1
|
Chu SF, Liao KH, Wei L. Increasing Risk of Dementia Among Patients with Subsequent Epilepsy Within 2 Years Post-Traumatic Brain Injury: A Population-Based Case-Control Study. J Multidiscip Healthc 2024; 17:1447-1457. [PMID: 38577293 PMCID: PMC10992670 DOI: 10.2147/jmdh.s452086] [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] [Received: 11/28/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
Background Although the association between neurodegenerative diseases, such as dementia, and traumatic brain injury (TBI) has long been known, the association between dementia and TBI with epilepsy has been controversial. Aim This data-driven population-based study is designed to investigate the association between dementia and epilepsy after TBI within a 2-year period. Methods This case-control cohort study was conducted using the Longitudinal Health Insurance Database 2000 (LHID2000). We included 784 individuals ambulatory or hospitalized for TBI with epilepsy from 2001 to 2011, compared with 2992 patients with TBI without epilepsy who were matched for characteristics including sex, age, and healthcare resource use index date. Every participant was followed up for 5 years to ascertain any dementia development. Data were stratified and analyzed using the Cox proportional hazards regression. Results Through the 5-year follow-up period, 39 patients (5.21%) with TBI with epilepsy and 55 (1.53%) with TBI without epilepsy developed dementia. TBI with epilepsy was independently associated with a >3.03 times risk of dementia after correcting for age, sex, and comorbidities. Conclusion These findings suggest an increased risk of dementia in patients with TBI with epilepsy. Our research recommends that individuals with TBI and epilepsy be monitored more intensively.
Collapse
Affiliation(s)
- Shu-Fen Chu
- College of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Kuo-Hsing Liao
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Critical Medicine, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Neurotraumatology and Intensive Care, Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li Wei
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
2
|
Chanti-Ketterl M, Pieper CF, Yaffe K, Plassman BL. Associations Between Traumatic Brain Injury and Cognitive Decline Among Older Male Veterans: A Twin Study. Neurology 2023; 101:e1761-e1770. [PMID: 37673685 PMCID: PMC10634649 DOI: 10.1212/wnl.0000000000207819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injuries (TBIs) are associated with increased risk of dementia, but whether lifetime TBI influences cognitive trajectories in later life is less clear. Cognitive interventions after TBI may improve cognitive trajectories and delay dementia. Because twins share many genes and environmental factors, we capitalize on the twin study design to examine the association between lifetime TBI and cognitive decline. METHODS Participants were members of the National Academy of Sciences-National Research Council's Twin Registry of male veterans of World War II with self or proxy-reported history of TBI and with up to 4 observations over 12 years of the modified Telephone Interview for Cognitive Status (TICS-m). We used linear random-effects mixed models to analyze the association between TBI and TICS-m in the full sample and among co-twins discordant for TBI. Additional TBI predictor variables included number of TBIs, severity (loss of consciousness [LOC]), and age of first TBI (age <25 vs 25+ years [older age TBI]). Models were adjusted for age (centered at 70 years), age-squared, education, wave, twin pair, lifestyle behaviors, and medical conditions. RESULTS Of 8,662 participants, 25% reported TBI. History of any TBI (β = -0.56, 95% CI -0.73 to -0.39), TBI with LOC (β = -0.51, 95% CI -0.71 to -0.31), and older age TBI (β = -0.66, 95% CI -0.90 to -0.42) were associated with lower TICS-m scores at 70 years. TBI with LOC (β = -0.03, 95% CI -0.05 to -0.001), more than one TBI (β = -0.05, 95% CI -0.09 to -0.002,), and older age TBI (β = -0.06, 95% CI -0.09 to -0.03) were associated with faster cognitive decline. Among monozygotic pairs discordant for TBI (589 pairs), history of any TBI (β = -0.55, 95% CI -0.91 to -0.19) and older age TBI (β = -0.74, 95% CI -1.22 to -0.26) were associated with lower TICS-m scores at 70 years. Those with more than one TBI (β = -0.13, 95% CI -0.23 to -0.03) and older age TBI (β = -0.07, 95% CI -0.13 to -0.002) showed greater cognitive decline compared with their co-twin without TBI. DISCUSSION These findings support an association of the effect of TBI on cognitive score and the rapidity of cognitive decline in later life. The results in monozygotic pairs, who share all genes and many exposures, particularly in early life, provide additional evidence of a causal relationship between TBI and poorer late-life cognitive outcomes.
Collapse
Affiliation(s)
- Marianne Chanti-Ketterl
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC.
| | - Carl F Pieper
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC
| | - Kristine Yaffe
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC
| | - Brenda L Plassman
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC
| |
Collapse
|
3
|
Bouchard HC, Sun D, Dennis EL, Newsome MR, Disner SG, Elman J, Silva A, Velez C, Irimia A, Davenport ND, Sponheim SR, Franz CE, Kremen WS, Coleman MJ, Williams MW, Geuze E, Koerte IK, Shenton ME, Adamson MM, Coimbra R, Grant G, Shutter L, George MS, Zafonte RD, McAllister TW, Stein MB, Thompson PM, Wilde EA, Tate DF, Sotiras A, Morey RA. Age-dependent white matter disruptions after military traumatic brain injury: Multivariate analysis results from ENIGMA brain injury. Hum Brain Mapp 2022; 43:2653-2667. [PMID: 35289463 PMCID: PMC9057089 DOI: 10.1002/hbm.25811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/18/2021] [Accepted: 02/10/2022] [Indexed: 01/27/2023] Open
Abstract
Mild Traumatic brain injury (mTBI) is a signature wound in military personnel, and repetitive mTBI has been linked to age-related neurogenerative disorders that affect white matter (WM) in the brain. However, findings of injury to specific WM tracts have been variable and inconsistent. This may be due to the heterogeneity of mechanisms, etiology, and comorbid disorders related to mTBI. Non-negative matrix factorization (NMF) is a data-driven approach that detects covarying patterns (components) within high-dimensional data. We applied NMF to diffusion imaging data from military Veterans with and without a self-reported TBI history. NMF identified 12 independent components derived from fractional anisotropy (FA) in a large dataset (n = 1,475) gathered through the ENIGMA (Enhancing Neuroimaging Genetics through Meta-Analysis) Military Brain Injury working group. Regressions were used to examine TBI- and mTBI-related associations in NMF-derived components while adjusting for age, sex, post-traumatic stress disorder, depression, and data acquisition site/scanner. We found significantly stronger age-dependent effects of lower FA in Veterans with TBI than Veterans without in four components (q < 0.05), which are spatially unconstrained by traditionally defined WM tracts. One component, occupying the most peripheral location, exhibited significantly stronger age-dependent differences in Veterans with mTBI. We found NMF to be powerful and effective in detecting covarying patterns of FA associated with mTBI by applying standard parametric regression modeling. Our results highlight patterns of WM alteration that are differentially affected by TBI and mTBI in younger compared to older military Veterans.
