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Yerramalla MS, Darin‐Mattsson A, Udeh‐Momoh CT, Holleman J, Kåreholt I, Aspö M, Hagman G, Kivipelto M, Solomon A, Marseglia A, Sindi S. Cognitive reserve, cortisol, and Alzheimer's disease biomarkers: A memory clinic study. Alzheimers Dement 2024; 20:4486-4498. [PMID: 38837661 PMCID: PMC11247673 DOI: 10.1002/alz.13866] [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: 01/10/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Cognitive reserve might mitigate the risk of Alzheimer's dementia among memory clinic patients. No study has examined the potential modifying role of stress on this relation. METHODS We examined cross-sectional associations of the cognitive reserve index (CRI; education, occupational complexity, physical and leisure activities, and social health) with cognitive performance and AD-related biomarkers among 113 memory clinic patients. The longitudinal association between CRI and cognition over a 3-year follow-up was assessed. We examined whether associations were influenced by perceived stress and five measures of diurnal salivary cortisol. RESULTS Higher CRI scores were associated with better cognition. Adjusting for cortisol measures reduced the beneficial association of CRI on cognition. A higher CRI score was associated with better working memory in individuals with higher (favorable) cortisol AM/PM ratio, but not among individuals with low cortisol AM/PM ratio. No association was found between CRI and AD-related biomarkers. DISCUSSION Physiological stress reduces the neurocognitive benefits of cognitive reserve among memory clinic patients. HIGHLIGHTS Physiological stress may reduce the neurocognitive benefits accrued from cognitively stimulating and enriching life experiences (cognitive reserve [CR]) in memory clinic patients. Cortisol awakening response modified the relation between CR and P-tau181, a marker of Alzheimer's disease (AD). Effective stress management techniques for AD and related dementia prevention are warranted.
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Affiliation(s)
- Manasa Shanta Yerramalla
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
| | | | - Chinedu T Udeh‐Momoh
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
- Brain and Mind InstituteThe Aga Khan UniversityNairobiKenya
- Department of Epidemiology and PreventionWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Jasper Holleman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
- Institute of GerontologySchool of Health and WelfareJönköping UniversityJönköpingSweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingKarolinska University HospitalStockholmSweden
| | - Göran Hagman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingKarolinska University HospitalStockholmSweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingKarolinska University HospitalStockholmSweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of MedicineImperial College LondonLondonUK
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingKarolinska University HospitalStockholmSweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of MedicineImperial College LondonLondonUK
- Institute of Clinical Medicine, NeurologyUniversity of Eastern FinlandKuopioFinland
| | - Anna Marseglia
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of MedicineImperial College LondonLondonUK
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Holleman J, Daniilidou M, Kåreholt I, Aspö M, Hagman G, Udeh-Momoh CT, Spulber G, Kivipelto M, Solomon A, Matton A, Sindi S. Diurnal cortisol, neuroinflammation, and neuroimaging visual rating scales in memory clinic patients. Brain Behav Immun 2024; 118:499-509. [PMID: 38503394 DOI: 10.1016/j.bbi.2024.03.024] [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: 10/30/2023] [Revised: 02/18/2024] [Accepted: 03/16/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Neuroinflammation is a hallmark of the Alzheimer's disease (AD) pathogenic process. Cortisol dysregulation may increase AD risk and is related to brain atrophy. This cross-sectional study aims to examine interactions of cortisol patterns and neuroinflammation markers in their association with neuroimaging correlates. METHOD 134 participants were recruited from the Karolinska University Hospital memory clinic (Stockholm, Sweden). Four visual rating scales were applied to magnetic resonance imaging or computed tomography scans: medial temporal lobe atrophy (MTA), global cortical atrophy (GCA), white matter lesions (WML), and posterior atrophy. Participants provided saliva samples for assessment of diurnal cortisol patterns, and underwent lumbar punctures for cerebrospinal fluid (CSF) sampling. Three cortisol measures were used: the cortisol awakening response, total daily output, and the ratio of awakening to bedtime levels. Nineteen CSF neuroinflammation markers were categorized into five composite scores: proinflammatory cytokines, other cytokines, angiogenesis markers, vascular injury markers, and glial activation markers. Ordinal logistic regressions were conducted to assess associations between cortisol patterns, neuroinflammation scores, and visual rating scales, and interactions between cortisol patterns and neuroinflammation scores in relation to visual rating scales. RESULT Higher levels of angiogenesis markers were associated with more severe WML. Some evidence was found for interactions between dysregulated diurnal cortisol patterns and greater neuroinflammation-related biomarkers in relation to more severe GCA and WML. No associations were found between cortisol patterns and visual rating scales. CONCLUSION This study suggests an interplay between diurnal cortisol patterns and neuroinflammation in relation to brain structure. While this cross-sectional study does not provide information on causality or temporality, these findings suggest that neuroinflammation may be involved in the relationship between HPA-axis functioning and AD.
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Affiliation(s)
- Jasper Holleman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden.
| | - Makrina Daniilidou
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
| | - Göran Hagman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
| | - Chinedu T Udeh-Momoh
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, UK; Division of Public Health Sciences, Wake Forest University School of Medicine, North Carolina, USA; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Gabriela Spulber
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, UK; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, UK; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anna Matton
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, UK
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, 171 64 Solna, Stockholm, Sweden; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, UK
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Huang YY, Wang HF, Wu BS, Ou YN, Ma LZ, Yang L, Cheng W, Yu JT. Clinical laboratory tests and dementia incidence: A prospective cohort study. J Affect Disord 2024; 351:1-7. [PMID: 38286224 DOI: 10.1016/j.jad.2024.01.226] [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: 10/16/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Dementia is a major public health issue and a heavy economic burden. It is urgently necessary to understand the underlying biological processes and to identify biomarkers predicting risk of dementia in the preclinical stage for prevention and treatment. METHODS By using the data of the 367,093 white British individuals from UK Biobank, we investigated the relationship between 56 laboratory measures and 5-year dementia incidence using logistic regression. Adjusted odds ratios for dementia incidence with values below or above the 95 % confidence interval (<2.5th or > 97.5th percentile) on each of clinical laboratory tests were computed. RESULTS We observed that markers of endocrine dysregulation: elevated hemoglobin A1C (AOR = 2.01 [1.35, 2.88]) was associated with increased dementia incidence. Indicators of liver dysfunction: elevated gamma glutamyltransferase (AOR = 2.28 [1.49, 3.32]), and albumin (AOR = 2.01 [1.15, 3.25]), indicators of renal impairment: high urea (AOR = 1.69 [1.15, 2.40]), and cystatin C (AOR = 1.89 [1.30, 2.67]), and some immune markers, like elevated neutrophill count, low lymphocyte count, and indicators of anemia were also observed to be associated with increased dementia incidence. Both low and high concentrations of insulin-like growth factor 1 were found to be risk factors for dementia. LIMITATIONS This is an observational study. CONCLUSION Several systemic biomarkers were associated with dementia incidence. These results implicate a contributory role of diverse biological processes to dementia onset, and enrich our understanding of potential dementia prevention strategy.
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Affiliation(s)
- Yu-Yuan Huang
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Bang-Sheng Wu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ling-Zhi Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Cheng
- The Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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Holleman J, Kåreholt I, Aspö M, Hagman G, Udeh-Momoh CT, Kivipelto M, Solomon A, Sindi S. Life-course stress, cognition, and diurnal cortisol in memory clinic patients without dementia. Arch Gerontol Geriatr 2024; 119:105316. [PMID: 38134708 DOI: 10.1016/j.archger.2023.105316] [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: 09/13/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
AIMS To examine associations of life-course stress with cognition and diurnal cortisol patterns in older adulthood, as well as potential mediation effects of diurnal cortisol patterns and perceived stress on the association between life-course stress and cognition. METHODS 127 participants without dementia were selected from a cohort of Swedish memory clinic patients. Cross-sectional associations between scores on two chronic stress questionnaires (perceived stress, stressful life events (SLEs)), five cognitive domains (overall cognition, memory, working memory, processing speed, perceptual reasoning), and two measures of diurnal cortisol patterns (total daily output, diurnal cortisol slope), as well as potential mediation effects of diurnal cortisol patterns and perceived stress on associations between life-course stress and cognition, were assessed using linear regressions. RESULTS Greater lifetime exposure to SLEs was associated with worse memory, working memory, and processing speed performance, but not with diurnal cortisol patterns. A greater number of SLEs in late childhood was associated with worse working memory and processing speed, while a greater number of SLEs in non-recent adulthood were associated with better overall cognition and perceptual reasoning. Greater perceived stress was associated with a flattened diurnal cortisol slope, but not with cognition. No evidence for interplay between self-reported and physiological stress markers was found in relation to cognition, although there appeared to be a significant positive indirect association between economic/legal SLEs and the diurnal cortisol slope via perceived stress. CONCLUSIONS The associations between SLEs and cognition depend on the period during which SLEs occur, but seem independent of late-life cortisol dysregulation.
