgery. Cognitive function of these patients was screened using Mini-Cog preoperatively. We considered that patients with Mini-Cog scores ≤ 3 had cognitive impairment. Delirium was assessed using the Short CAM scale on postoperative days 1-5. Results Of the 153 participants, 54 (35.3%) were assigned to the PCI group, and 99 (64.7%) were assigned to the Normal group. Place of residence, education level, and history of hypertension were significantly different between the two groups (P < 0.05). 51 (33.3%) patients developed POD. Multifactorial analysis revealed that PCI (OR = 2.37, P = 0.028), older age (OR = 1.13, P = 0.009), ASA grade III (OR = 2.75, P = 0.012), and longer duration of anesthesia (OR = 1.01, P = 0.007) were associated with POD. Conclusion Preoperative cognitive impairment is strongly associated with POD. Mini-Cog could be recommended for screening PCI. Clinical trial registration ClinicalTrials.gov, identifier NCT05798767.
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Mahinrad S, Bennett DA, Sorond FA, Gorelick PB. Blood pressure variability, dementia, and role of antihypertensive medications in older adults. Alzheimers Dement 2023; 19:2966-2974. [PMID: 36656086 PMCID: PMC10354219 DOI: 10.1002/alz.12935] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION We assessed the association between visit-to-visit blood pressure variability (BPV) up to 12 years and subsequent dementia risk, and tested the modifying effect of antihypertensive medications. METHODS We studied 2234 participants from two community-based cohorts of older adults with normal cognition or mild cognitive impairment. Participants were followed through annual assessments for up to 27 years. Visit-to-visit BPV was quantified over 3, 6, 9, and 12 years, respectively. RESULTS Higher systolic BPV (SBPV) during 3, 6, 9, and 12 years was associated with a subsequent increased risk of dementia, with hazard ratios ranging from 1.02 (95% confidence interval [CI]: 1.01-1.04) to 1.10 (95% CI: 1.05-1.16). The association between SBPV and dementia risk was stronger among participants not taking calcium channel blockers (p-for interaction < 0.05). DISCUSSION Among older adults, long-term exposure to higher visit-to-visit SBPV is associated with an increased risk of dementia later in life, and calcium channel blockers may modify this association. HIGHLIGHTS Among adults aged >65, higher systolic blood pressure variability spanning 3-12 years is associated with an increased risk of dementia later in life. Single blood pressure measurement or mean blood pressure levels does not seem to associate with dementia risk among older adults. The association between systolic blood pressure variability and dementia risk is stronger among those not taking calcium channel blocker medications.
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Affiliation(s)
- Simin Mahinrad
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David A. Bennett
- Department of Neurological Sciences and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Farzaneh A. Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip B. Gorelick
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Feinkohl I, Janke J, Slooter AJC, Winterer G, Spies C, Pischon T. Metabolic syndrome and the risk of postoperative delirium and postoperative cognitive dysfunction: a multi-centre cohort study. Br J Anaesth 2023:S0007-0912(23)00206-4. [PMID: 37344340 DOI: 10.1016/j.bja.2023.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Metabolic syndrome and its components are risk factors for cognitive impairment, but their contribution to perioperative neurocognitive disorders is unknown. We examined their associations with the risk of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in older patients. METHODS In 765 male and female participants aged ≥65 years, we measured preoperative metabolic parameters and screened for POD for 7 days or until discharge. POCD was defined through comparison of cognitive change on six neuropsychological tests with non-surgical controls. Multiple logistic regression analyses examined the association of metabolic parameters with risk of POD and POCD with adjustment for age, sex, and surgery type. RESULTS A total of 149 patients (19.5% of 765) developed POD and 53 (10.1% of 520 attendees) had POCD at 3 months. Patients with metabolic syndrome were at 1.85-fold higher risk of POD (95% confidence interval [CI] 1.26-2.70). Each 1 mmol L-1 higher high-density lipoprotein cholesterol (HDL-C) was associated with a 0.47-fold lower POD risk (95% CI 0.30-0.74). Each 1 kg m-2 higher body mass index (BMI) was associated with a 1.09-fold higher POCD risk (95% CI 1.02- 1.16). CONCLUSIONS Older surgical patients with metabolic syndrome were at increased risk of POD. Only reduced HDL-C was significantly associated with POD. For POCD, a higher preoperative BMI was identified as a risk factor. These findings add to mounting evidence of a distinct epidemiology of POD and POCD. Screening programmes taking advantage of HDL-C and BMI measurements and of metabolic interventions in reducing perioperative neurocognitive disorders should be evaluated. CLINICAL TRIAL REGISTRATION NCT02265263.