Collapse
Affiliation(s)
- Heather C. Bouchard
- Duke‐UNC Brain Imaging and Analysis CenterDuke UniversityDurhamNorth CarolinaUSA
- Mid‐Atlantic Mental Illness Research Education and Clinical CenterDurham VA Medical CenterDurhamNorth CarolinaUSA
- Center for Brain, Biology & BehaviorUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Delin Sun
- Duke‐UNC Brain Imaging and Analysis CenterDuke UniversityDurhamNorth CarolinaUSA
- Mid‐Atlantic Mental Illness Research Education and Clinical CenterDurham VA Medical CenterDurhamNorth CarolinaUSA
| | - Emily L. Dennis
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Mary R. Newsome
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- H. Ben Taub Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonTexasUSA
| | - Seth G. Disner
- Minneapolis VA Health Care SystemMinneapolisMinnesotaUSA
- Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Jeremy Elman
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Annelise Silva
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - Carmen Velez
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Andrei Irimia
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Biomedical Engineering, Viterbi School of EngineeringUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nicholas D. Davenport
- Minneapolis VA Health Care SystemMinneapolisMinnesotaUSA
- Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Scott R. Sponheim
- Minneapolis VA Health Care SystemMinneapolisMinnesotaUSA
- Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Carol E. Franz
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - William S. Kremen
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
- Center of Excellence for Stress and Mental HealthVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Michael J. Coleman
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - M. Wright Williams
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Elbert Geuze
- Department of PsychiatryUniversity Medical CenterUtrechtNetherlands
- Brain Research & Innovation CentreMinistry of DefenceUtrechtNetherlands
| | - Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - Martha E. Shenton
- Psychiatry Neuroimaging LaboratoryBrigham & Women's HospitalBostonMassachusettsUSA
| | - Maheen M. Adamson
- Rehabilitation ServiceVA Palo AltoPalo AltoCaliforniaUSA
- NeurosurgeryStanford School of MedicineStanfordCaliforniaUSA
| | - Raul Coimbra
- Department of SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Gerald Grant
- Department of NeurosurgeryStanford University Medical CenterPalo AltoCaliforniaUSA
| | - Lori Shutter
- Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Mark S. George
- Department of PsychiatryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Ross D. Zafonte
- Spaulding Rehabilitation HospitalMassachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Murray B. Stein
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics InstituteKeck School of Medicine of USCMarina del ReyCaliforniaUSA
- Department of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and OphthalmologyUniversity of Southern California (USC), Los AngelesCaliforniaUSA
- Department of PediatricsUSCLos AngelesCaliforniaUSA
- Department of PsychiatryUSCLos AngelesCaliforniaUSA
- Department of RadiologyUSCLos AngelesCaliforniaUSA
- Department of EngineeringUSCLos AngelesCaliforniaUSA
- Department of OphthalmologyUSCLos AngelesCaliforniaUSA
- Department of Radiology and Institute for Informatics, School of MedicineWashington University St. LouisSt. LouisMissouriUSA
| | - Elisabeth A. Wilde
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- Michael E. DeBakey VA Medical CenterHoustonTexasUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - David F. Tate
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Aristeidis Sotiras
- Department of Radiology and Institute for Informatics, School of MedicineWashington University St. LouisSt. LouisMissouriUSA
| | - Rajendra A. Morey
- Duke‐UNC Brain Imaging and Analysis CenterDuke UniversityDurhamNorth CarolinaUSA
- Mid‐Atlantic Mental Illness Research Education and Clinical CenterDurham VA Medical CenterDurhamNorth CarolinaUSA
| |
Collapse
|
4
|
Graham A, Livingston G, Purnell L, Huntley J. Mild Traumatic Brain Injuries and Future Risk of Developing Alzheimer’s Disease: Systematic Review and Meta-Analysis. J Alzheimers Dis 2022; 87:969-979. [DOI: 10.3233/jad-220069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Traumatic brain injury (TBI) increases the risk of future dementia and Alzheimer’s disease (AD). However, it is unclear whether this is true for mild TBI (mTBI). Objective: To explore the association between mTBI and subsequent risk of developing AD. Method: We systematically searched four electronic databases from January 1954 to April 2020. We included studies reporting primary data and where mTBI preceded AD by≥5 years. We meta-analyzed included studies for both high quality studies and studies with a follow up of > 10 years. Result: We included 5 of the 10,435 results found. Meta-analysis found a history of mTBI increased risk of AD (pooled relative risk = 1.18, 95% CI 1.11–1.25, N = 3,149,740). The sensitivity analysis including only studies in which mTBI preceded AD by > 10 years, excluded two very large studies and resulted in wider confidence intervals (RR = 2.02, 95% CI 0.66–6.21, N = 2307). Conclusion: There is an increased risk of AD following mTBI. Our findings of increased risk even with mTBI means it cannot be assumed that mild head injuries from sports are harmless. The sensitivity analysis suggests that we cannot exclude reverse causation, and longer follow up times are needed. Implementation of policy to reduce mTBIs, including in children and sportsmen, are urgently needed. Further research is needed on the effect of frequency and age at injury of mTBIs.
Collapse
|
5
|
Streubel-Gallasch L, Zyśk M, Beretta C, Erlandsson A. Traumatic brain injury in the presence of Aβ pathology affects neuronal survival, glial activation and autophagy. Sci Rep 2021; 11:22982. [PMID: 34837024 PMCID: PMC8626479 DOI: 10.1038/s41598-021-02371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
Traumatic brain injury (TBI) presents a widespread health problem in the elderly population. In addition to the acute injury, epidemiological studies have observed an increased probability and earlier onset of dementias in the elderly following TBI. However, the underlying mechanisms of the connection between TBI and Alzheimer's disease in the aged brain and potential exacerbating factors is still evolving. The aim of this study was to investigate cellular injury-induced processes in the presence of amyloid β (Aβ) pathology. For this purpose, a co-culture system of cortical stem-cell derived astrocytes, neurons and oligodendrocytes were exposed to Aβ42 protofibrils prior to a mechanically induced scratch injury. Cellular responses, including neurodegeneration, glial activation and autophagy was assessed by immunoblotting, immunocytochemistry, ELISA and transmission electron microscopy. Our results demonstrate that the combined burden of Aβ exposure and experimental TBI causes a decline in the number of neurons, the differential expression of the key astrocytic markers glial fibrillary acidic protein and S100 calcium-binding protein beta, mitochondrial alterations and prevents the upregulation of autophagy. Our study provides valuable information about the impact of TBI sustained in the presence of Aβ deposits and helps to advance the understanding of geriatric TBI on the cellular level.