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Affiliation(s)
- Jasper Holleman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden.
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; School of Health and Welfare, Aging Research Network -Jönköping (ARN-J), Institute of Gerontology, Jönköping University, Jönköping, Sweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Hagman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Chinedu T Udeh-Momoh
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK; Global Brain Health Institute, University of California San Francisco, USA; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska Vägen 37A - QA32, Stockholm, Solna 17164, Sweden; School of Public Health, Faculty of Medicine, Imperial College London, Ageing Epidemiology Research Unit (AGE), UK
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Abdullahi A, Wong TW, Ng SS. Understanding the mechanisms of disease modifying effects of aerobic exercise in people with Alzheimer's disease. Ageing Res Rev 2024; 94:102202. [PMID: 38272266 DOI: 10.1016/j.arr.2024.102202] [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: 10/17/2023] [Revised: 12/06/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
Alzheimer's disease (AD) is a very disabling disease. Pathologically, it is characterized by the presence of amyloid plaques and neurofibrillary tangles in the brain that results in neurodegeneration. Its clinical manifestations include progressive memory impairment, language decline and difficulty in carrying out activities of daily living (ADL). The disease is managed using interventions such as pharmacological interventions and aerobic exercise. Use of aerobic exercise has shown some promises in reducing the risk of developing AD, and improving cognitive function and the ability to carry out both basic and instrumental ADL. Although, the mechanisms through which aerobic exercise improves AD are poorly understood, improvement in vascular function, brain glucose metabolism and cardiorespiratory fitness, increase in antioxidant capacity and haemoglobin level, amelioration of immune-related and inflammatory responses, modulation of concentration of circulating Neurotrophins and peptides and decrease in concentration of tau protein and cortisol level among others seem to be the possible mechanisms. Therefore, understanding these mechanisms is important to help characterize the dose and the nature of the aerobic exercise to be given. In addition, they may also help in finding ways to optimize other interventions such as the pharmacological interventions. However, more quality studies are needed to verify the mechanisms.
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Affiliation(s)
- Auwal Abdullahi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Thomson Wl Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Shamay Sm Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Numakawa T, Kajihara R. An Interaction between Brain-Derived Neurotrophic Factor and Stress-Related Glucocorticoids in the Pathophysiology of Alzheimer's Disease. Int J Mol Sci 2024; 25:1596. [PMID: 38338875 PMCID: PMC10855648 DOI: 10.3390/ijms25031596] [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: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Both the brain-derived neurotrophic factor (BDNF) and glucocorticoids (GCs) play multiple roles in various aspects of neurons, including cell survival and synaptic function. BDNF and its receptor TrkB are extensively expressed in neurons of the central nervous system (CNS), and the contribution of the BDNF/TrkB system to neuronal function is evident; thus, its downregulation has been considered to be involved in the pathogenesis of Alzheimer's disease (AD). GCs, stress-related molecules, and glucocorticoid receptors (GRs) are also considered to be associated with AD in addition to mental disorders such as depression. Importantly, a growing body of evidence suggests a close relationship between BDNF/TrkB-mediated signaling and the GCs/GR system in the CNS. Here, we introduce the current studies on the interaction between the neurotrophic system and stress in CNS neurons and discuss their involvement in the pathophysiology of AD.
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Affiliation(s)
- Tadahiro Numakawa
- Department of Cell Modulation, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto 860-0811, Japan
| | - Ryutaro Kajihara
- Department of Biomedical Laboratory Sciences, Faculty of Life Science, Kumamoto University, Kumamoto 862-0976, Japan
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Cullen AE, Labad J, Oliver D, Al-Diwani A, Minichino A, Fusar-Poli P. The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence. Curr Neuropharmacol 2024; 22:350-377. [PMID: 36946486 PMCID: PMC10845079 DOI: 10.2174/1570159x21666230322145049] [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: 09/27/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 03/23/2023] Open
Abstract
Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise highrisk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, largescale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders.
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Affiliation(s)
- Alexis E. Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Sweden
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Javier Labad
- CIBERSAM, Sabadell, Barcelona, Spain
- Department of Mental Health and Addictions, Consorci Sanitari del Maresme, Mataró, Spain
| | - Dominic Oliver
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Adam Al-Diwani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Amedeo Minichino
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute of Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Balietti M, Galeazzi R, Giacconi R, Santillo E, Giuli C. Early Benefits with Potential Long-Term Risks of a Comprehensive Intervention on Serum Cortisol Levels and Cognitive Performance in Patients with Alzheimer's Disease. J Alzheimers Dis Rep 2023; 7:1445-1453. [PMID: 38225963 PMCID: PMC10789291 DOI: 10.3233/adr-230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024] Open
Abstract
Background Elevated cortisol levels represent a risk factor for Alzheimer's disease (AD), prompting treatments to lower hormone concentrations for preventive or therapeutic purposes. Objective To assess the efficacy of a comprehensive intervention (CI) in modulating serum cortisol levels in patients with AD. Methods CI consisted in a 2-month protocol involving cognitive stimulation, psychological support, lifestyle guidance, leisure activities, and socialization. AD subjects were randomly assigned to experimental (EG, n = 45) and control (CG, n = 45) groups. A wide range of sociodemographic, cognitive, psychosocial, and functional conditions were evaluated before, at the conclusion, and 24 months after CI. Data about lifestyle and drug prescription were also recorded. Results Baseline evaluations revealed that higher cortisol levels correlated with worse cognitive status (higher CDR and ADAS-Cog values and lower MMSE scores), increased depressive symptoms, and reduced physical and social engagement. Following CI, EG exhibited reduced cortisol levels, improved overall cognitive status, and enhanced verbal working memory and executive functions compared to CG. However, at the 24-month follow-up, EG displayed a rebound effect, characterized by elevated cortisol levels and cognitive decline compared to CG. Conclusions These findings strengthen the adverse relationship between excessive cortisol and deficits in cognition/behavior in AD, demonstrate the short-term benefits of CI, and emphasize the potential long-term risks, which may be attributed to the fragile nature of the AD brain. Comprehensive interventions can yield positive results, but careful calibration of type and duration is necessary, considering disease progression and the potential need for re-administration.
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Affiliation(s)
- Marta Balietti
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
| | - Roberta Galeazzi
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
| | - Robertina Giacconi
- Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy
| | | | - Cinzia Giuli
- Geriatric Operative Unit, IRCCS INRCA, Fermo, Italy
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Keihani A, Mayeli A, Ferrarelli F. Circadian Rhythm Changes in Healthy Aging and Mild Cognitive Impairment. Adv Biol (Weinh) 2023; 7:e2200237. [PMID: 36403250 PMCID: PMC10199146 DOI: 10.1002/adbi.202200237] [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: 08/29/2022] [Revised: 11/01/2022] [Indexed: 11/21/2022]
Abstract
Disruptions in circadian rhythms can occur in healthy aging; however, these changes are more severe and pervasive in individuals with age-related and neurodegenerative diseases, such as dementia. Circadian rhythm alterations are also present in preclinical stages of dementia, for example, in patients with mild cognitive impairments (MCI); thus, providing a unique window of opportunity for early intervention in neurodegenerative disorders. Nonetheless, there is a lack of studies examining the association between relevant changes in circadian rhythms and their relationship with cognitive dysfunctions in MCI individuals. In this review, circadian system alterations occurring in MCI patients are examined compared to healthy aging individuals while also considering their association with MCI neurocognitive alterations. The main findings are that abnormal circadian changes in rest-activity, core body temperature, melatonin, and cortisol rhythms appear in the MCI stage and that these circadian rhythm disruptions are associated with some of the neurocognitive deficits observed in MCI patients. In addition, preliminary evidence indicates that interventions aimed at restoring regular circadian rhythms may prevent or halt the progress of neurodegenerative diseases and mitigate their related cognitive impairments. Future longitudinal studies with repeated follow-up assessments are needed to establish the translational potential of these findings in clinical practice.
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Affiliation(s)
- Ahmadreza Keihani
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Pittsburgh, PA, 15213, USA
| | - Ahmad Mayeli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Pittsburgh, PA, 15213, USA
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh, 3501 Forbes Ave, Pittsburgh, PA, 15213, USA
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10
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Tian G, Zhou Z, Li M, Li X, Xu T, Zhang X. Oriented Antibody-Assembled Metal-Organic Frameworks for Persistent Wearable Sweat Cortisol Detection. Anal Chem 2023; 95:13250-13257. [PMID: 37615076 DOI: 10.1021/acs.analchem.3c02392] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The level of cortisol can reflect people's psychological stress, help diagnose adrenal gland diseases, and is also related to several mental diseases. In this study, we developed a cortisol monoclonal antibody-oriented approach to modify an immunosensor for wearable label-free and persistent sweat cortisol detection. On such an antibody-oriented immunosensor, the fragment crystallizable (Fc) region is partially inserted within the metal-organic framework (MOF), and antibody-binding regions of the cortisol monoclonal antibody (Cmab) were exposed on the MOF surface via selective growth and self-assembly. Such ordered and oriented embedding of antibodies in the MOF resulted in excellent antibody activity and improved stability and antigen-binding capacity. We also engineered the full integrated system for on-body sweat cortisol biosensing performance in several volunteers, and the results indicated that this wearable sensor is suitable for practical cortisol detection with a good linear detection range from 1 pg/mL to 1 μg/mL with a lower limit of detection of 0.26 pg/mL. Moreover, the wearable sensor demonstrated good persistence in detecting cortisol, with only 4.1% decay after 9 days of storage. The present work represents a simple oriented antibody assembling approach to improve the stability of antibodies, providing an important step toward long-term continuous sweat biomarker detection.