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Affiliation(s)
- Insa Feinkohl
- Witten/Herdecke University, Medical Biometry and Epidemiology Group, Witten, Germany; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
| | - Jürgen Janke
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Psychiatry and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Georg Winterer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Spies
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Biobank, Berlin, Germany
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Mulligan MD, Murphy R, Reddin C, Judge C, Ferguson J, Alvarez-Iglesias A, McGrath ER, O’Donnell MJ. Population attributable fraction of hypertension for dementia: global, regional, and national estimates for 186 countries. EClinicalMedicine 2023; 60:102012. [PMID: 37261323 PMCID: PMC10227413 DOI: 10.1016/j.eclinm.2023.102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Background Quantifying the proportion of dementia attributable to highly prevalent modifiable risk factors, such as hypertension, is important in informing effective dementia prevention strategies. We aim to quantify the population attributable fraction (PAF) of hypertension for dementia (the proportion of dementia cases that would not occur if hypertension was eliminated) at global, regional, and national levels. Methods In this study, we searched international and governmental websites for global, regional, and national data reporting population hypertension (according to 10-year age categories) and dementia prevalence. MEDLINE was searched for studies reporting the risk of dementia from age at hypertension diagnosis from database inception to December 31, 2022. Longitudinal observational studies with >500 participants reporting hazard ratios by age at hypertension diagnosis for risk of future all-cause dementia were eligible for inclusion. Studies excluded had cross-sectional methodology, specific vascular dementia or 'cognitive impairment' outcomes, and no age-specific metrics of association reported. The PAF of hypertension for dementia was calculated globally and for each country and region worldwide. Findings Data from the Global Burden of Disease, United Nations Population Prospectus, NCD Risk Factor Collaboration, UK Biobank, and Atherosclerosis Risk in Communities Study were obtained. 186 countries reported dementia and hypertension prevalence data. The global PAF of hypertension for dementia was 15.8% [95% Credible Interval (CI), 8.8%-22.7%]. Latin America and the Caribbean (18.0% [95% CI, 9.4%-26.6%]), and Europe (17.2% [95% CI, 9.6%-24.7%]) had the highest PAF of hypertension for dementia. Hypertension diagnosed between the ages of 30-44 had the highest age-specific global attributable fraction for dementia (8.4% [95% CI, 3.4%-13.5%]), followed by ages 45-54 (2.92% [ 95% CI, 0.96%-4.88%]), 55-64 (2.59% [95% CI, 1.15%-4.03%]) and 65-74 (1.82% [95% CI, -2.31%-5.96%]). Interpretation The population attributable risk of hypertension for dementia is 15.8%, suggesting that optimal detection and treatment, particularly at midlife, has the potential to markedly reduce the global burden of dementia. Funding Wellcome Trust; Health Research Board of Ireland; Alzheimer's Association.