Collapse
Affiliation(s)
- Linn Streubel-Gallasch
- Department of Public Health and Caring Sciences/Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, 751 85, Uppsala, Sweden
| | - Marlena Zyśk
- Department of Public Health and Caring Sciences/Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, 751 85, Uppsala, Sweden
| | - Chiara Beretta
- Department of Public Health and Caring Sciences/Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, 751 85, Uppsala, Sweden
| | - Anna Erlandsson
- Department of Public Health and Caring Sciences/Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, 751 85, Uppsala, Sweden.
| |
Collapse
|
6
|
Lusardi TA, Sandau US, Sakhanenko NA, Baker SCB, Wiedrick JT, Lapidus JA, Raskind MA, Li G, Peskind ER, Galas DJ, Quinn JF, Saugstad JA. Cerebrospinal Fluid MicroRNA Changes in Cognitively Normal Veterans With a History of Deployment-Associated Mild Traumatic Brain Injury. Front Neurosci 2021; 15:720778. [PMID: 34580583 PMCID: PMC8463659 DOI: 10.3389/fnins.2021.720778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/27/2021] [Indexed: 01/09/2023] Open
Abstract
A history of traumatic brain injury (TBI) increases the odds of developing Alzheimer's disease (AD). The long latent period between injury and dementia makes it difficult to study molecular changes initiated by TBI that may increase the risk of developing AD. MicroRNA (miRNA) levels are altered in TBI at acute times post-injury (<4 weeks), and in AD. We hypothesized that miRNA levels in cerebrospinal fluid (CSF) following TBI in veterans may be indicative of increased risk for developing AD. Our population of interest is cognitively normal veterans with a history of one or more mild TBI (mTBI) at a chronic time following TBI. We measured miRNA levels in CSF from three groups of participants: (1) community controls with no lifetime history of TBI (ComC); (2) deployed Iraq/Afghanistan veterans with no lifetime history of TBI (DepC), and (3) deployed Iraq/Afghanistan veterans with a history of repetitive blast mTBI (DepTBI). CSF samples were collected at the baseline visit in a longitudinal, multimodal assessment of Gulf War veterans, and represent a heterogenous group of male veterans and community controls. The average time since the last blast mTBI experienced was 4.7 ± 2.2 years [1.5 - 11.5]. Statistical analysis of TaqManTM miRNA array data revealed 18 miRNAs with significant differential expression in the group comparisons: 10 between DepTBI and ComC, 7 between DepC and ComC, and 8 between DepTBI and DepC. We also identified 8 miRNAs with significant differential detection in the group comparisons: 5 in DepTBI vs. ComC, 3 in DepC vs. ComC, and 2 in DepTBI vs. DepC. When we applied our previously developed multivariable dependence analysis, we found 13 miRNAs (6 of which are altered in levels or detection) that show dependencies with participant phenotypes, e.g., ApoE. Target prediction and pathway analysis with miRNAs differentially expressed in DepTBI vs. either DepC or ComC identified canonical pathways highly relevant to TBI including senescence and ephrin receptor signaling, respectively. This study shows that both TBI and deployment result in persistent changes in CSF miRNA levels that are relevant to known miRNA-mediated AD pathology, and which may reflect early events in AD.
Collapse
Affiliation(s)
- Theresa A Lusardi
- Knight Cancer Institute, Cancer Early Detection Advanced Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Ursula S Sandau
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
| | | | - Sarah Catherine B Baker
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Jack T Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland, OR, United States
| | - Jodi A Lapidus
- Biostatistics & Design Program, Oregon Health & Science University, Portland, OR, United States
| | - Murray A Raskind
- Northwest Mental Illness, Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Ge Li
- Northwest Mental Illness, Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States.,Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Elaine R Peskind
- Northwest Mental Illness, Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - David J Galas
- Pacific Northwest Research Institute, Seattle, WA, United States
| | - Joseph F Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States.,Parkinson Center and Movement Disorders Program, School of Medicine, Oregon Health & Science University, Portland, OR, United States.,Portland VAMC Parkinson's Disease Research, Education, and Clinical Center, Portland, OR, United States
| | - Julie A Saugstad
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, United States
| |
Collapse
|
7
|
Cognitive Reserve in Individuals Aging With Traumatic Brain Injury: Independent and Interactive Effects on Cognitive Functioning. J Head Trauma Rehabil 2021; 37:E196-E205. [PMID: 34145164 DOI: 10.1097/htr.0000000000000697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the influence of 2 temporal factors-age and injury chronicity-on the relationship between cognitive reserve (CR) and cognitive functioning in older adults with chronic traumatic brain injury (TBI). SETTING Outpatient research laboratory. PARTICIPANTS Adults, 50 years or older, with a 1- to 45-year history of moderate or severe TBI (N = 108). DESIGN Cross-sectional observational study. MAIN MEASURES CR was estimated using demographically corrected performance on a word-reading test (an approximation of premorbid IQ). Injury chronicity was operationalized as number of years since the date of injury. Composite cognitive scores were computed from performances on neuropsychological tests of processing speed, executive functioning, and memory. RESULTS CR was positively and significantly related to all cognitive performances independent of age, injury chronicity, and injury severity. Greater injury chronicity significantly attenuated the effect of CR on processing speed such that individuals more distal from their injury date evidenced a weaker positive relationship between CR and performance. CONCLUSION Temporal factors may modify associations between CR and cognition. Findings suggest that the protective effects of CR are temporally delimited, potentially contending with declines in brain reserve. The prognostic value of traditional outcome determinants should be considered in the context of injury chronicity.