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Affiliation(s)
- Guang Tian
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, Guangdong 518060, PR China
| | - Zhongzeng Zhou
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, Guangdong 518060, PR China
| | - Mengmeng Li
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, Guangdong 518060, PR China
| | - Xiangnan Li
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, Guangdong 518060, PR China
| | - Tailin Xu
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, Guangdong 518060, PR China
| | - Xueji Zhang
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, Guangdong 518060, PR China
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11
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Nilaweera D, Gurvich C, Freak-Poli R, Woods R, Owen A, Murray A, Orchard SG, Britt C, Wu Z, McNeil J, Ryan J. Adverse events in older adults and the risk of dementia and cognitive decline. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 13:100592. [PMID: 37475782 PMCID: PMC10357969 DOI: 10.1016/j.jadr.2023.100592] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Increasing evidence suggests that stress could be a risk factor for dementia but this might vary by gender. This study investigated whether adverse life events were associated with cognitive decline and dementia in later-life, separately in men and women. Methods Participants were 12,789 community-dwelling Australians aged ≥ 70 years. Ten common adverse events in later-life were self-reported. Cognitive decline was defined as a 1.5 SD decline from participants' baseline score in tests of global cognition, psychomotor speed, episodic memory, and executive functioning, which were assessed regularly over a maximum of 10.3 years. Dementia was diagnosed according to DSM-IV criteria. Results An increased risk of dementia was observed in participants who experienced the death of a spouse/partner (HR: 1.72, 95% CI: 1.17 - 2.52) and for individuals who experienced major financial problems (HR: 1.53, 95% CI: 1.05 - 2.23). The latter also increased the risk of cognitive decline in men specifically (HR: 1.43, 95% CI: 1.10 - 1.86). In contrast, some events for women were associated with a reduced risk of dementia (e.g. close family or friends lost their job/retired (HR: 0.62, 95% CI: 0.40-0.95)). Limitations Events including major money problems may result from prodromal dementia symptoms, thus reverse causation needs to be considered. Conclusions Adverse life events may influence dementia risk in older adults, but associations vary depending on the nature of the event, and across genders. These findings support the need for early interventions in older people who have experienced adversities, particularly for the death of a loved one.
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Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Caroline Gurvich
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Anne Murray
- Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, USA
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Zimu Wu
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
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Melchiorri D, Merlo S, Micallef B, Borg JJ, Dráfi F. Alzheimer's disease and neuroinflammation: will new drugs in clinical trials pave the way to a multi-target therapy? Front Pharmacol 2023; 14:1196413. [PMID: 37332353 PMCID: PMC10272781 DOI: 10.3389/fphar.2023.1196413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Despite extensive research, no disease-modifying therapeutic option, able to prevent, cure or halt the progression of Alzheimer's disease [AD], is currently available. AD, a devastating neurodegenerative pathology leading to dementia and death, is characterized by two pathological hallmarks, the extracellular deposits of amyloid beta (Aβ) and the intraneuronal deposits of neurofibrillary tangles (NFTs) consisting of altered hyperphosphorylated tau protein. Both have been widely studied and pharmacologically targeted for many years, without significant therapeutic results. In 2022, positive data on two monoclonal antibodies targeting Aβ, donanemab and lecanemab, followed by the 2023 FDA accelerated approval of lecanemab and the publication of the final results of the phase III Clarity AD study, have strengthened the hypothesis of a causal role of Aβ in the pathogenesis of AD. However, the magnitude of the clinical effect elicited by the two drugs is limited, suggesting that additional pathological mechanisms may contribute to the disease. Cumulative studies have shown inflammation as one of the main contributors to the pathogenesis of AD, leading to the recognition of a specific role of neuroinflammation synergic with the Aβ and NFTs cascades. The present review provides an overview of the investigational drugs targeting neuroinflammation that are currently in clinical trials. Moreover, their mechanisms of action, their positioning in the pathological cascade of events that occur in the brain throughout AD disease and their potential benefit/limitation in the therapeutic strategy in AD are discussed and highlighted as well. In addition, the latest patent requests for inflammation-targeting therapeutics to be developed in AD will also be discussed.
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Affiliation(s)
- Daniela Melchiorri
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | - Sara Merlo
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy
| | | | - John-Joseph Borg
- Malta Medicines Authority, San Ġwann, Malta
- School of Pharmacy, Department of Biology, University of Tor Vergata, Rome, Italy
| | - František Dráfi
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS Bratislava, Bratislava, Slovakia
- State Institute for Drug Control, Bratislava, Slovakia
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13
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Dronse J, Ohndorf A, Richter N, Bischof GN, Fassbender R, Behfar Q, Gramespacher H, Dillen K, Jacobs HIL, Kukolja J, Fink GR, Onur OA. Serum cortisol is negatively related to hippocampal volume, brain structure, and memory performance in healthy aging and Alzheimer's disease. Front Aging Neurosci 2023; 15:1154112. [PMID: 37251803 PMCID: PMC10213232 DOI: 10.3389/fnagi.2023.1154112] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Elevated cortisol levels have been frequently reported in Alzheimer's disease (AD) and linked to brain atrophy, especially of the hippocampus. Besides, high cortisol levels have been shown to impair memory performance and increase the risk of developing AD in healthy individuals. We investigated the associations between serum cortisol levels, hippocampal volume, gray matter volume and memory performance in healthy aging and AD. Methods In our cross-sectional study, we analyzed the relationships between morning serum cortisol levels, verbal memory performance, hippocampal volume, and whole-brain voxel-wise gray matter volume in an independent sample of 29 healthy seniors (HS) and 29 patients along the spectrum of biomarker-based AD. Results Cortisol levels were significantly elevated in patients with AD as compared to HS, and higher cortisol levels were correlated with worse memory performance in AD. Furthermore, higher cortisol levels were significantly associated with smaller left hippocampal volumes in HS and indirectly negatively correlated to memory function through hippocampal volume. Higher cortisol levels were further related to lower gray matter volume in the hippocampus and temporal and parietal areas in the left hemisphere in both groups. The strength of this association was similar in HS and AD. Conclusion In AD, cortisol levels are elevated and associated with worse memory performance. Furthermore, in healthy seniors, higher cortisol levels show a detrimental relationship with brain regions typically affected by AD. Thus, increased cortisol levels seem to be indirectly linked to worse memory function even in otherwise healthy individuals. Cortisol may therefore not only serve as a biomarker of increased risk for AD, but maybe even more importantly, as an early target for preventive and therapeutic interventions.
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Affiliation(s)
- Julian Dronse
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Centre, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Ohndorf
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Richter
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Centre, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gérard N. Bischof
- Department of Nuclear Medicine, Multimodal Neuroimaging Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ronja Fassbender
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Centre, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Qumars Behfar
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Centre, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hannes Gramespacher
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Centre, Jülich, Germany
- Department of Palliative Medicine, Multimodal Neuroimaging Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Heidi I. L. Jacobs
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health Witten/Herdecke University, Witten, Germany
| | - Gereon R. Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Centre, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Oezguer A. Onur
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Centre, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Su LJ, Chen MJ, Yang R, Zou H, Chen TT, Li SL, Guo Y, Hu RF. Plasma biomarkers and delirium in critically ill patients after cardiac surgery: A prospective observational cohort study. Heart Lung 2023; 59:139-145. [PMID: 36801548 DOI: 10.1016/j.hrtlng.2023.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Delirium is common in postoperative critically ill patients and may affect by intraoperative events. Biomarkers are vital indicators in the development and prediction of delirium. OBJECTIVES This study aimed to investigate the associations between various plasma biomarkers and delirium. METHODS We performed a prospective cohort study on cardiac surgery patients. Delirium assessment was performed twice daily using the confusion assessment method for the intensive care unit (ICU), and the Richmond Agitation Sedation Scale was used to assess the depth of sedation and agitation. Blood samples were collected on the day after ICU admission, and the concentrations of cortisol, interleukin (IL)-1β, IL-6, tumor necrosis factor α, soluble tumor necrosis factor receptor-1 (sTNFR-1), and sTNFR-2 were measured. RESULTS Delirium in the ICU was noted in 93 (29.2%, 95% CI 24.2-34.3) out of 318 patients (mean age 52 years, SD 12.0). The longer duration of cardiopulmonary bypass, aortic clamping and surgery, and higher plasma, erythrocytes, and platelet transfusion requirements were among the significant differences in intraoperative events between patients with and without delirium. Median levels of IL-6 (p = 0.017), TNF-α (p = 0.048), sTNFR-1 (p < 0.001), and sTNFR-2 (p = 0.001) were significantly higher in patients with delirium than in those without it. After adjusting for demographic variables and intraoperative events, only sTNFR-1 (odds ratio 6.83, 95% CI: 1.14-40.90) was associated with delirium. CONCLUSIONS Plasma IL-6, TNF-α, sTNFR-1, and sTNFR-2 levels were higher in ICU-acquired delirium patients after cardiac surgery. sTNFR-1 was a potential indicator of the disorder.
