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Arenaza‐Urquijo EM, Boyle R, Casaletto K, Anstey KJ, Vila‐Castelar C, Colverson A, Palpatzis E, Eissman JM, Kheng Siang Ng T, Raghavan S, Akinci M, Vonk JMJ, Machado LS, Zanwar PP, Shrestha HL, Wagner M, Tamburin S, Sohrabi HR, Loi S, Bartrés‐Faz D, Dubal DB, Vemuri P, Okonkwo O, Hohman TJ, Ewers M, Buckley RF. Sex and gender differences in cognitive resilience to aging and Alzheimer's disease. Alzheimers Dement 2024; 20:5695-5719. [PMID: 38967222 PMCID: PMC11350140 DOI: 10.1002/alz.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 07/06/2024]
Abstract
Sex and gender-biological and social constructs-significantly impact the prevalence of protective and risk factors, influencing the burden of Alzheimer's disease (AD; amyloid beta and tau) and other pathologies (e.g., cerebrovascular disease) which ultimately shape cognitive trajectories. Understanding the interplay of these factors is central to understanding resilience and resistance mechanisms explaining maintained cognitive function and reduced pathology accumulation in aging and AD. In this narrative review, the ADDRESS! Special Interest Group (Alzheimer's Association) adopted a multidisciplinary approach to provide the foundations and recommendations for future research into sex- and gender-specific drivers of resilience, including a sex/gender-oriented review of risk factors, genetics, AD and non-AD pathologies, brain structure and function, and animal research. We urge the field to adopt a sex/gender-aware approach to resilience to advance our understanding of the intricate interplay of biological and social determinants and consider sex/gender-specific resilience throughout disease stages. HIGHLIGHTS: Sex differences in resilience to cognitive decline vary by age and cognitive status. Initial evidence supports sex-specific distinctions in brain pathology. Findings suggest sex differences in the impact of pathology on cognition. There is a sex-specific change in resilience in the transition to clinical stages. Gender and sex factors warrant study: modifiable, immune, inflammatory, and vascular.
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Affiliation(s)
- Eider M. Arenaza‐Urquijo
- Environment and Health Over the Life Course Programme, Climate, Air Pollution, Nature and Urban Health ProgrammeBarcelona Institute for Global Health (ISGlobal)BarcelonaSpain
- University of Pompeu FabraBarcelonaBarcelonaSpain
| | - Rory Boyle
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Kaitlin Casaletto
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Kaarin J. Anstey
- University of New South Wales Ageing Futures InstituteSydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Psychology, University of New South WalesSidneyNew South WalesAustralia
| | | | - Aaron Colverson
- University of Florida Center for Arts in Medicine Interdisciplinary Research LabUniversity of Florida, Center of Arts in MedicineGainesvilleFloridaUSA
| | - Eleni Palpatzis
- Environment and Health Over the Life Course Programme, Climate, Air Pollution, Nature and Urban Health ProgrammeBarcelona Institute for Global Health (ISGlobal)BarcelonaSpain
- University of Pompeu FabraBarcelonaBarcelonaSpain
| | - Jaclyn M. Eissman
- Vanderbilt Memory and Alzheimer's Center, Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ted Kheng Siang Ng
- Rush Institute for Healthy Aging and Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | | | - Muge Akinci
- Environment and Health Over the Life Course Programme, Climate, Air Pollution, Nature and Urban Health ProgrammeBarcelona Institute for Global Health (ISGlobal)BarcelonaSpain
- University of Pompeu FabraBarcelonaBarcelonaSpain
| | - Jet M. J. Vonk
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Luiza S. Machado
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal Do Rio Grande Do Sul, FarroupilhaPorto AlegreBrazil
| | - Preeti P. Zanwar
- Jefferson College of Population Health, Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- The Network on Life Course and Health Dynamics and Disparities, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Maude Wagner
- Rush Alzheimer's Disease Center, Rush University Medical CenterChicagoIllinoisUSA
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Hamid R. Sohrabi
- Centre for Healthy AgeingHealth Future InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
- School of Psychology, Murdoch UniversityMurdochWestern AustraliaAustralia
| | - Samantha Loi
- Neuropsychiatry Centre, Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryUniversity of MelbourneParkvilleVictoriaAustralia
| | - David Bartrés‐Faz
- Department of MedicineFaculty of Medicine and Health Sciences & Institut de NeurociènciesUniversity of BarcelonaBarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques (IDIBAPS)BarcelonaBarcelonaSpain