Collapse
|
8
|
Alosco ML, Culhane J, Mez J. Neuroimaging Biomarkers of Chronic Traumatic Encephalopathy: Targets for the Academic Memory Disorders Clinic. Neurotherapeutics 2021; 18:772-791. [PMID: 33847906 PMCID: PMC8423967 DOI: 10.1007/s13311-021-01028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts, such as those from contact sports. The pathognomonic lesion for CTE is the perivascular accumulation of hyper-phosphorylated tau in neurons and other cell process at the depths of sulci. CTE cannot be diagnosed during life at this time, limiting research on risk factors, mechanisms, epidemiology, and treatment. There is an urgent need for in vivo biomarkers that can accurately detect CTE and differentiate it from other neurological disorders. Neuroimaging is an integral component of the clinical evaluation of neurodegenerative diseases and will likely aid in diagnosing CTE during life. In this qualitative review, we present the current evidence on neuroimaging biomarkers for CTE with a focus on molecular, structural, and functional modalities routinely used as part of a dementia evaluation. Supporting imaging-pathological correlation studies are also presented. We targeted neuroimaging studies of living participants at high risk for CTE (e.g., aging former elite American football players, fighters). We conclude that an optimal tau PET radiotracer with high affinity for the 3R/4R neurofibrillary tangles in CTE has not yet been identified. Amyloid PET scans have tended to be negative. Converging structural and functional imaging evidence together with neuropathological evidence show frontotemporal and medial temporal lobe neurodegeneration, and increased likelihood for a cavum septum pellucidum. The literature offers promising neuroimaging biomarker targets of CTE, but it is limited by cross-sectional studies of small samples where the presence of underlying CTE is unknown. Imaging-pathological correlation studies will be important for the development and validation of neuroimaging biomarkers of CTE.
Collapse
Affiliation(s)
- Michael L Alosco
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA.
| | - Julia Culhane
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA
| | - Jesse Mez
- Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University School of Medicine, 72 E Concord St, Suite B7800, MA, 02118, Boston, USA
- Framingham Heart Study, Boston University School of Medicine, MA, Boston, USA
| |
Collapse
|
9
|
An update on the association between traumatic brain injury and Alzheimer's disease: Focus on Tau pathology and synaptic dysfunction. Neurosci Biobehav Rev 2020; 120:372-386. [PMID: 33171143 DOI: 10.1016/j.neubiorev.2020.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
L.P. Li, J.W. Liang and H.J. Fu. An update on the association between traumatic brain injury and Alzheimer's disease: Focus on Tau pathology and synaptic dysfunction. NEUROSCI BIOBEHAV REVXXX-XXX,2020.-Traumatic brain injury (TBI) and Alzheimer's disease (AD) are devastating conditions that have long-term consequences on individual's cognitive functions. Although TBI has been considered a risk factor for the development of AD, the link between TBI and AD is still in debate. Aggregation of hyperphosphorylated tau and intercorrelated synaptic dysfunction, two key pathological elements in both TBI and AD, play a pivotal role in mediating neurodegeneration and cognitive deficits, providing a mechanistic link between these two diseases. In the first part of this review, we analyze the experimental literatures on tau pathology in various TBI models and review the distribution, biological features and mechanisms of tau pathology following TBI with implications in AD pathogenesis. In the second part, we review evidences of TBI-mediated structural and functional impairments in synapses, with a focus on the overlapped mechanisms underlying synaptic abnormalities in both TBI and AD. Finally, future perspectives are proposed for uncovering the complex relationship between TBI and neurodegeneration, and developing potential therapeutic avenues for alleviating cognitive deficits after TBI.
Collapse
|
10
|
Green TRF, Ortiz JB, Wonnacott S, Williams RJ, Rowe RK. The Bidirectional Relationship Between Sleep and Inflammation Links Traumatic Brain Injury and Alzheimer's Disease. Front Neurosci 2020; 14:894. [PMID: 32982677 PMCID: PMC7479838 DOI: 10.3389/fnins.2020.00894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
Traumatic brain injury (TBI) and Alzheimer's disease (AD) are diseases during which the fine-tuned autoregulation of the brain is lost. Despite the stark contrast in their causal mechanisms, both TBI and AD are conditions which elicit a neuroinflammatory response that is coupled with physical, cognitive, and affective symptoms. One commonly reported symptom in both TBI and AD patients is disturbed sleep. Sleep is regulated by circadian and homeostatic processes such that pathological inflammation may disrupt the chemical signaling required to maintain a healthy sleep profile. In this way, immune system activation can influence sleep physiology. Conversely, sleep disturbances can exacerbate symptoms or increase the risk of inflammatory/neurodegenerative diseases. Both TBI and AD are worsened by a chronic pro-inflammatory microenvironment which exacerbates symptoms and worsens clinical outcome. Herein, a positive feedback loop of chronic inflammation and sleep disturbances is initiated. In this review, the bidirectional relationship between sleep disturbances and inflammation is discussed, where chronic inflammation associated with TBI and AD can lead to sleep disturbances and exacerbated neuropathology. The role of microglia and cytokines in sleep disturbances associated with these diseases is highlighted. The proposed sleep and inflammation-mediated link between TBI and AD presents an opportunity for a multifaceted approach to clinical intervention.
Collapse
Affiliation(s)
- Tabitha R. F. Green
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, United States
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - J. Bryce Ortiz
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, United States
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Sue Wonnacott
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Robert J. Williams
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Rachel K. Rowe
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, United States
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, United States
| |
Collapse
|
11
|
Abstract
With age, the presence of multiple neuropathologies in a single individual becomes increasingly common. Given that traumatic brain injury and the repetitive head impacts (RHIs) that occur in contact sports have been associated with the development of many neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), Alzheimer's disease, Lewy body disease, and amyotrophic lateral sclerosis, it is becoming critical to understand the relationship and interactions between these pathologies. In fact, comorbid pathology is common in CTE and likely influenced by both age and the severity and type of exposure to RHI as well as underlying genetic predisposition. Here, we review the major comorbid pathologies seen with CTE and in former contact sports athletes and discuss what is known about the associations between RHI, age, and the development of neuropathologies. In addition, we examine the distinction between CTE and age-related pathology including primary age-related tauopathy and age-related tau astrogliopathy.