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Affiliation(s)
- Li-Jing Su
- School of Nursing, Fujian Medical University, Fuzhou 350122, China
| | - Mei-Jing Chen
- School of Nursing, Fujian Medical University, Fuzhou 350122, China
| | - Rong Yang
- Follow-up Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Zou
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ting-Ting Chen
- School of Nursing, Fujian Medical University, Fuzhou 350122, China
| | - Sai-Lan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuan Guo
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong-Fang Hu
- School of Nursing, Fujian Medical University, Fuzhou 350122, China.
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15
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Li H, Chen K, Yang L, Wang Q, Zhang J, He J. The role of plasma cortisol in dementia, epilepsy, and multiple sclerosis: A Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1107780. [PMID: 37008911 PMCID: PMC10050717 DOI: 10.3389/fendo.2023.1107780] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Many clinical studies have shown a correlation between plasma cortisol and neurological disorders. This study explored the causal relationship between plasma cortisol and dementia, epilepsy and multiple sclerosis based on Mendelian randomization (MR) method. METHODS Data were taken from the summary statistics of a genome-wide association study, FinnGen consortium and United Kingdom Biobank. Dementia, epilepsy, and multiple sclerosis were used as outcomes, and genetic variants associated with plasma cortisol were used as instrumental variables. The main analysis was performed using the inverse variance weighted method, and the results were assessed according to the odds ratio (OR) and 95% confidence interval. Heterogeneity tests, pleiotropy tests, and leave-one-out method were conducted to evaluate the stability and accuracy of the results. RESULTS In two-sample MR analysis, the inverse variance weighted method showed that plasma cortisol was associated with Alzheimer's disease (AD) [odds ratio (95% confidence interval) = 0.99 (0.98-1.00), P = 0.025], vascular dementia (VaD) [odds ratio (95% confidence interval) = 2.02 (1.00-4.05), P = 0.049)], Parkinson's disease with dementia (PDD) [odds ratio (95% confidence interval) = 0.24 (0.07-0.82), P = 0.023] and epilepsy [odds ratio (95% confidence interval) = 2.00 (1.03-3.91), P = 0.042]. There were no statistically significant associations between plasma cortisol and dementia with Lewy bodies (DLB), frontotemporal dementia (FTD) and multiple sclerosis. CONCLUSION This study demonstrates that plasma cortisol increase the incidence rates of epilepsy and VaD and decrease the incidence rates of AD and PDD. Monitoring plasma cortisol concentrations in clinical practice can help prevent diseases, such as AD, PDD, VaD and epilepsy.
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Affiliation(s)
- Haiqi Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Kaili Chen
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Le Yang
- Department of Endocrinology, Jilin Province People’s Hospital, Changchun, China
| | - Qiaoli Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiao Zhang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jinting He
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Jinting He,
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Ouanes S, Rabl M, Clark C, Kirschbaum C, Popp J. Persisting neuropsychiatric symptoms, Alzheimer's disease, and cerebrospinal fluid cortisol and dehydroepiandrosterone sulfate. Alzheimers Res Ther 2022; 14:190. [PMID: 36529757 PMCID: PMC9762003 DOI: 10.1186/s13195-022-01139-9] [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: 08/27/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Neuropsychiatric symptoms are important treatment targets in the management of dementia and can be present at very early clinical stages of neurodegenerative diseases. Increased cortisol has been reported in Alzheimer's disease (AD) and has been associated with faster cognitive decline. Elevated cortisol output has been observed in relation to perceived stress, depression, and anxiety. Dehydroepiandrosterone sulfate (DHEAS) has known anti-glucocorticoid effects and may counter the effects of cortisol. OBJECTIVES We aimed to examine whether CSF cortisol and DHEAS levels were associated with (1) neuropsychiatric symptoms at baseline, (2) changes in neuropsychiatric symptoms over 3 years, and (3) whether these associations were related to or independent of AD pathology. METHODS One hundred and eighteen participants on a prospective study in a memory clinic setting, including patients with cognitive impairment (n = 78), i.e., mild cognitive impairment or mild dementia, and volunteers with normal cognition (n = 40), were included. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). CSF cortisol and DHEAS, as well as CSF AD biomarkers, were obtained at baseline. Neuropsychiatric symptoms were re-assessed at follow-up visits 18 and 36 months from baseline. We constructed linear regression models to examine the links between baseline neuropsychiatric symptoms, the presence of AD pathology as indicated by CSF biomarkers, and CSF cortisol and DHEAS. We used repeated-measures mixed ANCOVA models to examine the associations between the neuropsychiatric symptoms' changes over time, baseline CSF cortisol and DHEAS, and AD pathology. RESULTS Higher CSF cortisol was associated with higher NPI-Q severity scores at baseline after controlling for covariates including AD pathology status (B = 0.085 [0.027; 0.144], p = 0.027; r = 0.277). In particular, higher CSF cortisol was associated with higher baseline scores of depression/dysphoria, anxiety, and apathy/indifference. Elevated CSF cortisol was also associated with more marked increase in NPI-Q scores over time regardless of AD status (p = 0.036, η2 = 0.207), but this association was no longer significant after controlling for BMI and the use of psychotropic medications. CSF DHEAS was associated neither with NPI-Q scores at baseline nor with their change over time. Cortisol did not mediate the association between baseline NPI-Q and changes in clinical dementia rating sum of boxes over 36 months. CONCLUSION Higher CSF cortisol may reflect or contribute to more severe neuropsychiatric symptoms at baseline, as well as more pronounced worsening over 3 years, independently of the presence of AD pathology. Our findings also suggest that interventions targeting the HPA axis may be helpful to treat neuropsychiatric symptoms in patients with dementia.
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Affiliation(s)
- Sami Ouanes
- grid.8515.90000 0001 0423 4662Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland ,grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, PO BOX 3050, Doha, Qatar
| | - Miriam Rabl
- grid.412004.30000 0004 0478 9977Centre for Gerontopsychiatric Medicine, Department of Geriatric Psychiatry, University Hospital of Psychiatry, Minervastrasse 145, P.O. Box 341, 8032 Zurich, Switzerland
| | - Christopher Clark
- grid.412004.30000 0004 0478 9977Centre for Gerontopsychiatric Medicine, Department of Geriatric Psychiatry, University Hospital of Psychiatry, Minervastrasse 145, P.O. Box 341, 8032 Zurich, Switzerland
| | - Clemens Kirschbaum
- grid.4488.00000 0001 2111 7257Biopsychology, Technische Universität Dresden, Andreas Schubert Bau, Dresden, Germany
| | - Julius Popp
- grid.8515.90000 0001 0423 4662Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland ,grid.412004.30000 0004 0478 9977Centre for Gerontopsychiatric Medicine, Department of Geriatric Psychiatry, University Hospital of Psychiatry, Minervastrasse 145, P.O. Box 341, 8032 Zurich, Switzerland
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Santoso C, Stuckler D, Ihle A. Investigating longitudinal associations of hair cortisol and cortisone with cognitive functioning and dementia. Sci Rep 2022; 12:20642. [PMID: 36450857 PMCID: PMC9712516 DOI: 10.1038/s41598-022-25143-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
We rigorously investigated potential longitudinal associations of hair cortisol and cortisone with verbal memory, time orientation, and dementia, adjusting for sociodemographic and health confounders. Data from the English Longitudinal Study of Ageing wave 6-9 (6-year follow-up, covering 4399 persons aged 50+) were analysed using linear random effects and cox regression models. In unadjusted models, hair cortisol was associated with worsened verbal memory (β 0.19; SE 0.08), but not with time orientation (β 0.02; SE 0.01), or dementia (β 0.07; SE 0.16). Hair cortisone was associated with worsened verbal memory (β 0.74; SE 0.14) and time orientation (β 0.06; SE 0.02), but not with dementia (β 0.47; SE 0.28). However, in the fully adjusted models, neither hair cortisol nor cortisone was associated with verbal memory, time orientation, or dementia. Consistent with prior studies, we found that more advanced age was associated with worsened verbal memory (β 0.15; SE 0.01), time orientation (β 0.01; SE 0.00), and dementia risk (β 0.11; SE 0.02). Our rigorous analyses did not detect robust associations of neither hair cortisol nor cortisone with cognitive functioning or dementia across 6 years. More detailed insights into potential mechanisms are discussed.