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de BarcelonaBadalonaBarcelonaSpain
| | - Dena B. Dubal
- Department of Neurology and Weill Institute of NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Biomedical and Neurosciences Graduate ProgramsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | - Ozioma Okonkwo
- Alzheimer's Disease Research Center and Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Timothy J. Hohman
- Vanderbilt Memory and Alzheimer's Center, Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Michael Ewers
- Institute for Stroke and Dementia ResearchKlinikum der Universität MünchenLudwig Maximilians Universität (LMU)MunichGermany
- German Center for Neurodegenerative Diseases (DZNE, Munich)MunichGermany
| | - Rachel F. Buckley
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Chahine LM, Lafontant DE, Ho Choi S, Iwaki H, Blauwendraat C, Singleton AB, Brumm MC, Alcalay RN, Merchant K, Nudelman KNH, Dagher A, Vo A, Tao Q, Venuto CS, Kieburtz K, Poston KL, Bressman S, Gonzalez-Latapi P, Avants B, Coffey C, Jennings D, Tolosa E, Siderowf A, Marek K, Simuni T. LRRK2-Associated Parkinsonism With and Without In Vivo Evidence of Alpha-Synuclein Aggregates. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.22.24310806. [PMID: 39108519 PMCID: PMC11302724 DOI: 10.1101/2024.07.22.24310806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Background Among LRRK2-associated parkinsonism cases with nigral degeneration, over two-thirds demonstrate evidence of pathologic alpha-synuclein, but many do not. Understanding the clinical phenotype and underlying biology in such individuals is critical for therapeutic development. Our objective was to compare clinical and biomarker features, and rate of progression over 4 years follow-up, among LRRK2-associated parkinsonism cases with and without in vivo evidence of alpha-synuclein aggregates. Methods Data were from the Parkinson's Progression Markers Initiative, a multicenter prospective cohort study. The sample included individuals diagnosed with Parkinson disease with pathogenic variants in LRRK2. Presence of CSF alpha-synuclein aggregation was assessed with seed amplification assay. A range of clinician- and patient- reported outcome assessments were administered. Biomarkers included dopamine transporter SPECT scan, CSF amyloid-beta1-42, total tau, phospho-tau181, urine bis(monoacylglycerol)phosphate levels, and serum neurofilament light chain. Linear mixed effects models examined differences in trajectory in CSF negative and positive groups. Results 148 LRRK2-parkinsonism cases (86% with G2019S variant), 46 negative and 102 positive for CSF alpha-synuclein seed amplification assay were included. At baseline, the negative group were older than the positive group (median [interquartile range] 69.1 [65.2-72.3] vs 61.5 [55.6-66.9] years, p<0.001) and a greater proportion were female (28 (61%) vs 43 (42%), p=0.035). Despite being older, the negative group had similar duration since diagnosis, and similar motor rating scale (16 [11-23] vs 16 [10-22], p=0.480) though lower levodopa equivalents. Only 13 (29%) of the negative group were hyposmic, compared to 75 (77%) of the positive group. Lowest putamen dopamine transporter binding expected for age and sex was greater in the negative vs positive groups (0.36 [0.29-0.45] vs 0.26 [0.22-0.37], p<0.001). Serum neurofilament light chain was higher in the negative group compared to the positive group (17.10 [13.60-22.10] vs 10.50 [8.43-14.70]; age-adjusted p-value=0.013). In terms of longitudinal change, the negative group remained stable in functional rating scale score in contrast to the positive group who had a significant increase (worsening) of 0.729 per year (p=0.037), but no other differences in trajectory were found. Conclusion Among individuals diagnosed with Parkinson disease with pathogenic variants in the LRRK2 gene, we found clinical and biomarker differences in cases without versus with in vivo evidence of CSF alpha-synuclein aggregates. LRRK2 parkinsonism cases without evidence of alpha-synuclein aggregates as a group exhibit less severe motor manifestations and decline may have more significant cognitive dysfunction. The underlying biology in LRRK2-parkinsonism cases without evidence of alpha-synuclein aggregates requires further investigation.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA, 15213
| | - David-Erick Lafontant
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Seung Ho Choi
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Hirotaka Iwaki