Collapse
Affiliation(s)
- Thor D. Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts,Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts,Departments of Research and Pathology & Laboratory Medicine, VA Boston Healthcare System, Boston, Massachusetts,Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - John F. Crary
- Department of Pathology, Neuropathology Brain Bank & Research Core, Ronald M. Loeb Center for Alzheimer’s Disease, Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York
| |
Collapse
|
12
|
Barr WB. POINT/COUNTER-POINT-Links between traumatic brain injury and dementia remain poorly defined. Arch Clin Neuropsychol 2020; 35:128-132. [PMID: 32008038 DOI: 10.1093/arclin/acz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
There has been considerable public interest in the topic of traumatic brain injury (TBI) as a risk factor for development of late-life dementia. A review was performed on empirical studies examining the relationship between these two conditions. Although results from a number of studies clearly demonstrate that TBI is a positive risk factor for developing dementia, there are an equivalent number of studies that obtain inconclusive or negative findings. Inconsistencies across studies are often the result of methodological findings including the nature of the investigational design, choice of comparison groups, and criteria used to define cases. In many studies, the diagnosis of TBI is obtained retrospectively in a manner that is subject to bias. Accurate identification of dementia cases is often compromised by the use of inappropriately brief follow-up periods and variations in diagnostic methods. There remains no universally accepted neurobiological mechanism to explain the transition from acute TBI to the chronic effects of dementia. Studies of specialty populations, including athletes and military personnel are beset by secular and cohort effects, raising questions about the applicability of findings to the general population. No existing studies have been able to exclude the possible effects of confounding medical or lifestyle factors in facilitating the onset of dementia following TBI. Although the research findings suggest a general association between TBI and dementia, the specifics of the relationship remain poorly defined.
Collapse
Affiliation(s)
- William B Barr
- Departments of Neurology & Psychiatry, NYU School of Medicine, Ney York, NY, USA
| |
Collapse
|
13
|
Sugarman MA, McKee AC, Stein TD, Tripodis Y, Besser LM, Martin B, Palmisano JN, Steinberg EG, O'Connor MK, Au R, McClean M, Killiany R, Mez J, Weiner MW, Kowall NW, Stern RA, Alosco ML. Failure to detect an association between self-reported traumatic brain injury and Alzheimer's disease neuropathology and dementia. Alzheimers Dement 2019; 15:686-698. [PMID: 30852157 PMCID: PMC6511462 DOI: 10.1016/j.jalz.2018.12.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Recent research with neuropathologic or biomarker evidence of Alzheimer's disease (AD) casts doubt on traumatic brain injury (TBI) as a risk factor for AD. We leveraged the National Alzheimer's Coordinating Center to examine the association between self-reported TBI with loss of consciousness and AD neuropathologic changes, and with baseline and longitudinal clinical status. METHODS The sample included 4761 autopsy participants (453 with remote TBI with loss of consciousness; 2822 with AD neuropathologic changes) from National Alzheimer's Coordinating Center. RESULTS Self-reported TBI did not predict AD neuropathologic changes (P > .10). Reported TBI was not associated with baseline or change in dementia severity or cognitive function in participants with or without autopsy-confirmed AD. DISCUSSION Self-reported TBI with loss of consciousness may not be an independent risk factor for clinical or pathological AD. Research that evaluates number and severity of TBIs is needed to clarify the neuropathological links between TBI and dementia documented in other large clinical databases.
Collapse
Affiliation(s)
- Michael A Sugarman
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Edith Nourse Rogers Memorial Veterans Hospital, Department of Neuropsychology, Bedford, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Lilah M Besser
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - Brett Martin
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Eric G Steinberg
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Maureen K O'Connor
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Edith Nourse Rogers Memorial Veterans Hospital, Department of Neuropsychology, Bedford, MA, USA
| | - Rhoda Au
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ronald Killiany
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA; Center for Biomedical Imaging, Boston University School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael W Weiner
- Department of Veteran Affairs Medical Center, Center for Imaging and Neurodegenerative Diseases, San Francisco, CA, USA; Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology, University of California, San Francisco, CA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; Neurology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
| |
Collapse
|
14
|
Kaup AR, Yaffe K. Reassuring News About Football and Cognitive Decline?: Not So Fast. JAMA Neurol 2019; 74:898-899. [PMID: 28672374 DOI: 10.1001/jamaneurol.2017.1324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Allison R Kaup
- Research Service, San Francisco Veterans Affairs Healthcare System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco.,Department of Neurology, University of California, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco.,San Francisco Veterans Affairs Healthcare System, San Francisco, California
| |
Collapse
|
15
|
Kaup AR, Toomey R, Bangen KJ, Delano-Wood L, Yaffe K, Panizzon MS, Lyons MJ, Franz CE, Kremen WS. Interactive Effect of Traumatic Brain Injury and Psychiatric Symptoms on Cognition among Late Middle-Aged Men: Findings from the Vietnam Era Twin Study of Aging. J Neurotrauma 2019; 36:338-347. [PMID: 29978738 PMCID: PMC6338572 DOI: 10.1089/neu.2018.5695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and depressive symptoms each increase the risk for cognitive impairment in older adults. We investigated whether TBI has long-term associations with cognition in late middle-aged men, and examined the role of current PTSD/depressive symptoms. Participants were 953 men (ages 56-66) from the Vietnam Era Twin Study of Aging (VETSA), who were classified by presence or absence of (1) history of TBI and (2) current elevated psychiatric symptoms (defined as PTSD or depressive symptoms above cutoffs). TBIs had occurred an average of 35 years prior to assessment. Participants completed cognitive testing examining nine domains. In mixed-effects models, we tested the effect of TBI on cognition including for interactions between TBI and elevated psychiatric symptoms. Models adjusted for age, pre-morbid cognitive ability assessed at average age 20 years, apolipoprotein E genotype, and substance abuse; 33% (n = 310) of participants had TBI, mostly mild and remote; and 23% (n = 72) of those with TBI and 18% (n = 117) without TBI had current elevated psychiatric symptoms. TBI and psychiatric symptoms had interactive effects on cognition, particularly executive functioning. Group comparison analyses showed that men with both TBI and psychiatric symptoms demonstrated deficits primarily in executive functioning. Cognition was largely unaffected in men with either risk factor in isolation. Among late middle-aged men, the combination of even mild and very remote TBI with current elevated psychiatric symptoms is associated with deficits in executive function and related abilities. Future longitudinal studies should investigate how TBI and psychiatric factors interact to impact brain aging.