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Affiliation(s)
- Cornelia Santoso
- Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| | - David Stuckler
- Dondena Centre for Research On Social Dynamics, Bocconi University, Milan, Italy
| | - Andreas Ihle
- Department of Psychology, University of Geneva, 1205, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205, Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES-Overcoming Vulnerability: Life Course Perspectives, 1015, Lausanne, Switzerland
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Holleman J, Adagunodo S, Kåreholt I, Hagman G, Aspö M, Udeh-Momoh CT, Solomon A, Kivipelto M, Sindi S. Cortisol, cognition and Alzheimer's disease biomarkers among memory clinic patients. BMJ Neurol Open 2022; 4:e000344. [PMID: 36277478 PMCID: PMC9582323 DOI: 10.1136/bmjno-2022-000344] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022] Open
Abstract
Objective This study aims to investigate the relationship between diurnal cortisol patterns, cognition and Alzheimer's disease (AD) biomarkers in memory clinic patients. Method Memory clinic patients were recruited from Karolinska University Hospital in Sweden (n=155). Diurnal cortisol patterns were assessed using five measures: awakening levels, cortisol awakening response, bedtime levels, the ratio of awakening to bedtime levels (AM/PM ratio) and total daily output. Cognition was measured in five domains: memory, working memory, processing speed, perceptual reasoning and overall cognition. AD biomarkers Aβ42, total tau and phosphorylated tau were assessed from cerebrospinal fluid (CSF). Cognition was measured at follow-up (average 32 months) in a subsample of participants (n=57). Results In assessing the associations between cortisol and cognition, higher awakening cortisol levels were associated with greater processing speed at baseline. No relationship was found between diurnal cortisol patterns and change in cognition over time or CSF AD biomarkers in the total sample. After stratification by CSF Aβ42 levels, higher awakening cortisol levels were associated with worse memory performance in amyloid-positive participants. In amyloid-negative participants, higher bedtime cortisol levels and a lower AM/PM ratio were associated with lower overall cognition, greater awakening cortisol levels were associated with better processing speed, and a higher AM/PM ratio was associated with better perceptual reasoning. Additionally, higher awakening cortisol levels were associated with lower CSF Aβ42 levels in amyloid-positive participants, while higher bedtime cortisol levels and a lower AM/PM ratio were associated with higher CSF total tau in amyloid-negative participants. Conclusions Our findings suggest that diurnal cortisol patterns are associated with cognitive function and provide new insights into the association between diurnal cortisol patterns and AD-related CSF biomarkers. Further research is needed to examine the complex relationship between cortisol, cognition and brain pathology.
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Affiliation(s)
- Jasper Holleman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Adagunodo
- Memory Clinic Zentralschweiz, Luzerner Psychiatrie, Pfaffnau-Sankt Urban, Switzerland
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health and Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jonkoping, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Göran Hagman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Chinedu T Udeh-Momoh
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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19
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The increased cortisol levels with preserved rhythmicity in aging and its relationship with dementia and metabolic syndrome. Aging Clin Exp Res 2022; 34:2733-2740. [PMID: 36190660 DOI: 10.1007/s40520-022-02262-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND In the aging process, the cumulative exposure to stress with increased cortisol levels is considered to be associated to the senescence itself and its related disorders. AIMS To evaluate the role of cortisol in elderly subjects, with or without dementia, by the means of the AGICO study. METHODS The AGICO study enrolled patients from ten Geriatric Units in Italy in 2012-2017 (Study Director Prof Paolo Falaschi, S. Andrea Hospital of Rome). Every subject received a comprehensive geriatric assessment (including the Mini-Mental State Examination, MMSE), the neurological examination (with a computed tomography scan or magnetic resonance imaging of the brain), the assessment of the metabolic syndrome (MetS), the evaluation of the cortisol activity by two consecutive urine collections (diurnal and nocturnal). RESULTS The MMSE was inversely related to the standardized diurnal and nocturnal urinary cortisol levels (p < 0.025 and p < 0.01, respectively) and the age was positively related (p < 0.01 and p < 0.001, respectively). The ratio between the standardized diurnal and nocturnal urinary cortisol levels was 1.50 ± 1.2 (mean ± standard deviation) and it was not modified by the age or dementia. The standardized diurnal and nocturnal urinary cortisol levels were significantly higher in patients with dementia (MMSE < 24) (p < 0.01). In the analysis of the subgroups with MetS, the highest concentrations of diurnal and nocturnal cortisol were found in patients with both dementia and MetS (p < 0.025 and p < 0.01, respectively). DISCUSSION The AGICO study showed that the stress response significantly and progressively increases with age. CONCLUSION The cortisol increase in aging is related to the presence of both dementia and metabolic syndrome.
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20
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Ouanes S, Clark C, Richiardi J, Maréchal B, Lewczuk P, Kornhuber J, Kirschbaum C, Popp J. Cerebrospinal Fluid Cortisol and Dehydroepiandrosterone Sulfate, Alzheimer’s Disease Pathology, and Cognitive Decline. Front Aging Neurosci 2022; 14:892754. [PMID: 35875796 PMCID: PMC9301040 DOI: 10.3389/fnagi.2022.892754] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/22/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Elevated cortisol levels have been reported in Alzheimer’s disease (AD) and may accelerate the development of brain pathology and cognitive decline. Dehydroepiandrosterone sulfate (DHEAS) has anti-glucocorticoid effects and it may be involved in the AD pathophysiology. Objectives To investigate associations of cerebrospinal fluid (CSF) cortisol and DHEAS levels with (1) cognitive performance at baseline; (2) CSF biomarkers of amyloid pathology (as assessed by CSF Aβ levels), neuronal injury (as assessed by CSF tau), and tau hyperphosphorylation (as assessed by CSF p-tau); (3) regional brain volumes; and (4) clinical disease progression. Materials and Methods Individuals between 49 and 88 years (n = 145) with mild cognitive impairment or dementia or with normal cognition were included. Clinical scores, AD biomarkers, brain MRI volumetry along with CSF cortisol and DHEAS were obtained at baseline. Cognitive and functional performance was re-assessed at 18 and 36 months from baseline. We also assessed the following covariates: apolipoprotein E (APOE) genotype, BMI, and education. We used linear regression and mixed models to address associations of interest. Results Higher CSF cortisol was associated with poorer global cognitive performance and higher disease severity at baseline. Cortisol and cortisol/DHEAS ratio were positively associated with tau and p-tau CSF levels, and negatively associated with the amygdala and insula volumes at baseline. Higher CSF cortisol predicted more pronounced cognitive decline and clinical disease progression over 36 months. Higher CSF DHEAS predicted more pronounced disease progression over 36 months. Conclusion Increased cortisol in the CNS is associated with tau pathology and neurodegeneration, and with decreased insula and amygdala volume. Both CSF cortisol and DHEAS levels predict faster clinical disease progression. These results have implications for the identification of patients at risk of rapid decline as well as for the development of interventions targeting both neurodegeneration and clinical manifestations of AD.
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Affiliation(s)
- Sami Ouanes
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Christopher Clark
- Centre for Gerontopsychiatric Medicine, Geriatric Psychiatry, University Hospital of Psychiatry Zürich, Zurich, Switzerland
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bénédicte Maréchal
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Clemens Kirschbaum
- Chair of Biopsychology, Technische Universität Dresden, Andreas-Schubert-Bau, Dresden, Germany
| | - Julius Popp
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Centre for Gerontopsychiatric Medicine, Geriatric Psychiatry, University Hospital of Psychiatry Zürich, Zurich, Switzerland
- *Correspondence: Julius Popp,
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21
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John A, Desai R, Saunders R, Buckman JEJ, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, Richards M, Gaysina D, Stott J. Salivary cortisol in longitudinal associations between affective symptoms and midlife cognitive function: A British birth cohort study. J Psychiatr Res 2022; 151:217-224. [PMID: 35500449 PMCID: PMC10442295 DOI: 10.1016/j.jpsychires.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
Affective disorders are associated with accelerated cognitive ageing. However, current understanding of biological mechanisms which underlie these observed associations is limited. The aim of this study was to test: 1) Whether cortisol acts as a pathway in the association between depressive or anxiety symptoms across adulthood and midlife cognitive function; 2) Whether cortisol is associated with later depressive or anxiety symptoms, and cognitive function. Data were used from the National Child Development Study (NCDS), a sample of infants born in mainland UK during one week of 1958. A measure of the accumulation of affective symptoms was derived from data collected from age 23 to 42 using the Malaise Inventory Scale. Salivary cortisol measures were available at age 44-45. Cognitive function (memory, fluency, information processing) and affective symptoms were assessed at the age of 50. Path models were run to test whether salivary cortisol explained the longitudinal association between depressive or anxiety disorder symptoms and cognitive function. Direct effects of affective symptoms are shown across early to middle adulthood on cognitive function in midlife (memory and information processing errors). However, there were no effects of affective symptoms on cognitive function through cortisol measures. Additionally, cortisol measures were not significantly associated with subsequent affective symptoms or cognitive function at the age of 50. These results do not provide clear evidence to suggest that cortisol plays a role in the association between affective symptoms and cognitive function over this period of time. These findings contribute to our understanding of how the association between affective symptoms and cognitive function operates over time.