- DataTecnica LLC, Washington, District of Columbia, USA. (2) Center for Alzheimer's and Related Dementias, National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Center for Alzheimer's and Related Dementias, National Institute on Aging and Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Cornelis Blauwendraat
- Center for Alzheimer's and Related Dementias, National Institute on Aging and Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew B Singleton
- Center for Alzheimer's and Related Dementias, National Institute on Aging and Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael C Brumm
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Roy N Alcalay
- Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel and Department of Neurology; Columbia University Irving Medical Center
| | - Kalpana Merchant
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Alain Dagher
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Andrew Vo
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Qin Tao
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Charles S Venuto
- Department of Neurology, Center for Health and Technology, University of Rochester Medical Center, Rochester, NY
| | - Karl Kieburtz
- Department of Neurology, Center for Health and Technology, University of Rochester Medical Center, Rochester, NY
| | - Kathleen L Poston
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Susan Bressman
- Department of Neurology, Mount Sinai Beth Israel and Icahn School of Medicine, Mount Sinai, New York City, New York, USA
| | - Paulina Gonzalez-Latapi
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | - Eduard Tolosa
- Parkinson's disease & Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII) Barcelona, Spain
| | - Andrew Siderowf
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ken Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wood Alexander M, Wu CY, Coughlan GT, Puri T, Buckley RF, Palta P, Swardfager W, Masellis M, Galea LAM, Einstein G, Black SE, Rabin JS. Associations Between Age at Menopause, Vascular Risk, and 3-Year Cognitive Change in the Canadian Longitudinal Study on Aging. Neurology 2024; 102:e209298. [PMID: 38569140 DOI: 10.1212/wnl.0000000000209298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mounting evidence supports sex differences in Alzheimer disease (AD) risk. Vascular and hormonal factors may together contribute to AD risk in female adults. We investigated whether age at menopause, vascular risk, and history of hormone therapy (HT) containing estrogens together influence cognition over a 3-year follow-up period. We hypothesized that earlier menopause and elevated vascular risk would have a synergistic association with lower cognitive scores at follow-up and that HT containing estrogens would attenuate this synergistic association to preserve cognition. METHODS We used data from postmenopausal female participants and age-matched male participants in the Canadian Longitudinal Study on Aging. Vascular risk was calculated using a summary score of elevated blood pressure, antihypertensive medications, elevated low-density lipoprotein cholesterol, diabetes, smoking, and obesity. Cognition was measured with a global cognitive composite at baseline and 3-year follow-up. Linear models tested independent and interactive associations of age at menopause, vascular risk, and HT history with cognition at 3-year follow-up, adjusting for baseline cognition, baseline age, years of education, and test language (English/French). RESULTS We included 8,360 postmenopausal female participants (mean age at baseline = 65.0 ± 8.53 years, mean age at menopause = 50.1 ± 4.62 years) and 8,360 age-matched male participants for comparison. There was an interaction between age at menopause and vascular risk, such that earlier menopause and higher vascular risk were synergistically associated with lower cognitive scores at follow-up (β = 0.013, 95% CI 0.001-0.025, p = 0.03). In stratified analyses, vascular risk was associated with lower cognitive scores in female participants with earlier menopause (menopausal ages 35-48 years; β = -0.044, 95% CI -0.066 to -0.022, p < 0.001), but not average (ages 49-52 years; β = -0.007, 95% CI -0.027 to 0.012, p = 0.46) or later menopause (ages 53-65 years; β = 0.003, 95% CI -0.020 to 0.025, p = 0.82). The negative association of vascular risk with cognition in female participants with earlier menopause was stronger than the equivalent association in age-matched male participants. HT history did not further modify the synergistic association of age at menopause and vascular risk with follow-up cognition (β = -0.005, 95% CI -0.032 to 0.021, p = 0.69). DISCUSSION Endocrine and vascular processes may synergistically contribute to increased risk of cognitive decline in female adults. These findings have implications for the development of sex-specific dementia prevention strategies.