Collapse
Affiliation(s)
- Allison R. Kaup
- Research Service, San Francisco VA Health Care System and Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.,Address correspondence to: Allison R. Kaup, PhD, Research Service, San Francisco VA Health Care System and Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 4150 Clement Street (116B), San Francisco, CA, 94121
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Katherine J. Bangen
- Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, La Jolla, California.,Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, La Jolla, California
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco and San Francisco VA Health Care System, San Francisco, California
| | - Matthew S. Panizzon
- Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, La Jolla, California.,Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Carol E. Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, California.,Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| | - William S. Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, California.,Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California
| |
Collapse
|
16
|
Ginnivan NA, Butler TG, Withall AN. The rising health, social and economic costs of Australia's ageing prisoner population. Med J Aust 2018; 209:422-424. [DOI: 10.5694/mja18.00266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Natasha A Ginnivan
- The Kirby Institute, UNSW Sydney, Sydney, NSW
- ARC Centre of Excellence in Population Ageing Research, UNSW Sydney, Sydney, NSW
| | | | - Adrienne N Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW
| |
Collapse
|
17
|
Cohen-Zimerman S, Salvi C, Krueger F, Gordon B, Grafman J. Intelligence across the seventh decade in patients with brain injuries acquired in young adulthood. Trends Neurosci Educ 2018; 13:1-7. [PMID: 30613804 DOI: 10.1016/j.tine.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In this longitudinal study, we examined intelligence in a group of Vietnam veterans in their 60 s who suffered combat-related penetrating traumatic brain injuries (pTBI) in their 20 s (n = 120), as well as matched veterans with no brain damage (n = 33). Intelligence was evaluated using the Armed Forces Qualification Test (AFQT) administered before the injury occurred and then again at three points in time over the following 45 years. We tested for potential predictors and correlates of late midlife intelligence score, as well as the recent change in score over the seventh decade. The pTBI group had lower intelligence scores than the control group when currently evaluated. Pre-injury intelligence and the presence of a pTBI were the most consistent predictors of current intelligence scores. While exacerbated intellectual decline occurs following a young-adulthood pTBI and affects everyday life, no evidence for late midlife accelerated cognitive decline or dementia was found.
Collapse
Affiliation(s)
- Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Think+Speak Lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA
| | - Carola Salvi
- Cognitive Neuroscience Laboratory, Think+Speak Lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA.,Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, USA.,Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Cognitive Science Department, Johns Hopkins University, Baltimore, MD, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think+Speak Lab, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
18
|
Castranio EL, Wolfe CM, Nam KN, Letronne F, Fitz NF, Lefterov I, Koldamova R. ABCA1 haplodeficiency affects the brain transcriptome following traumatic brain injury in mice expressing human APOE isoforms. Acta Neuropathol Commun 2018; 6:69. [PMID: 30049279 PMCID: PMC6062955 DOI: 10.1186/s40478-018-0569-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023] Open
Abstract
Expression of human Apolipoprotein E (APOE) modulates the inflammatory response in an isoform specific manner, with APOE4 isoform eliciting a stronger pro-inflammatory response, suggesting a possible mechanism for worse outcome following traumatic brain injury (TBI). APOE lipidation and stability is modulated by ATP-binding cassette transporter A1 (ABCA1), a transmembrane protein that transports lipids and cholesterol onto APOE. We examined the impact of Abca1 deficiency and APOE isoform expression on the response to TBI using 3-months-old, human APOE3+/+ (E3/Abca1+/+) and APOE4+/+ (E4/Abca1+/+) targeted replacement mice, and APOE3+/+ and APOE4+/+ mice with only one functional copy of the Abca1 gene (E3/Abca1+/-; E4/Abca1+/-). TBI-treated mice received a craniotomy followed by a controlled cortical impact (CCI) brain injury in the left hemisphere; sham-treated mice received the same surgical procedure without the impact. We performed RNA-seq using samples from cortices and hippocampi followed by genome-wide differential gene expression analysis. We found that TBI significantly impacted unique transcripts within each group, however, the proportion of unique transcripts was highest in E4/Abca1+/- mice. Additionally, we found that Abca1 haplodeficiency increased the expression of microglia sensome genes among only APOE4 injured mice, a response not seen in injured APOE3 mice, nor in either group of sham-treated mice. To identify gene networks, or modules, correlated to TBI, APOE isoform and Abca1 haplodeficiency, we used weighted gene co-expression network analysis (WGCNA). The module that positively correlated to TBI groups was associated with immune response and featured hub genes that were microglia-specific, including Trem2, Tyrobp, Cd68 and Hexb. The modules positively correlated with APOE4 isoform and negatively to Abca1 haplodeficient mice represented "protein translation" and "oxidation-reduction process", respectively. Our results reveal E4/Abca1+/- TBI mice have a distinct response to injury, and unique gene networks are associated with APOE isoform, Abca1 insufficiency and injury.
Collapse
Affiliation(s)
- Emilie L Castranio
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Cody M Wolfe
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Kyong Nyon Nam
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Florent Letronne
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Nicholas F Fitz
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Iliya Lefterov
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
| | - Radosveta Koldamova
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
| |
Collapse
|
19
|
Zhang Y, Liu S, Yue W, Shi Z, Guan Y, Li M, Ji Y, Li X. Association of apolipoprotein E genotype with outcome in hospitalized ischemic stroke patients. Medicine (Baltimore) 2017; 96:e8964. [PMID: 29390290 PMCID: PMC5815702 DOI: 10.1097/md.0000000000008964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to study the ability of the genotype to predict impairment and disability in hospitalized ischemic stroke (IS) patients after hospital discharge and 6 months after the onset of stroke symptoms.A total of 786 patients with a first IS were enrolled. Apolipoprotein E (ApoE) polymorphism was examined using polymerase chain reaction. Stroke subtype was classified using the Oxfordshire Community Stroke Project classification scheme and the Trial of Org 10172 in Acute Stroke Treatment criteria. Impairment as assessed using the National Institutes of Health Stroke Scale (NIHSS), and disability as measured using the modified Rankin Scale (mRS), were compared against the ApoE genotype.There was no significant association between the type of ApoE allele present and the stroke subtype. On multivariate regression analysis, the apolipoprotein EE4 allele genotype did not predict poor outcome at discharge and or at 6 months after stroke onset. A higher NIHSS score on admission, older age, and higher fasting glucose levels did predict poor outcome at hospital discharge. Higher glucose levels and higher NIHSS scores on admission were independent risk factors predicting poor neurologic status at 6 months after stroke onset.The presence of the apolipoprotein EE4 and apolipoprotein EE2 genotypes, although related to cholesterol and triglyceride levels, do not affect recovery during rehabilitation. A higher NIHSS score on admission and a higher fasting glucose level predict poor neurologic status, both at hospital discharge and 6 months after onset.