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Affiliation(s)
- Martin D. Mulligan
- School of Medicine, University of Galway, University Road, Galway, H91TK33, Ireland
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
| | - Robert Murphy
- School of Medicine, University of Galway, University Road, Galway, H91TK33, Ireland
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
| | - Catriona Reddin
- School of Medicine, University of Galway, University Road, Galway, H91TK33, Ireland
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
| | - Conor Judge
- School of Medicine, University of Galway, University Road, Galway, H91TK33, Ireland
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
| | - John Ferguson
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
| | - Alberto Alvarez-Iglesias
- School of Medicine, University of Galway, University Road, Galway, H91TK33, Ireland
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
| | - Emer R. McGrath
- School of Medicine, University of Galway, University Road, Galway, H91TK33, Ireland
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
| | - Martin J. O’Donnell
- School of Medicine, University of Galway, University Road, Galway, H91TK33, Ireland
- HRB Clinical Research Facility, University of Galway, University Road, Galway, H91TK33, Ireland
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Sachs BC, Gaussoin SA, Brenes GA, Casanova R, Chlebowski RT, Chen JC, Luo J, Rapp SR, Shadyab AH, Shumaker S, Wactawski-Wende J, Wells GL, Hayden KM. The relationship between optimism, MCI, and dementia among postmenopausal women. Aging Ment Health 2023; 27:1208-1216. [PMID: 35694859 PMCID: PMC9741664 DOI: 10.1080/13607863.2022.2084710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The relationship between optimism and cognitive functioning is not fully understood. We examined the association of optimism with risk of mild cognitive impairment (MCI) and dementia in the Women's Health Initiative Memory Study (WHIMS). METHODS Optimism was measured by the Life Orientation Test-Revised (LOT-R) total score, and optimism and pessimism subscales. A panel of experts adjudicated cognitive endpoints based on annual cognitive assessments. We used cox proportional hazard regression models to examine the association of LOT-R total score and optimism and pessimism sub-scores with MCI/dementia. We also examined the relationship between vascular disease, LOT-R total score, optimism and pessimism, and cognition. RESULTS Mean age was 70.5 (SD = 3.9) years. The sample (N = 7249) was 87% white, and 29.8% of participants had < 12 years of education. Total LOT-R score (HR = 0.96, 95% CI: 0.94, 0.98, p < 0.001) was associated with lower risk of combined MCI or dementia. More pessimism (HR = 1.08, 95% CI: 1.05, 1.11, p < 0.0001) was associated with higher risk of MCI or dementia after adjustment for ethnicity, education, vascular disease, and depression. No significant relationships emerged from the optimism subscale. CONCLUSION These data suggest that less pessimism, but not more optimism, was associated with a lower risk of MCI and dementia.
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Affiliation(s)
- Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem,NC USA
| | - Sarah A Gaussoin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine Winston-Salem, NC USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem,NC USA
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine Winston-Salem, NC USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA USA
| | - Jiu-Chiuan Chen
- Departments of Population & Public Health Sciences and Neurology, University of Southern California, Los Angeles, CA, USA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN USA
| | - Stephen R Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Sally Shumaker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY USA
| | - Gretchen L Wells
- Gill Heart and Vascular Institute, University of Kentucky School of Medicine, Lexington, KY USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC USA
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Valsdóttir V, Magnúsdóttir BB, Gylfason HF, Chang M, Aspelund T, Gudnason V, Launer LJ, Jónsdóttir MK. Exposure factors associated with dementia among older adults in Iceland: the AGES-Reykjavik study. GeroScience 2023:10.1007/s11357-023-00804-7. [PMID: 37160657 PMCID: PMC10400491 DOI: 10.1007/s11357-023-00804-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
The study aimed to assess whether factors related to cognitive performance were associated with the development of dementia. Additionally, the study aimed to establish whether cognitive performance at baseline or change in cognition between baseline and follow-up (five-year period) had a stronger association with whether an individual would fulfill a dementia criterion at follow-up. The data was collected from 2002 to 2011. Logistic regression was applied to the AGES-Reykjavik Study epidemiological data. The analysis, which builds upon previous data analyses of the same dataset, included 1,491 participants between the ages of 66 and 90. All those included were considered to have normal cognition at baseline; 8.2% (n = 123) of them fulfilled a dementia criterion at follow-up five years later. The study's results indicated that being high on cognitive reserve factors reduced the risk of developing dementia. Compared to other known dementia risk factors, cognitive reserve factors (education level, participation in leisure activities, and self-reported health) were more likely than others to have an association with dementia. Additionally, the study's findings showed that cognitive performance at baseline, rather than change in cognition between baseline and follow-up five years later, had a stronger association with dementia at the follow-up assessment. Together, these findings support the notion that promoting high cognitive reserve throughout the lifespan and reaching high cognitive performance is important in reducing dementia risk.
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Affiliation(s)
- Vaka Valsdóttir
- Department of Psychology, Reykjavik University, Menntavegur 1, 102, Reykjavik, Iceland.