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Affiliation(s)
- Amber John
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London, United Kingdom.
| | - Roopal Desai
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - Rob Saunders
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - Joshua E J Buckman
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom; iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, United Kingdom
| | - Barbara Brown
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - Shirley Nurock
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - Stewart Michael
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | - Paul Ware
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London, United Kingdom
| | | | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, United Kingdom
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, United Kingdom
| | | | - Stephen Pilling
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom; Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Darya Gaysina
- EDGE Lab, School of Psychology, University of Sussex, Falmer, United Kingdom
| | - Josh Stott
- ADAPT Lab, Clinical, Educational and Health Psychology, UCL, London, United Kingdom
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22
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Clement A, Madsen MJ, Kastaniegaard K, Wiborg O, Asuni AA, Stensballe A. Chronic Stress Induces Hippocampal Mitochondrial Damage in APPPS1 Model Mice and Wildtype Littermates. J Alzheimers Dis 2022; 87:259-272. [PMID: 35275551 DOI: 10.3233/jad-220064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disorder and the most common cause of dementia worldwide. Despite decades of investigation, the etiology of AD is not fully understood, although emerging evidence suggest that chronic environmental and psychological stress plays a role in the mechanisms and contributes to the risk of developing AD. Thus, dissecting the impact of stress on the brain could improve our understanding of the pathological mechanisms. OBJECTIVE We aimed to study the effect of chronic stress on the hippocampal proteome in male APPPS1 transgenic mice and wildtype (WT) littermates. METHODS APPPS1 and WT mice were subjected to 4 weeks of chronic stress followed by 3 weeks of continued diurnal disruption. Hippocampal tissue was used for proteomics analysis using label-free quantitative DIA based LC-MS/MS analysis. RESULTS We identified significantly up- and downregulated proteins in both APPPS1 and WT mice exposed to chronic stress compared to the control groups. Via interaction network mapping, significant proteins could be annotated to specific pathways of mitochondrial function (oxidative phosphorylation and TCA cycle), metabolic pathways, AD pathway and synaptic functions (long term potentiation). In WT mice, chronic stress showed the highest impact on complex I of the oxidative phosphorylation pathway, while in APPPS1 mice this pathway was compromised broadly by chronic stress. CONCLUSION Our data shows that chronic stress and amyloidosis additively contribute to mitochondrial damage in hippocampus. Although these results do not explain all effects of chronic stress in AD, they add to the scientific knowledge on the topic.
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Affiliation(s)
- Amalie Clement
- Department of Health Science and Technology, Aalborg University, Denmark.,Department of Pathology and Fluid Biomarkers, H. Lundbeck A/S, Copenhagen, Denmark
| | | | | | - Ove Wiborg
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Ayodeji A Asuni
- Department of Pathology and Fluid Biomarkers, H. Lundbeck A/S, Copenhagen, Denmark
| | - Allan Stensballe
- Department of Health Science and Technology, Aalborg University, Denmark
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23
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Antypa D, Basta M, Vgontzas A, Zaganas I, Panagiotakis S, Vogiatzi E, Kokosali E, Simos P. The association of basal cortisol levels with episodic memory in older adults is mediated by executive function. Neurobiol Learn Mem 2022; 190:107600. [PMID: 35182737 DOI: 10.1016/j.nlm.2022.107600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/24/2022] [Accepted: 02/12/2022] [Indexed: 01/08/2023]
Abstract
Elevated basal cortisol levels in elderly may indicate dysregulation of the internal stress-related system, as well as dysfunction and structural alterations in brain structures necessary for cognition, such as hippocampus and prefrontal cortex. Because of the close relation of executive functions and episodic memory processing, in this study we explored whether the association of elevated cortisol levels on episodic memory could be partly attributed to cortisol effects on executive functions. In this cross-sectional study we analyzed data from a sample of 236 community-dwelling older adults from the Cretan Aging Cohort aged 75.56 ± 7.21 years [53 with dementia due to probable Alzheimer's disease, 99 with Mild Cognitive Impairment (MCI) and 84 cognitively non-impaired participants (NI)]. Morning serum cortisol levels were higher in the probable AD as compared to the NI group (p = .031). Mediated regression models in the total sample supported the hypothesis that the negative association of basal cortisol levels with delayed memory was fully mediated by the relation of basal cortisol levels with executive functions and immediate memory (adjusted for age and self-reported depression symptoms). Moderated mediation regression models revealed that the direct effect of cortisol on executive function and the effect of executive function on delayed memory performance were statistically significant among participants diagnosed with MCI, while the immediate memory effect on delayed memory was more pronounced in AD patients, as compared to the NI group. The current findings corroborate neuroimaging research highlighting cortisol effects on executive functions and immediate memory and further suggest that dysregulation of systems involved in these functions may account for the purported detrimental long-term effects of high cortisol levels on delayed memory.
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Affiliation(s)
- Despina Antypa
- School of Medicine, University of Crete, Heraklion, Crete, Greece.
| | - Maria Basta
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Ioannis Zaganas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Symeon Panagiotakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | | | - Evgenia Kokosali
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Panagiotis Simos
- School of Medicine, University of Crete, Heraklion, Crete, Greece; Foundation of Research and Technology, Heraklion, Crete, Greece
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24
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Kumar D, Sharma A, Taliyan R, Urmera MT, Herrera Calderon O, Heinbockel T, Rahman S, Goyal R. Orchestration of the circadian clock and its association with Alzheimer's disease: Role of endocannabinoid signaling. Ageing Res Rev 2022; 73:101533. [PMID: 34844016 PMCID: PMC8729113 DOI: 10.1016/j.arr.2021.101533] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/24/2021] [Accepted: 11/22/2021] [Indexed: 01/03/2023]
Abstract
Circadian rhythms are 24-hour natural rhythms regulated by the suprachiasmatic nucleus, also known as the "master clock". The retino-hypothalamic tract entrains suprachiasmatic nucleus with photic information to synchronise endogenous circadian rhythms with the Earth's light-dark cycle. However, despite the robustness of circadian rhythms, an unhealthy lifestyle and chronic photic disturbances cause circadian rhythm disruption in the suprachiasmatic nucleus's TTFL loops via affecting glutamate and γ-aminobutyric acid-mediated neurotransmission in the suprachiasmatic nucleus. Recently, considerable evidence has been shown correlating CRd with the incidence of Alzheimer's disease. The present review aims to identify the existence and signalling of endocannabinoids in CRd induced Alzheimer's disease through retino-hypothalamic tract- suprachiasmatic nucleus-cortex. Immunohistochemistry has confirmed the expression of cannabinoid receptor 1 in the suprachiasmatic nucleus to modulate the circadian phases of the master clock. Literature also suggests that cannabinoids may alter activity of suprachiasmatic nucleus by influencing the activity of their major neurotransmitter γ-aminobutyric acid or by interacting indirectly with the suprachiasmatic nucleus's two other major inputs i.e., the geniculo-hypothalamic tract-mediated release of neuropeptide Y and serotonergic inputs from the dorsal raphe nuclei. Besides, the expression of cannabinoid receptor 2 ameliorates cognitive deficits via reduction of tauopathy and microglial activation. In conclusion, endocannabinoids may be identified as a putative target for correcting CRd and decelerating Alzheimer's disease.