Collapse
Affiliation(s)
- Yajing Zhang
- Department of Neurology, The Second Hospital of Tianjin Medical University,Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Disease and Neurodegenerative Disease, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuling Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Disease and Neurodegenerative Disease, Tianjin Huanhu Hospital, Tianjin, China
- School of Nursing, Peking University,Beijing, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Disease and Neurodegenerative Disease, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Disease and Neurodegenerative Disease, Tianjin Huanhu Hospital, Tianjin, China
| | - Yalin Guan
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Disease and Neurodegenerative Disease, Tianjin Huanhu Hospital, Tianjin, China
| | - Mingzi Li
- School of Nursing, Peking University,Beijing, China
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Disease and Neurodegenerative Disease, Tianjin Huanhu Hospital, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University,Tianjin, China
| |
Collapse
|
20
|
The chronic and evolving neurological consequences of traumatic brain injury. Lancet Neurol 2017; 16:813-825. [PMID: 28920887 DOI: 10.1016/s1474-4422(17)30279-x] [Citation(s) in RCA: 318] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) can have lifelong and dynamic effects on health and wellbeing. Research on the long-term consequences emphasises that, for many patients, TBI should be conceptualised as a chronic health condition. Evidence suggests that functional outcomes after TBI can show improvement or deterioration up to two decades after injury, and rates of all-cause mortality remain elevated for many years. Furthermore, TBI represents a risk factor for a variety of neurological illnesses, including epilepsy, stroke, and neurodegenerative disease. With respect to neurodegeneration after TBI, post-mortem studies on the long-term neuropathology after injury have identified complex persisting and evolving abnormalities best described as polypathology, which includes chronic traumatic encephalopathy. Despite growing awareness of the lifelong consequences of TBI, substantial gaps in research exist. Improvements are therefore needed in understanding chronic pathologies and their implications for survivors of TBI, which could inform long-term health management in this sizeable patient population.
Collapse
|
21
|
Wood RL. Accelerated cognitive aging following severe traumatic brain injury: A review. Brain Inj 2017; 31:1270-1278. [DOI: 10.1080/02699052.2017.1332387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rodger Ll. Wood
- Neuropsychology Clinic, Institute of Life Sciences, College of Medicine, Swansea University, Swansea, UK
| |
Collapse
|
22
|
Van Horn JD, Irimia A, Torgerson CM, Bhattrai A, Jacokes Z, Vespa PM. Mild cognitive impairment and structural brain abnormalities in a sexagenarian with a history of childhood traumatic brain injury. J Neurosci Res 2017; 96:652-660. [PMID: 28543689 DOI: 10.1002/jnr.24084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 12/30/2022]
Abstract
In this report, we present a case study involving an older, female patient with a history of pediatric traumatic brain injury (TBI). Magnetic resonance imaging and diffusion tensor imaging volumes were acquired from the volunteer in question, her brain volumetrics and morphometrics were extracted, and these were then systematically compared against corresponding metrics obtained from a large sample of older healthy control (HC) subjects as well as from subjects in various stages of mild cognitive impairment (MCI) and Alzheimer disease (AD). Our analyses find the patient's brain morphometry and connectivity most similar to those of patients classified as having early-onset MCI, in contrast to HC, late MCI, and AD samples. Our examination will be of particular interest to those interested in assessing the clinical course in older patients having suffered TBI earlier in life, in contradistinction to those who experience incidents of head injury during aging.
Collapse
Affiliation(s)
- John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California
| | - Carinna M Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California
| | - Avnish Bhattrai
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California
| | - Paul M Vespa
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
23
|
Weiner MW, Harvey D, Hayes J, Landau SM, Aisen PS, Petersen RC, Tosun D, Veitch DP, Jack CR, Decarli C, Saykin AJ, Grafman J, Neylan TC. Effects of traumatic brain injury and posttraumatic stress disorder on development of Alzheimer's disease in Vietnam Veterans using the Alzheimer's Disease Neuroimaging Initiative: Preliminary Report. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:177-188. [PMID: 28758146 PMCID: PMC5526098 DOI: 10.1016/j.trci.2017.02.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) have previously been reported to be associated with increased risk of Alzheimer's disease (AD). We are using biomarkers to study Vietnam Veterans with/without mild cognitive impairment with a history of at least one TBI and/or ongoing PTSD to determine whether these contribute to the development of AD. METHODS Potential subjects identified by Veterans Administration records underwent an initial telephone screen. Consented subjects underwent clinical evaluation, lumbar puncture, structural MRI and amyloid PET scans. RESULTS We observed worse cognitive functioning in PTSD and TBI + PTSD groups, worse global cognitive functioning in the PTSD group, lower superior parietal volume in the TBI + PTSD group, and lower amyloid positivity in the PTSD group, but not the TBI group compared to controls without TBI/PTSD. Medial temporal lobe atrophy was not increased in the PTSD and/or TBI groups. DISCUSSION Preliminary results do not indicate that TBI or PTSD increase the risk for AD measured by amyloid PET. Additional recruitment, longitudinal follow-up, and tau PET scans will provide more information in the future.
Collapse
Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA.,Department of Radiology, University of California, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA.,Department of Psychiatry, University of California, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, CA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Jacqueline Hayes
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | | | - Duygu Tosun
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA
| | | | - Charles Decarli
- Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology and Center for Neuroscience, University of California, Davis, CA, USA
| | - Andrew J Saykin
- Indiana Alzheimer Disease Center, Department of Radiology and Imaging Sciences, Indiana University, School of Medicine, Indianapolis, IN, USA.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jordan Grafman
- Psychiatry and Behavioral Sciences & Cognitive Neurology/Alzheimer's Disease Research Center, Feinberg School of Medicine and Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | | |
Collapse
|
24
|
Disordered APP metabolism and neurovasculature in trauma and aging: Combined risks for chronic neurodegenerative disorders. Ageing Res Rev 2017; 34:51-63. [PMID: 27829172 DOI: 10.1016/j.arr.2016.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/20/2016] [Accepted: 11/04/2016] [Indexed: 11/20/2022]
Abstract
Traumatic brain injury (TBI), advanced age, and cerebral vascular disease are factors conferring increased risk for late onset Alzheimer's disease (AD). These conditions are also related pathologically through multiple interacting mechanisms. The hallmark pathology of AD consists of pathological aggregates of amyloid-β (Aβ) peptides and tau proteins. These molecules are also involved in neuropathology of several other chronic neurodegenerative diseases, and are under intense investigation in the aftermath of TBI as potential contributors to the risk for developing AD and chronic traumatic encephalopathy (CTE). The pathology of TBI is complex and dependent on injury severity, age-at-injury, and length of time between injury and neuropathological evaluation. In addition, the mechanisms influencing pathology and recovery after TBI likely involve genetic/epigenetic factors as well as additional disorders or comorbid states related to age and central and peripheral vascular health. In this regard, dysfunction of the aging neurovascular system could be an important link between TBI and chronic neurodegenerative diseases, either as a precipitating event or related to accumulation of AD-like pathology which is amplified in the context of aging. Thus with advanced age and vascular dysfunction, TBI can trigger self-propagating cycles of neuronal injury, pathological protein aggregation, and synaptic loss resulting in chronic neurodegenerative disease. In this review we discuss evidence supporting TBI and aging as dual, interacting risk factors for AD, and the role of Aβ and cerebral vascular dysfunction in this relationship. Evidence is discussed that Aβ is involved in cyto- and synapto-toxicity after severe TBI, and that its chronic effects are potentiated by aging and impaired cerebral vascular function. From a therapeutic perspective, we emphasize that in the fields of TBI- and aging-related neurodegeneration protective strategies should include preservation of neurovascular function.