- RHLÖ - Icelandic Gerontological Research Center, Landspítali University Hospital, Reykjavik, Iceland.
| | - Brynja Björk Magnúsdóttir
- Department of Psychology, Reykjavik University, Menntavegur 1, 102, Reykjavik, Iceland
- Mental Health Services, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Milan Chang
- RHLÖ - Icelandic Gerontological Research Center, Landspítali University Hospital, Reykjavik, Iceland
| | - Thor Aspelund
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, National Institutes of Health (NIH), Bethesda, MD, USA
| | - María K Jónsdóttir
- Department of Psychology, Reykjavik University, Menntavegur 1, 102, Reykjavik, Iceland
- Mental Health Services, Landspitali University Hospital, Reykjavik, Iceland
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Ding L, Zhu X, Xiong Z, Yang F, Zhang X. The Association of Age at Diagnosis of Hypertension with Cognitive Decline: the China Health and Retirement Longitudinal Study (CHARLS). J Gen Intern Med 2023; 38:1431-1438. [PMID: 36443629 PMCID: PMC10160298 DOI: 10.1007/s11606-022-07951-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
AIM This study investigated whether an individual's age at diagnosis of hypertension, which is associated with a decline in cognitive performance in the China Health and Retirement Longitudinal Study (CHARLS) participants. METHODS Our analysis was based on the CHARLS with baseline data collected between 2011 and 2018. We randomly selected a control participant for each hypertensive participant using propensity score. The cohort comprised 2413 individuals with hypertension and 2411 controls. Participants were divided into three groups as follows: non-hypertension, hypertension diagnose ≥55 years, and hypertension diagnose <55 years. Cognitive performance was measured in both visits and evaluated by the scores of the memory, executive function, and orientation and global cognitive. RESULTS After multivariable adjustment, individuals with hypertension diagnosed <55 years had a significantly faster cognitive decline in memory test (β (95% CI, -1.117 [-1.405, -0.83]), orientation test (β (95% CI, -1.273 [-1.348, -1.198]) and global cognitive (β (95% CI, -1.611 [-1.744, -1.478]) compared with the corresponding controls. A longer hypertension duration was associated with worse memory test (β (95% CI, -0.069 [-0.113 to -0.025]). Among treated individuals, blood pressure control at baseline was inversely associated with the decline in orientation test (β (95% CI, -0.659 [-0.939, -0.380]), orientation test (β (95% CI, -0.259[-0.365, -0.153])and global cognitive (β (95% CI, -0.124 [-0.162, -0.086]). CONCLUSIONS Our findings suggest that hypertension diagnosed in mid-life is associated with worse cognition compared to late life. Besides, longer duration of diagnosis is associated with worse memory test. In addition to hypertension, pressure control might be critical for the preservation of cognitive function.
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Affiliation(s)
- Linlin Ding
- School of Nursing, Hubei University of Chinese Medicine, #16 Huangjiahu west road, Wuhan, 430065, Hubei province, China
| | - Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, #16 Huangjiahu west road, Wuhan, 430065, Hubei province, China.
| | - Zhenfang Xiong
- School of Nursing, Hubei University of Chinese Medicine, #16 Huangjiahu west road, Wuhan, 430065, Hubei province, China.
| | - Fen Yang
- School of Nursing, Hubei University of Chinese Medicine, #16 Huangjiahu west road, Wuhan, 430065, Hubei province, China
| | - Xiaona Zhang
- School of Nursing, Hubei University of Chinese Medicine, #16 Huangjiahu west road, Wuhan, 430065, Hubei province, China
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Wang X, Yang C, Lu L, Bai J, Wu H, Chen T, Liao W, Duan Z, Chen D, Liu Z, Ju K. Assessing the causal effect of long-term exposure to air pollution on cognitive decline in middle-aged and older adults - Empirical evidence from a nationwide longitudinal cohort. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 255:114811. [PMID: 36963183 DOI: 10.1016/j.ecoenv.2023.114811] [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: 09/21/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Air pollution remains a risk factor for the global burden of disease. Middle-aged and older people are more susceptible to air pollution because of their declining physical function and are more likely to develop diseases from long-term air pollution exposure. Studies of the effects of air pollution on cognitive function in middle-aged and older adults have been inconsistent. More representative and definitive evidence is needed. This study analysed data from the Chinese Family Panel Study, an ongoing nationwide prospective cohort study, collected in waves 2014, 2016 and 2018. Rigorously tested instrument was selected for analysis and participants' PM2.5 and instrument exposures were assessed using high-precision satellite data. The causal relationship between long-term exposure to air pollution and poor cognitive function in middle-aged and older adults was investigated using the Correlated Random Effects Control Function (CRE-CF) method within a quasi-experimental framework. This study included a total of 7042 participants aged 45 years or older. A comparison of CRE-CF with other models (OLS model, ordered probit model, and ordered probit-CRE model) demonstrated the necessity of using CRE-CF given the endogeneity of air pollution. The credibility and validity of the instrumental variable were verified. In the CRE-CF model, long-term exposure to PM2.5 was found to accelerate cognitive decline in middle-aged and older adults (coefficients of -0.159, -0.336 and -0.244 for the total cognitive, verbal and mathematical scores, respectively). Taken together, these results suggest that chronic exposure to ambient air pollution is associated with cognitive decline in middle-aged and older adults, which highlights the need for appropriate protective policies.