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Affiliation(s)
- Madeline Wood Alexander
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Che-Yuan Wu
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Gillian T Coughlan
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Tanvi Puri
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Rachel F Buckley
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Priya Palta
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Walter Swardfager
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Mario Masellis
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Liisa A M Galea
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Gillian Einstein
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Sandra E Black
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Jennifer S Rabin
- From the Hurvitz Brain Sciences Program (M.W.A., C.-Y.W., W.S., M.M., S.E.B., J.S.R.), Sunnybrook Research Institute; Rehabilitation Sciences Institute (M.W.A., J.S.R.), Department of Pharmacology & Toxicology (C.-Y.W., W.S.), University of Toronto, Ontario, Canada; Department of Neurology (G.T.C., R.F.B.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Psychology (T.P.), University of British Columbia, Vancouver, Canada; Center for Alzheimer Research and Treatment (CART) (R.F.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Melbourne School of Psychological Sciences (R.F.B.), University of Melbourne, Parkville, Victoria, Australia; Department of Neurology (P.P.), University of North Carolina at Chapel Hill School of Medicine; Division of Neurology (M.M., S.E.B., J.S.R.), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Campbell Family Mental Health Research Institute (L.A.M.G.), The Centre for Addition and Mental Health; Department of Psychiatry (L.A.M.G.), Temerty Faculty of Medicine, Dalla Lana School of Public Health (G.E.), and Department of Psychology (G.E.), University of Toronto; Rotman Research Institute (G.E.), Baycrest Hospital; and Harquail Centre for Neuromodulation (J.S.R.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Gordon EH, Ward DD, Xiong H, Berkovsky S, Hubbard RE. Delirium and incident dementia in hospital patients in New South Wales, Australia: retrospective cohort study. BMJ 2024; 384:e077634. [PMID: 38537951 PMCID: PMC10966895 DOI: 10.1136/bmj-2023-077634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To determine the strength and nature of the association between delirium and incident dementia in a population of older adult patients without dementia at baseline. DESIGN Retrospective cohort study using large scale hospital administrative data. SETTING Public and private hospitals in New South Wales, Australia between July 2001 and March 2020. PARTICIPANTS Data were extracted for 650 590 hospital patients aged ≥65 years. Diagnoses of dementia and delirium were identified from ICD-10 (international classification of diseases, 10th revision) codes. Patients with dementia at baseline were excluded. Delirium-no delirium pairs were identified by matching personal and clinical characteristics, and were followed for more than five years. MAIN OUTCOME MEASURES Cox proportional hazards models and Fine-Gray hazard models were used to estimate the associations of delirium with death and incident dementia, respectively. Delirium-outcome dose-response associations were quantified, all analyses were performed in men and women separately, and sensitivity analyses were conducted. RESULTS The study included 55 211 matched pairs (48% men, mean age 83.4 years, standard deviation 6.5 years). Collectively, 58% (n=63 929) of patients died and 17% (n=19 117) had a newly reported dementia diagnosis during 5.25 years of follow-up. Patients with delirium had 39% higher risk of death (hazard ratio 1.39, 95% confidence interval 1.37 to 1.41) and three times higher risk of incident dementia (subdistribution hazard ratio 3.00, 95% confidence interval 2.91 to 3.10) than patients without delirium. The association with dementia was stronger in men (P=0.004). Each additional episode of delirium was associated with a 20% increased risk of dementia (subdistribution hazard ratio 1.20, 95% confidence interval 1.18 to 1.23). CONCLUSIONS The study findings suggest delirium was a strong risk factor for death and incident dementia among older adult patients. The data support a causal interpretation of the association between delirium and dementia. The clinical implications of delirium as a potentially modifiable risk factor for dementia are substantial.