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Affiliation(s)
- Deepak Kumar
- Department of Neuropharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, H.P., 173229, India
| | - Ashish Sharma
- School of Medicine, Washington University, St. Louis, USA
| | - Rajeev Taliyan
- Department of Pharmacy, Birla Institute of Technology Science, Pilani, Rajasthan, 333301, India
| | - Maiko T. Urmera
- Institute on Aging and Centre for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oscar Herrera Calderon
- Department of Pharmacology, Bromatology and Toxicology, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Thomas Heinbockel
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - Shafiqur Rahman
- Department of Pharmaceutical Sciences, College of Pharmacy South Dakota State University, Brookings, South Dakota, USA
| | - Rohit Goyal
- Department of Neuropharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, H.P., 173229, India.,Corresponding author: Dr Rohit Goyal, Professor, Department of Neuropharmacology, School of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, H.P., 173229, India, ; Mob. +91 98160 62679
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25
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Kalecký K, German DC, Montillo AA, Bottiglieri T. Targeted Metabolomic Analysis in Alzheimer's Disease Plasma and Brain Tissue in Non-Hispanic Whites. J Alzheimers Dis 2022; 86:1875-1895. [PMID: 35253754 PMCID: PMC9108583 DOI: 10.3233/jad-215448] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metabolites are biological compounds reflecting the functional activity of organs and tissues. Understanding metabolic changes in Alzheimer's disease (AD) can provide insight into potential risk factors in this multifactorial disease and suggest new intervention strategies or improve non-invasive diagnosis. OBJECTIVE In this study, we searched for changes in AD metabolism in plasma and frontal brain cortex tissue samples and evaluated the performance of plasma measurements as biomarkers. METHODS This is a case-control study with two tissue cohorts: 158 plasma samples (94 AD, 64 controls; Texas Alzheimer's Research and Care Consortium - TARCC) and 71 postmortem cortex samples (35 AD, 36 controls; Banner Sun Health Research Institute brain bank). We performed targeted mass spectrometry analysis of 630 compounds (106 small molecules: UHPLC-MS/MS, 524 lipids: FIA-MS/MS) and 232 calculated metabolic indicators with a metabolomic kit (Biocrates MxP® Quant 500). RESULTS We discovered disturbances (FDR≤0.05) in multiple metabolic pathways in AD in both cohorts including microbiome-related metabolites with pro-toxic changes, methylhistidine metabolism, polyamines, corticosteroids, omega-3 fatty acids, acylcarnitines, ceramides, and diglycerides. In AD, plasma reveals elevated triglycerides, and cortex shows altered amino acid metabolism. A cross-validated diagnostic prediction model from plasma achieves AUC = 82% (CI95 = 75-88%); for females specifically, AUC = 88% (CI95 = 80-95%). A reduced model using 20 features achieves AUC = 79% (CI95 = 71-85%); for females AUC = 84% (CI95 = 74-92%). CONCLUSION Our findings support the involvement of gut environment in AD and encourage targeting multiple metabolic areas in the design of intervention strategies, including microbiome composition, hormonal balance, nutrients, and muscle homeostasis.
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Affiliation(s)
- Karel Kalecký
- Institute of Biomedical Studies, Baylor University, Waco, TX, USA
- Center of Metabolomics, Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Dwight C. German
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Albert A. Montillo
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teodoro Bottiglieri
- Institute of Biomedical Studies, Baylor University, Waco, TX, USA
- Center of Metabolomics, Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
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26
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Kumar D, Sharma A, Taliyan R, Urmera MT, Herrera-Calderon O, Heinbockel T, Rahman S, Goyal R. Orchestration of the circadian clock and its association with Alzheimer's disease: Role of endocannabinoid signaling. Ageing Res Rev 2022. [DOI: https://doi.org/10.1016/j.arr.2021.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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27
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Beserra A, Oliveira B, Portugal E, Dutra P, Laks J, Deslandes A, Moraes H. Cortisol Reactivity to a physical stressor in Patients with Depression and Alzheimer's disease. Dement Neuropsychol 2022; 16:61-68. [PMID: 35719259 PMCID: PMC9170255 DOI: 10.1590/1980-5764-dn-2021-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/21/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Some prevalent mental disorders in the elderly, such as Alzheimer's disease (AD) and major depression disorder (MDD), are associated with chronic stress and consequently with possible dysregulation of hypothalamic–pituitary–adrenal (HPA) axis and cortisol levels in basal conditions or in the reactivity of an acute stressor. However, evidence of cortisol behavior after a physical stressor in patients with AD and MDD is scarce.
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Affiliation(s)
- Ana Beserra
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.,Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ, Brazil
| | - Bruno Oliveira
- Universidade Federal Rural do Rio de Janeiro, Departamento de Educação Física e Esportes, Rio de Janeiro RJ, Brazil
| | - Eduardo Portugal
- Universidade Federal do Rio de Janeiro, Laboratório de Fisiologia do Exercício, Rio de Janeiro RJ, Brazil
| | - Patrícia Dutra
- Universidade do Estado do Rio de Janeiro, Laboratório de Imunofisiologia do Exercício, Rio de Janeiro RJ, Brazil
| | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.,Universidade do Grande Rio, Programa de Biomedicina Translacional, Rio de Janeiro RJ, Brazil
| | - Andrea Deslandes
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.,Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ, Brazil
| | - Helena Moraes
- Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ, Brazil.,Universidade Federal do Rio de Janeiro, Laboratório de Fisiologia do Exercício, Rio de Janeiro RJ, Brazil
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28
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Basta M, Vgontzas AN, Fernandez-Mendoza J, Antypa D, Li Y, Zaganas I, Panagiotakis S, Karagkouni E, Simos P. Basal Cortisol Levels Are Increased in Patients with Mild Cognitive Impairment: Role of Insomnia and Short Sleep Duration. J Alzheimers Dis 2022; 87:933-944. [PMID: 35404277 DOI: 10.3233/jad-215523] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is frequent in elderly and a risk factor for dementia. Both insomnia and increased cortisol levels are risk factors for MCI. OBJECTIVE We examined cross-sectionally whether increased cortisol levels are associated with short sleep duration (SSD) and/or the insomnia short sleep duration (ISS) phenotype, in elderly with MCI. METHODS One hundred twenty-four participants with MCI and 84 cognitively non-impaired controls (CNI)≥60 years underwent medical history, physical examination, neuropsychiatric evaluation, neuropsychological testing, 3-day actigraphy, assessment of subjective insomnia symptoms, and a single morning plasma cortisol level. The short sleep phenotypes were defined by sleep efficiency below the median of the entire sample (i.e.,≤81%) with at least one insomnia symptom (ISS) or without (SSD). ANOVA models were used to compare the various sleep phenotypes to those who did not present either short sleep or insomnia symptoms [non-insomnia (NI)]. RESULTS MCI participants had higher cortisol levels compared to the CNI group (p = 0.009). MCI participants with insomnia (n = 44) or SSD (n = 38) had higher cortisol levels compared to the NI group (n = 42; p = 0.014 and p = 0.045, respectively). Furthermore, MCI participants with ISS phenotype but not those with insomnia with normal sleep duration had higher cortisol levels compared to NI (p = 0.011 and p = 0.4, respectively). Both linear trend analyses showed that cortisol reached the highest levels in the ISS phenotype. CONCLUSION The ISS and SSD phenotypes are associated with increased cortisol levels in elderly with MCI. Improving sleep quality and duration and decreasing cortisol levels may delay further cognitive decline.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Despina Antypa
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Yun Li
- Department of Sleep Medicine, Mental Health Center of Shantou University, Shantou, Guangdong, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Ioannis Zaganas
- Department of Neurology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Symeon Panagiotakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Efthalia Karagkouni
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State University, Hershey, PA, USA
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Greece
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Saelzler UG, Verhaeghen P, Panizzon MS, Moffat SD. Intact circadian rhythm despite cortisol hypersecretion in Alzheimer's disease: A meta-analysis. Psychoneuroendocrinology 2021; 132:105367. [PMID: 34340133 DOI: 10.1016/j.psyneuen.2021.105367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 12/26/2022]
Abstract
Hypersecretion of the glucocorticoid steroid hormone cortisol by individuals with Alzheimer's disease (AD) has been suspected for several decades, during which time dozens of examinations of this phenomenon have been conducted and published. The goals of this investigation were to summarize this sizeable body of literature, test whether participant and methodological characteristics modify the magnitude of the AD-associated basal cortisol hypersecretion, and examine whether cortisol circadian rhythmicity is maintained among individuals with AD. To this end, the present meta-analysis and systematic review examined over 300 comparisons of indices of basal HPA-axis functioning between individuals with AD and cognitively normal older adults. AD was associated with basal cortisol elevations (g = 0.45) but the magnitude of the effect was not systematically impacted by any of the participant characteristics considered or the time-of-day of the cortisol sampling. Further, there was no evidence of group differences among direct indices of circadian rhythmicity such as the cortisol awakening response or the diurnal cortisol slope. These results suggest that basal hypersecretion of cortisol, but not circadian dysrhythmia, is characteristic of individuals with AD. Mechanistically, the observed hypersecretion is consistent with the theorized AD-driven deterioration of the hippocampus and subsequent reduction in hypothalamic-pituitary-adrenal axis inhibition. Further investigation is warranted to elucidate the role and timing of cortisol elevations in the progression of AD.
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Affiliation(s)
- Ursula G Saelzler
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA.
| | - Paul Verhaeghen
- Department of Psychology, Georgia Institute of Technology, 648 Cherry St. NW, Atlanta GA 30313, USA.
| | - Matthew S Panizzon
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA.
| | - Scott D Moffat
- Department of Psychology, Georgia Institute of Technology, 648 Cherry St. NW, Atlanta GA 30313, USA.