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Affiliation(s)
- Xu Wang
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenyu Yang
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Liyong Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Jing Bai
- Department of neurology, Xijing Hospital, Xi'an 710032, China
| | - Hao Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Ting Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Weibin Liao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Zhongxin Duan
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Dapeng Chen
- Department of Economics, Lehigh University, Bethlehem, PA 18015, United States
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.
| | - Ke Ju
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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George KM, Maillard P, Gilsanz P, Fletcher E, Peterson RL, Fong J, Mayeda ER, Mungas DM, Barnes LL, Glymour MM, DeCarli C, Whitmer RA. Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers. JAMA Netw Open 2023; 6:e236431. [PMID: 37010868 PMCID: PMC10071343 DOI: 10.1001/jamanetworkopen.2023.6431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/19/2023] [Indexed: 04/04/2023] Open
Abstract
Importance The association between hypertension developed before midlife and late-life brain health is understudied and, because of the cardioprotective benefits of estrogen before menopause, may differ by sex. Objective To assess the association of early adulthood hypertension and blood pressure (BP) change with late-life neuroimaging biomarkers and examine potential sex differences. Design, Setting, and Participants This cohort study used data from the Study of Healthy Aging in African Americans (STAR) and Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, which were harmonized longitudinal cohorts of racially and ethnically diverse adults aged 50 years and older from the San Francisco Bay area and Sacramento Valley in California. The STAR was conducted from November 6, 2017, to November 5, 2021, and the KHANDLE study was conducted from April 27, 2017, to June 15, 2021. The current study included 427 participants from the KHANDLE and STAR studies who received health assessments between June 1, 1964, and March 31, 1985. Regional brain volumes and white matter (WM) integrity were measured via magnetic resonance imaging between June 1, 2017, and March 1, 2022. Exposures Hypertension status (normotension, transition to hypertension, and hypertension) and BP change (last measure minus first measure) were assessed at 2 multiphasic health checkups (MHCs; 1964-1985) in early adulthood (ages 30-40 years). Main Outcomes and Measures Regional brain volumes and WM integrity were measured using 3T magnetic resonance imaging and z standardized. General linear models adjusted for potential confounders (demographic characteristics and study [KHANDLE or STAR]) were used to assess the association of hypertension and BP change with neuroimaging biomarkers. Sex interactions were tested. Results Among 427 participants, median (SD) ages were 28.9 (7.3) years at the first MHC, 40.3 (9.4) years at the last MHC, and 74.8 (8.0) years at neuroimaging. A total of 263 participants (61.6%) were female and 231 (54.1%) were Black. Overall, 191 participants (44.7%) had normotension, 68 (15.9%) transitioned to hypertension, and 168 (39.3%) had hypertension. Compared with participants who had normotension, those who had hypertension and those who transitioned to hypertension had smaller cerebral volumes (hypertension: β = -0.26 [95% CI, -0.41 to -0.10]; transition to hypertension: β = -0.23 [95% CI, -0.44 to -0.23]), with similar differences in cerebral gray matter volume (hypertension: β = -0.32 [95% CI, -0.52 to -0.13]; transition to hypertension: β = -0.30 [95% CI, -0.56 to -0.05]), frontal cortex volume (hypertension: β = -0.43 [95% CI, -0.63 to -0.23]; transition to hypertension: β = -0.27 [95% CI, -0.53 to 0]), and parietal cortex volume (hypertension: β = -0.22 [95% CI, -0.42 to -0.02]; transition to hypertension: β = -0.29 [95% CI, -0.56 to -0.02]). Participants with hypertension also had smaller hippocampal volume (β = -0.22; 95% CI, -0.42 to -0.02), greater ventricular volumes (lateral ventricle: β = 0.44 [95% CI, 0.25-0.63]; third ventricle: β = 0.20 [95% CI, 0.01-0.39]), larger free water volume (β = 0.35; 95% CI, 0.18-0.52), and lower fractional anisotropy (β = -0.26; 95% CI, -0.45 to -0.08) than those who had normotension. Holding hypertension status constant, a 5-mm Hg increase in systolic BP was associated with smaller temporal cortex volume (β = -0.03; 