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Affiliation(s)
- Emily H Gordon
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Australian Frailty Network, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - David D Ward
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Australian Frailty Network, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Hao Xiong
- Centre for Health Informatics, Macquarie University, North Ryde, NSW, Australia
| | - Shlomo Berkovsky
- Centre for Health Informatics, Macquarie University, North Ryde, NSW, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Australian Frailty Network, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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5
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Oltra J, Habich A, Schwarz CG, Nedelska Z, Przybelski SA, Inguanzo A, Diaz‐Galvan P, Lowe VJ, Oppedal K, Gonzalez MC, Philippi N, Blanc F, Barkhof F, Lemstra AW, Hort J, Padovani A, Rektorova I, Bonanni L, Massa F, Kramberger MG, Taylor J, Snædal JG, Walker Z, Antonini A, Dierks T, Segura B, Junque C, Westman E, Boeve BF, Aarsland D, Kantarci K, Ferreira D. Sex differences in brain atrophy in dementia with Lewy bodies. Alzheimers Dement 2024; 20:1815-1826. [PMID: 38131463 PMCID: PMC10947875 DOI: 10.1002/alz.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/13/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Sex influences neurodegeneration, but it has been poorly investigated in dementia with Lewy bodies (DLB). We investigated sex differences in brain atrophy in DLB using magnetic resonance imaging (MRI). METHODS We included 436 patients from the European-DLB consortium and the Mayo Clinic. Sex differences and sex-by-age interactions were assessed through visual atrophy rating scales (n = 327; 73 ± 8 years, 62% males) and automated estimations of regional gray matter volume and cortical thickness (n = 165; 69 ± 9 years, 72% males). RESULTS We found a higher likelihood of frontal atrophy and smaller volumes in six cortical regions in males and thinner olfactory cortices in females. There were significant sex-by-age interactions in volume (six regions) and cortical thickness (seven regions) across the entire cortex. DISCUSSION We demonstrate that males have more widespread cortical atrophy at younger ages, but differences tend to disappear with increasing age, with males and females converging around the age of 75. HIGHLIGHTS Male DLB patients had higher odds for frontal atrophy on radiological visual rating scales. Male DLB patients displayed a widespread pattern of cortical gray matter alterations on automated methods. Sex differences in gray matter measures in DLB tended to disappear with increasing age.
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Affiliation(s)
- Javier Oltra
- Medical Psychology UnitDepartment of MedicineInstitute of NeuroscienceUniversity of BarcelonaBarcelonaCataloniaSpain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
- Division of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Annegret Habich
- Division of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- University Hospital of Psychiatry and Psychotherapy Bern, University of BernBernSwitzerland
| | | | - Zuzana Nedelska
- Memory ClinicDepartment of NeurologyCharles University2nd Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | | | - Anna Inguanzo
- Division of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | | | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Ketil Oppedal
- Center for Age‐Related MedicineStavanger University HospitalStavangerNorway
- Stavanger Medical Imaging Laboratory (SMIL)Department of RadiologyStavanger University HospitalStavangerNorway
- The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
| | - Maria C. Gonzalez
- Center for Age‐Related MedicineStavanger University HospitalStavangerNorway
- Stavanger Medical Imaging Laboratory (SMIL)Department of RadiologyStavanger University HospitalStavangerNorway
- The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
- Department of Quality and Health TechnologyFaculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Nathalie Philippi
- Geriatrics and Neurology UnitsResearch and Resources Memory Center (CM2R)Hôpitaux Universitaires de StrasbourgStrasbourgFrance
- ICube Laboratory (CNRS, UMR 7357)StrasbourgFrance
| | - Frederic Blanc
- Geriatrics and Neurology UnitsResearch and Resources Memory Center (CM2R)Hôpitaux Universitaires de StrasbourgStrasbourgFrance
- ICube Laboratory (CNRS, UMR 7357)StrasbourgFrance
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine (AMC)Amsterdam UMC, Vrije UniversiteitAmsterdamthe Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing (CMIC)University College LondonLondonUK