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Ng TKS, Feng L, Fam J, Rawtaer I, Kumar AP, Rane G, Cheah IKM, Mahendran R, Lee YK, Tan EC, Goh LG, Kua EH, Mahendran R. Mindfulness Awareness Practice (MAP) to Prevent Dementia in Older Adults with Mild Cognitive Impairment: Protocol of a Randomized Controlled Trial and Implementation Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10205. [PMID: 34639513 PMCID: PMC8508350 DOI: 10.3390/ijerph181910205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND With an aging population, developing non-pharmacological interventions (NPIs) to delay dementia has become critical. Apart from cognitive decline, dementia is associated with multiple pathophysiology, including increased oxidative stress, dysregulated gene expressions, cytokine, neurotrophin, and stress markers, telomere shortening, and deteriorations in brain connectivity. Although mindfulness practices have been proposed to ameliorate these biological changes, no empirical studies were conducted. We thus aimed to investigate the effects of mindfulness awareness practice (MAP) to prevent cognitive decline and improve peripheral biomarkers in community-dwelling older adults diagnosed with mild cognitive impairment (MCI). METHODS/DESIGN This was a single-blinded and parallel-group randomized controlled trial with two arms (intervention and active control arms), conducted over nine months. A total of 60 consenting community-dwelling older adults diagnosed with MCI were planned to be randomized in a 1:1 ratio to either the MAP or the Health Education Program (HEP). Interventions were performed weekly for the initial 12 weeks, and monthly for the subsequent six months. Outcome measures were assessed at baseline, 3-month, and 9-month post-intervention by blinded assessors. Primary outcomes were neurocognitive tests, comprehensive peripheral biomarkers, and brain imaging scans. Secondary outcomes included basic health screening measures, affective symptoms, and measures of physical functions. Linear-mixed models were used to examine the effects of MAP on these outcome measures. SIGNIFICANCE This is the first randomized controlled trial to systematically investigate the effects of a mindfulness intervention in improving cognitive functions and various biomarkers in community-dwelling older adults diagnosed with MCI. Our findings have the potential to inform mindfulness intervention as a novel approach to delay dementia.
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Affiliation(s)
- Ted Kheng Siang Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Lei Feng
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Johnson Fam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Iris Rawtaer
- Department of Psychiatry, Sengkang General Hospital & SingHealth Duke-NUS Centre of Memory and Cognitive Disorders, Singapore 544886, Singapore;
| | - Alan Prem Kumar
- Cancer Science Institute of Singapore, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore; (A.P.K.); (G.R.)
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore
| | - Grishma Rane
- Cancer Science Institute of Singapore, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore; (A.P.K.); (G.R.)
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, Singapore 117599, Singapore
| | - Irwin Kee-Mun Cheah
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore;
| | - Ratha Mahendran
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Yuan Kun Lee
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, Singapore 117545, Singapore;
| | - Ene Choo Tan
- Division of Clinical Support Services, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
| | - Lee Gan Goh
- Department of Family Medicine, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore;
| | - Ee Heok Kua
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
| | - Rathi Mahendran
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (J.F.); (E.H.K.)
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 117599, Singapore;
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Franks KH, Bransby L, Saling MM, Pase MP. Association of Stress with Risk of Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 82:1573-1590. [PMID: 34366334 DOI: 10.3233/jad-210094] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although many studies have investigated the association between stress and risk of dementia, findings are inconsistent due to the variation in the measures used to assess stress. OBJECTIVE We conducted a systematic review and meta-analysis to investigate the association between psychological stress (including neuroticism, stressful life events, and perceived stress) and the risk of incident dementia and mild cognitive impairment in adults. METHODS PsycINFO, Embase, and MEDLINE were searched to October 2020 for eligible observational, prospective studies. Of the 1,607 studies screened, 26 (24 unique cohorts) were included in the qualitative analysis and 16 (15 unique cohorts) were included in the quantitative analysis. RESULTS Across studies, higher perceived stress was significantly associated with an increased risk of mild cognitive impairment (Cases/Total N = 207/860: hazard ratio [HR] = 1.19, 95% confidence interval [CI] = 1.03-1.38) and all-cause dementia (Cases/Total N = 203/1,882: HR = 1.44, 95% CI = 1.07-1.95). Exposure to two or more stressful life events (versus none) was significantly associated with an increased risk of all-cause dementia (Cases/Total N = 3,354/11,597: HR = 1.72, 95% CI = 1.14-2.60), while one or more stressful life events was not. Higher neuroticism was significantly associated with an increased risk of Alzheimer's disease dementia (Cases/Total N = 497/4,771: HR = 1.07, 95% CI = 1.01-1.12), but not all-cause dementia. CONCLUSION This review suggests that psychological stress in adulthood is associated with an increased risk of dementia. Further research is needed to clarify the mechanisms underlying these associations.
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Affiliation(s)
- Katherine H Franks
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Lisa Bransby
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Rajkumar RP. The Relationship Between Four Measures of Religiosity and Cross-National Variations in the Burden of Dementia. Cureus 2021; 13:e17034. [PMID: 34395146 PMCID: PMC8357016 DOI: 10.7759/cureus.17034] [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] [Accepted: 08/09/2021] [Indexed: 12/05/2022] Open
Abstract
Background Several researchers have identified a possible protective effect of religiosity on the risk of dementia. Specific aspects of religiosity may be associated with this attenuation of risk, and it may be partially mediated through an effect on depressive symptoms or social support. However, this effect has only been demonstrated in selected cohorts to date. Methods This study was based on a cross-national analysis of associations. Correlations between World Health Organization estimates of the burden of dementia and four survey-derived measures of religiosity were examined across 101 countries, while controlling for estimates of late-life depression and social capital. Results Specific aspects of religiosity, such as attendance at religious services (Pearson’s r= -0.57), daily prayer (r = -0.58), and perception of religion as very important (r = -0.65), were associated with lower national levels of Alzheimer’s and other dementias (p< 0.01 for all correlations). This effect was partially mediated through an inverse relationship between religiosity and depression, but remained significant even after controlling for it and on multivariate analyses (β = -0.38 to -0.57, p< 0.01 for all measures). There was no evidence for a mediating effect of social capital. Conclusions Specific religious beliefs and practices may have a protective effect on dementia risk at the population level. These may involve group effects that require further study, such as reductions in depression in the elderly, or may involve beneficial effects on the stress response and cellular ageing in vulnerable individuals; however, the latter cannot be inferred with certainty from a group-level analysis. These results are consistent with earlier research and suggest a potential role for religious-based preventive strategies at the population level.
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Affiliation(s)
- Ravi P Rajkumar
- Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
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33
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Ancelin ML, Norton J, Scali J, Ritchie K, Chaudieu I, Ryan J. A Prospective Study of Diurnal Cortisol and Incident Dementia in Community-Dwelling Older Adults. J Alzheimers Dis 2021; 82:899-904. [PMID: 34120906 DOI: 10.3233/jad-210389] [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: 11/15/2022]
Abstract
Diurnal salivary cortisol was measured in 334 older adults without dementia, at four times on two separate days, under quiet and stressful conditions. In multivariate Cox proportional hazard models, higher global diurnal cortisol secretion was associated with incident dementia (HR = 1.09 [1.02-1.15] per one-unit increase in cortisol measure, p = 0.007) and Alzheimer's disease (HR = 1.12 [1.04-1.21], p = 0.003) over a mean (SD) of 8.1 (4.0) years, independent of potential confounders and stressful conditions. Individuals with incident dementia had a slower rate of cortisol elimination under non-stressful conditions, reflected by higher cortisol levels in the evening, and an abnormal response to stress (blunted evening stress response).
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Affiliation(s)
| | | | | | - Karen Ritchie
- INM, Univ Montpellier, INSERM, Montpellier, France.,Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Joanne Ryan
- Biological Neuropsychiatry Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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34
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Suh M. [Influences of Autonomic Function, Salivary Cortisol and Physical Activity on Cognitive Functions in Institutionalized Older Adults with Mild Cognitive Impairment: Based on Neurovisceral Integration Model]. J Korean Acad Nurs 2021; 51:294-304. [PMID: 34215708 DOI: 10.4040/jkan.20282] [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: 12/11/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to investigate objectively measured physical activity (PA) in institutionalized older adults with mild cognitive impairment (MCI) and to elucidate the influence of autonomic nervous function, salivary cortisol, and PA on cognitive functions based on neurovisceral integration model. METHODS Overall cognitive function was evaluated using the mini-mental state examination (MMSE) and executive function was evaluated using semantic verbal fluency test and clock drawing test. Actigraph for PA, HRV and sAA for autonomous function, and the geriatric depression scale for depression were used. Saliva specimens were collected in the morning for sAA and cortisol. RESULTS Ninety-eight older adults from four regional geriatric hospitals participated in the study. They took 4,499 steps per day on average. They spent 753.93 minutes and 23.12 minutes on average in sedentary and moderate-to-vigorous activity, respectively. In the multiple regression analysis, lower salivary cortisol level (β = - .33, p = .041) and greater step counts (β = .37, p = .029) significantly improved MMSE score. Greater step count (β = .27, p = .016) also exerted a significant influence on verbal fluency, and greater sAA (β = .35, p = .026) was significantly associated with a better clock drawing test result. CONCLUSION Salivary cortisol, sAA and physical activity were significantly associated with cognitive functions. To prevent older adults from developing dementia, strategies are needed to increase their overall PA amount by decreasing sedentary time and to decrease salivary cortisol for cognitive function, and to maintain their sympathetic nervous activity for executive function.
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Affiliation(s)
- Minhee Suh
- Department of Nursing, College of Medicine, Inha University, Incheon, Korea.
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