95% CI, -0.06 to -0.01), while a 5-mm Hg increase in diastolic BP was associated with smaller parietal cortex volume (β = -0.06; 95% CI, -0.10 to -0.02). The negative association of hypertension and BP change with regional brain volumes appeared stronger in men than women for some regions. Conclusions and Relevance In this cohort study, early adulthood hypertension and BP change were associated with late-life volumetric and WM differences implicated in neurodegeneration and dementia. Sex differences were observed for some brain regions whereby hypertension and increasing BP appeared more detrimental for men. These findings suggest that prevention and treatment of hypertension in early adulthood is important for late-life brain health, particularly among men.
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Affiliation(s)
- Kristen M. George
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Pauline Maillard
- Department of Neurology, University of California Davis School of Medicine, Sacramento
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente, Oakland, California
| | - Evan Fletcher
- Department of Neurology, University of California Davis School of Medicine, Sacramento
| | - Rachel L. Peterson
- School of Public and Community Health Sciences, University of Montana, Missoula
| | - Joseph Fong
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles
| | - Dan M. Mungas
- Department of Neurology, University of California Davis School of Medicine, Sacramento
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush Medical College, Chicago, Illinois
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Charles DeCarli
- Department of Neurology, University of California Davis School of Medicine, Sacramento
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Department of Neurology, University of California Davis School of Medicine, Sacramento
- Division of Research, Kaiser Permanente, Oakland, California
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Kang SH, Liu M, Park G, Kim SY, Lee H, Matloff W, Zhao L, Yoo H, Kim JP, Jang H, Kim HJ, Jahanshad N, Oh K, Koh SB, Na DL, Gallacher J, Gottesman RF, Seo SW, Kim H. Different effects of cardiometabolic syndrome on brain age in relation to gender and ethnicity. Alzheimers Res Ther 2023; 15:68. [PMID: 36998058 PMCID: PMC10061789 DOI: 10.1186/s13195-023-01215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND A growing body of evidence shows differences in the prevalence of cardiometabolic syndrome (CMS) and dementia based on gender and ethnicity. However, there is a paucity of information about ethnic- and gender-specific CMS effects on brain age. We investigated the different effects of CMS on brain age by gender in Korean and British cognitively unimpaired (CU) populations. We also determined whether the gender-specific difference in the effects of CMS on brain age changes depending on ethnicity. METHODS These analyses used de-identified, cross-sectional data on CU populations from Korea and United Kingdom (UK) that underwent brain MRI. After propensity score matching to balance the age and gender between the Korean and UK populations, 5759 Korean individuals (3042 males and 2717 females) and 9903 individuals from the UK (4736 males and 5167 females) were included in this study. Brain age index (BAI), calculated by the difference between the predicted brain age by the algorithm and the chronological age, was considered as main outcome and presence of CMS, including type 2 diabetes mellitus (T2DM), hypertension, obesity, and underweight was considered as a predictor. Gender (males and females) and ethnicity (Korean and UK) were considered as effect modifiers. RESULTS The presence of T2DM and hypertension was associated with a higher BAI regardless of gender and ethnicity (p < 0.001), except for hypertension in Korean males (p = 0.309). Among Koreans, there were interaction effects of gender and the presence of T2DM (p for T2DM*gender = 0.035) and hypertension (p for hypertension*gender = 0.046) on BAI in Koreans, suggesting that T2DM and hypertension are each associated with a higher BAI in females than in males. In contrast, among individuals from the UK, there were no differences in the effects of T2DM (p for T2DM*gender = 0.098) and hypertension (p for hypertension*gender = 0.203) on BAI between males and females. CONCLUSIONS Our results highlight gender and ethnic differences as important factors in mediating the effects of CMS on brain age. Furthermore, these results suggest that ethnic- and gender-specific prevention strategies may be needed to protect against accelerated brain aging.