| | - Afina W. Lemstra
- Alzheimer Center AmsterdamNeurologyVrije Universiteit Amsterdam, Amsterdam UMC location VumcAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegeneration, Vrije Universiteit Amsterdam, Amsterdam UMC location VumcAmsterdamThe Netherlands
| | - Jakub Hort
- Memory ClinicDepartment of NeurologyCharles University2nd Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Alessandro Padovani
- Neurology UnitDepartment of Clinical and Experimental Sciences (DSCS)University of BresciaBresciaItaly
| | - Irena Rektorova
- Brain and Mind ResearchCentral European Institute of Technology (CEITET)Masaryk UniversityBrnoCzech Republic
| | - Laura Bonanni
- Department of Medicine and Aging Sciences University G. d'Annunzio of Chieti‐Pescara ChietiChietiItaly
| | - Federico Massa
- Department of NeuroscienceRehabilitationOphthalmology, Genetics, Maternal and Child HealthUniversity of GenovaGenovaItaly
| | | | - John‐Paul Taylor
- Translational and Clinical Research InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | | | - Zuzana Walker
- Division of PsychiatryUniversity College LondonLondonUK
- St Margaret's HospitalEssex Partnership University NHS Foundation TrustEssexUK
| | - Angelo Antonini
- Parkinson and Movement Disorders UnitStudy Center on Neurodegeneration (CESNE)PadovaItaly
| | - Thomas Dierks
- University Hospital of Psychiatry and Psychotherapy Bern, University of BernBernSwitzerland
| | - Barbara Segura
- Medical Psychology UnitDepartment of MedicineInstitute of NeuroscienceUniversity of BarcelonaBarcelonaCataloniaSpain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED: CB06/05/0018‐ISCIII)BarcelonaCataloniaSpain
| | - Carme Junque
- Medical Psychology UnitDepartment of MedicineInstitute of NeuroscienceUniversity of BarcelonaBarcelonaCataloniaSpain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
- Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED: CB06/05/0018‐ISCIII)BarcelonaCataloniaSpain
| | - Eric Westman
- Division of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | | | - Dag Aarsland
- Center for Age‐Related MedicineStavanger University HospitalStavangerNorway
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology & Neuroscience (IoPPN)King's College LondonLondonUK
| | | | - Daniel Ferreira
- Division of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
- Facultad de Ciencias de la SaludUniversidad Fernando Pessoa CanariasLas PalmasEspaña
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Bayram E, Reho P, Litvan I, Ding J, Gibbs JR, Dalgard CL, Traynor BJ, Scholz SW, Chia R. Genetic analysis of the X chromosome in people with Lewy body dementia nominates new risk loci. NPJ Parkinsons Dis 2024; 10:39. [PMID: 38378815 PMCID: PMC10879525 DOI: 10.1038/s41531-024-00649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
Sex influences the prevalence and symptoms of Lewy body dementia (LBD). However, genome-wide association studies typically focus on autosomal variants and exclude sex-specific risk factors. We addressed this gap by performing an X chromosome-wide association study using whole-genome sequence data from 2591 LBD cases and 4391 controls. We identified a significant risk locus within intron 1 of MAP3K15 (rs141773145, odds ratio = 2.42, 95% confidence interval = 1.65-3.56, p-value = 7.0 × 10-6) in female LBD cases conditioned for APOE ε4 dosage. The locus includes an enhancer region that regulates MAP3K15 expression in ganglionic eminence cells derived from primary cultured neurospheres. Rare variant burden testing showed differential enrichment of missense mutations in TEX13A in female LBD cases, that did not reach significance (p-value = 1.34 × 10-4). These findings support the sex-specific effects of genetic factors and a potential role of Alzheimer's-related risk for females with LBD.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, CA, USA
| | - Paolo Reho
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, CA, USA
| | - Jinhui Ding
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - J Raphael Gibbs
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Clifton L Dalgard
- Department of Anatomy, Physiology & Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bryan J Traynor
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Neuromuscular Diseases Research Section, National Institute on Aging, Bethesda, MD, USA
- Therapeutics Development Laboratory, National Center for Advancing Translational Sciences, Rockville, MD, USA
| | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Ruth Chia
- Neuromuscular Diseases Research Section, National Institute on Aging, Bethesda, MD, USA.