Collapse
|
25
|
Serum Proteome Alterations in Patients with Cognitive Impairment after Traumatic Brain Injury Revealed by iTRAQ-Based Quantitative Proteomics. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8572509. [PMID: 28251161 PMCID: PMC5303854 DOI: 10.1155/2017/8572509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/01/2016] [Accepted: 12/13/2016] [Indexed: 12/26/2022]
Abstract
Background. Cognitive impairment is the leading cause of traumatic brain injury- (TBI-) related disability; however, the underlying pathogenesis of this dysfunction is not completely understood. Methods. Using an isobaric tagging for relative and absolute quantitation- (iTRAQ-) based quantitative proteomic approach, serum samples from healthy control subjects, TBI patients with cognitive impairment, and TBI patients without cognitive impairment were analysed to identify differentially expressed proteins (DEPs) related to post-TBI cognitive impairment. In addition, DEPs were further analysed using bioinformatic platforms and validated using enzyme-linked immunosorbent assays (ELISA). Results. A total of 56 DEPs were identified that were specifically related to TBI-induced cognitive impairment. Bioinformatic analysis revealed that a wide variety of cellular and metabolic processes and some signaling pathways were involved in the pathophysiology of cognitive deficits following TBI. Five randomly selected DEPs were validated using ELISA in an additional 105 cases, and the results also supported the experimental findings. Conclusions. Despite limitations, our findings will facilitate further studies of the pathological mechanisms underlying TBI-induced cognitive impairment and provide new methods for the research and development of neuroprotective agents. However, further investigation on a large cohort is warranted.
Collapse
|
26
|
Abstract
OBJECTIVES The aim of this study was to characterize the neuropsychological profile of lifetime traumatic brain injury (TBI) in older Veterans. METHODS Participants were 169 older Veterans [mean age=79.1 years (range, 51-97 years), 89% male, 92% Caucasian], 88 with lifetime TBI and 81 without TBI, living in Veterans' retirement homes in independent residence. TBI history was ascertained with the Ohio State TBI Identification Method structured interview. Cognition was assessed with neuropsychological tests: Raw scores were converted to Z-scores compared to age-corrected normative data and combined into five domain composite Z-scores (attention/working memory, learning/memory, language, processing speed, executive functioning). We investigated the association between TBI and performance in each cognitive domain in linear mixed effects models, with and without adjustment for demographics, medical comorbidities, and psychiatric variables. RESULTS Compared to those without TBI, older Veterans with TBI had greater deficits in processing speed (estimate=-.52; p=.01; f 2=.08 in fully adjusted model) and executive functioning (estimate=-.41; p=.02; f 2=.06 in fully adjusted model) but performed similarly in the attention/working memory, learning/memory, and language domains (all p>.05). TBI-associated deficits were most prominent among individuals with multiple mild TBIs and those with any moderate-to-severe TBI, but were not clearly present among those with single mild TBI. CONCLUSIONS The neuropsychological profile of lifetime TBI in older Veterans is characterized by slowed processing speed and executive dysfunction, especially among those with greater injury burden. This pattern may reflect long-standing deficits or a TBI-associated cognitive decline process distinct from Alzheimer's disease. (JINS, 2017, 23, 56-64).
Collapse
|
27
|
Serum Metabolic Profiling Reveals Altered Metabolic Pathways in Patients with Post-traumatic Cognitive Impairments. Sci Rep 2016; 6:21320. [PMID: 26883691 PMCID: PMC4756382 DOI: 10.1038/srep21320] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/21/2016] [Indexed: 12/18/2022] Open
Abstract
Cognitive impairment, the leading cause of traumatic brain injury (TBI)-related disability, adversely affects the quality of life of TBI patients, and exacts a personal and economic cost that is difficult to quantify. The underlying pathophysiological mechanism is currently unknown, and an effective treatment of the disease has not yet been identified. This study aimed to advance our understanding of the mechanism of disease pathogenesis; thus, metabolomics based on gas chromatography/mass spectrometry (GC-MS), coupled with multivariate and univariate statistical methods were used to identify potential biomarkers and the associated metabolic pathways of post-TBI cognitive impairment. A biomarker panel consisting of nine serum metabolites (serine, pyroglutamic acid, phenylalanine, galactose, palmitic acid, arachidonic acid, linoleic acid, citric acid, and 2,3,4-trihydroxybutyrate) was identified to be able to discriminate between TBI patients with cognitive impairment, TBI patients without cognitive impairment and healthy controls. Furthermore, associations between these metabolite markers and the metabolism of amino acids, lipids and carbohydrates were identified. In conclusion, our study is the first to identify several serum metabolite markers and investigate the altered metabolic pathway that is associated with post-TBI cognitive impairment. These markers appear to be suitable for further investigation of the disease mechanisms of post-TBI cognitive impairment.
Collapse
|
28
|
Montine TJ, Montine KS. Precision medicine: Clarity for the clinical and biological complexity of Alzheimer's and Parkinson's diseases. J Exp Med 2015; 212:601-5. [PMID: 25941321 PMCID: PMC4419342 DOI: 10.1084/jem.20150656] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 04/13/2015] [Indexed: 01/10/2023] Open
Abstract
The goal of precision medicine is to deliver optimally targeted and timed interventions tailored to an individual's molecular drivers of disease. This concept has wide currency in cancer care and in some diseases caused by monogenetic mutations, such as cystic fibrosis, and recently has been endorsed by the White House Office of Science and Technology for more widespread application in medicine. Here we describe our vision of how precision medicine can bring greater clarity to the clinical and biological complexity of the two most common neurodegenerative diseases, Alzheimer's disease and Parkinson's disease.
Collapse
Affiliation(s)
- Thomas J Montine
- T.J. Montine and K.S. Montine are at the Department of Pathology, University of Washington, Seattle, WA 98104
| | - Kathleen S Montine
- T.J. Montine and K.S. Montine are at the Department of Pathology, University of Washington, Seattle, WA 98104
| |
Collapse
|