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Affiliation(s)
- Sung Hoon Kang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Mengting Liu
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen, China
- Keck School of Medicine of University of Southern California, USC Steven Neuroimaging and Informatics Institute, Los Angeles, CA, 90033, USA
| | - Gilsoon Park
- Keck School of Medicine of University of Southern California, USC Steven Neuroimaging and Informatics Institute, Los Angeles, CA, 90033, USA
| | - Sharon Y Kim
- Keck School of Medicine of University of Southern California, USC Steven Neuroimaging and Informatics Institute, Los Angeles, CA, 90033, USA
| | - Hyejoo Lee
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - William Matloff
- Keck School of Medicine of University of Southern California, USC Steven Neuroimaging and Informatics Institute, Los Angeles, CA, 90033, USA
| | - Lu Zhao
- Keck School of Medicine of University of Southern California, USC Steven Neuroimaging and Informatics Institute, Los Angeles, CA, 90033, USA
| | - Heejin Yoo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Pyo Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyemin Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Neda Jahanshad
- Keck School of Medicine of University of Southern California, USC Steven Neuroimaging and Informatics Institute, Los Angeles, CA, 90033, USA
| | - Kyumgmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Duk L Na
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea.
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea.
| | - Hosung Kim
- Keck School of Medicine of University of Southern California, USC Steven Neuroimaging and Informatics Institute, Los Angeles, CA, 90033, USA
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Gavriilaki M, Anyfanti P, Mastrogiannis K, Gavriilaki E, Lazaridis A, Kimiskidis V, Gkaliagkousi E. Association between ambulatory blood pressure monitoring patterns with cognitive function and risk of dementia: a systematic review and meta-analysis. Aging Clin Exp Res 2023; 35:745-761. [PMID: 36995461 PMCID: PMC10115699 DOI: 10.1007/s40520-023-02361-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The objective of this systematic review and meta-analysis is to investigate whether nocturnal blood pressure fall, expressed by dipping patterns according to 24 h ambulatory blood pressure monitoring (ABPM), is associated with abnormal cognitive function (cognitive impairment or dementia). METHODS We systematically searched PubMed, Embase, and Cochrane databases to identify original articles through December 2022. We included any study with at least ten participants reporting on all-cause dementia or cognitive impairment incidence (primary outcome) or validated cognitive tests (secondary outcome) among ABPM patterns. We assessed risk of bias using Newcastle-Ottawa Quality Assessment Scale. We pooled odds ratios (OR) and standardized mean differences (SMD) using random-effect models for primary and secondary outcome, respectively. RESULTS In the qualitative synthesis, 28 studies examining 7595 patients were included. The pooled analysis of 18 studies showed that dippers had a 51% [OR 0.49(0.35-0.69)] lower risk of abnormal cognitive function and a 63% [OR 0.37(0.23-0.61)] lower risk of dementia alone, compared to non-dippers. Reverse dippers presented an up to sixfold higher risk [OR 6.06(3.15-11.64)] of abnormal cognitive function compared to dippers and an almost twofold higher risk [OR 1.81(1.26-2.6)] compared to non-dippers. Reverse dippers performed worse in global function neuropsychological tests compared with both dippers [SMD - 0.66(- 0.93 to - 0.39)] and non-dippers [SMD - 0.35(- 0.53 to - 0.16)]. CONCLUSION Dysregulation of the normal circadian BP rhythm, specifically non-dipping and reverse dipping is associated with abnormal cognitive function. Further studies are required to determine potential underlying mechanisms and possible prognostic or therapeutic implications. PROTOCOL REGISTRATION PROSPERO database (ID: CRD42022310384).
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Affiliation(s)
- Maria Gavriilaki
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Konstantinos Mastrogiannis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Eleni Gavriilaki
- Hematology Department, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Antonios Lazaridis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Vasilios Kimiskidis
- 1st Department of Neurology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Efkarpia, 56429, Thessaloniki, Greece.
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