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Gannon O, Tremble SM, McGinn C, Guth R, Scoppettone N, Hunt RD, Prakash K, Johnson AC. Angiotensin II-mediated hippocampal hypoperfusion and vascular dysfunction contribute to vascular cognitive impairment in aged hypertensive rats. Alzheimers Dement 2024; 20:890-903. [PMID: 37817376 PMCID: PMC10917018 DOI: 10.1002/alz.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Chronic hypertension increases the risk of vascular cognitive impairment (VCI) by ∼60%; however, how hypertension affects the vasculature of the hippocampus remains unclear but could contribute to VCI. METHODS Memory, hippocampal perfusion, and hippocampal arteriole (HA) function were investigated in male Wistar rats or spontaneously hypertensive rats (SHR) in early (4 to 5 months old), mid (8 to 9 months old), or late adulthood (14 to 15 months old). SHR in late adulthood were chronically treated with captopril (angiotensin converting enzyme inhibitor) or apocynin (antioxidant) to investigate the mechanisms by which hypertension contributes to VCI. RESULTS Impaired memory in SHR in late adulthood was associated with HA endothelial dysfunction, hyperconstriction, and ∼50% reduction in hippocampal blood flow. Captopril, but not apocynin, improved HA function, restored perfusion, and rescued memory function in aged SHR. DISCUSSION Hippocampal vascular dysfunction contributes to hypertension-induced memory decline through angiotensin II signaling, highlighting the therapeutic potential of HAs in protecting neurocognitive health later in life. HIGHLIGHTS Vascular dysfunction in the hippocampus contributes to vascular cognitive impairment. Memory declines with age during chronic hypertension. Angiotensin II causes endothelial dysfunction in the hippocampus in hypertension. Angiotensin II-mediated hippocampal arteriole dysfunction reduces blood flow. Vascular dysfunction in the hippocampus impairs perfusion and memory function.
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Affiliation(s)
- Olivia Gannon
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Sarah M. Tremble
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Conor McGinn
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Ruby Guth
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Nadia Scoppettone
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Ryan D. Hunt
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Kirtika Prakash
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Abbie C. Johnson
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
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Bayram E, Coughlin DG, Rajmohan R, Litvan I. Sex differences for clinical correlates of substantia nigra neuron loss in people with Lewy body pathology. Biol Sex Differ 2024; 15:8. [PMID: 38243325 PMCID: PMC10797801 DOI: 10.1186/s13293-024-00583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Lewy body dementia (LBD) phenotype is associated with the presence and degree of Lewy body, Alzheimer's pathologies, and substantia nigra neuron loss. Nigral neuron loss is associated with parkinsonism in LBD, and females with LBD are less likely than males to have parkinsonism. As sex differences were reported for clinical correlates of Lewy body and Alzheimer's pathologies, we aimed to investigate whether there are also sex differences for correlates of nigral neuron loss. METHODS Data were obtained from the National Alzheimer's Coordinating Center for females (n = 159) and males (n = 263) with brainstem, limbic, and neocortical Lewy body pathology. Sex differences for the nigral neuron loss' association with Lewy body pathology staging and core clinical LBD features (cognitive fluctuations, visual hallucinations, rapid eye movement sleep behavior disorder, parkinsonism) during follow-up were analyzed with generalized linear models adjusting for age and Alzheimer's pathology staging. Whether any of the core clinical features at the time of dementia onset can predict underlying nigral neuron loss for females and males were also analyzed with generalized linear models. RESULTS Compared to males, females died older and had higher levels of Braak tau staging, but had similar levels of Lewy body pathology staging and nigral neuron loss. Females were less likely than males to have a clinical Lewy body disease diagnosis during follow-up. More advanced Lewy body pathology staging was associated with more nigral neuron loss, more so for males than females. More nigral neuron loss was associated with parkinsonism and clinical LBD diagnosis during follow-up, more so for males than females. Across the subgroup with dementia (40 females, 58 males), core LBD features at first visit with dementia were not associated with nigral neuron loss. CONCLUSIONS Nigral neuron loss' association with Lewy body pathology staging and core LBD features can differ by sex. Compared to males, females with Lewy body pathology have a higher risk of underdiagnosis. There is a need to elucidate the mechanisms underlying sex differences for pathology and clinicopathological correlations to advance diagnostic and therapeutic efforts in LBD.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, Parkinson and other Movement Disorders Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0886, USA.
| | - David G Coughlin
- Department of Neurosciences, Parkinson and other Movement Disorders Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0886, USA
| | - Ravi Rajmohan
- Department of Neurology, University of California Irvine, 1001 Health Sciences Road, Irvine, CA, 92697-3950, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and other Movement Disorders Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0886, USA
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9
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Wagemann O, Li Y, Hassenstab J, Aschenbrenner AJ, McKay NS, Gordon BA, Benzinger TLS, Xiong C, Cruchaga C, Renton AE, Perrin RJ, Berman SB, Chhatwal JP, Farlow MR, Day GS, Ikeuchi T, Jucker M, Lopera F, Mori H, Noble JM, Sánchez‐Valle R, Schofield PR, Morris JC, Daniels A, Levin J, Bateman RJ, McDade E, Llibre‐Guerra JJ. Investigation of sex differences in mutation carriers of the Dominantly Inherited Alzheimer Network. Alzheimers Dement 2024; 20:47-62. [PMID: 37740921 PMCID: PMC10841236 DOI: 10.1002/alz.13460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Studies suggest distinct differences in the development, presentation, progression, and response to treatment of Alzheimer's disease (AD) between females and males. We investigated sex differences in cognition, neuroimaging, and fluid biomarkers in dominantly inherited AD (DIAD). METHODS Three hundred twenty-five mutation carriers (55% female) and one hundred eighty-six non-carriers (58% female) of the Dominantly Inherited Alzheimer Network Observational Study were analyzed. Linear mixed models and Spearman's correlation explored cross-sectional sex differences in cognition, cerebrospinal fluid (CSF) biomarkers, Pittsburgh compound B positron emission tomography (11 C-PiB PET) and structural magnetic resonance imaging (MRI). RESULTS Female carriers performed better than males on delayed recall and processing speed despite similar hippocampal volumes. As the disease progressed, symptomatic females revealed higher increases in MRI markers of neurodegeneration and memory impairment. PiB PET and established CSF AD markers revealed no sex differences. DISCUSSION Our findings suggest an initial cognitive reserve in female carriers followed by a pronounced increase in neurodegeneration coupled with worse performance on delayed recall at later stages of DIAD.
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Affiliation(s)
- Olivia Wagemann
- Department of NeurologyWashington University St. LouisSt. LouisMissouriUSA
- Department of NeurologyLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Yan Li
- Department of BiostatisticsWashington University St. LouisSt. LouisMissouriUSA
| | - Jason Hassenstab
- Department of NeurologyWashington University St. LouisSt. LouisMissouriUSA
| | | | - Nicole S. McKay
- Department of RadiologyWashington University St. LouisSt. LouisMissouriUSA
| | - Brian A. Gordon
- Department of RadiologyWashington University St. LouisSt. LouisMissouriUSA
| | | | - Chengjie Xiong
- Department of BiostatisticsWashington University St. LouisSt. LouisMissouriUSA
| | - Carlos Cruchaga
- Department of PsychiatryWashington University St. LouisSt. LouisMissouriUSA
| | - Alan E. Renton
- Department of NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Richard J. Perrin
- Department of NeurologyWashington University St. LouisSt. LouisMissouriUSA
- Department of Pathology and ImmunologyWashington University St. LouisSt. LouisMissouriUSA
| | - Sarah B. Berman
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jasmeer P. Chhatwal
- Department of NeurologyMassachusetts General and Brigham & Female's HospitalsHarvard Medical SchoolBostonMassachusettsUSA
| | - Martin R. Farlow
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gregory S. Day
- Department of NeurologyMayo Clinic FloridaJacksonvilleFloridaUSA
| | - Takeshi Ikeuchi
- Department of Molecular GeneticsBrain Research InstituteNiigata UniversityNiigataJapan
| | - Mathias Jucker
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- German Center for Neurodegenerative Diseases (DZNE)TübingenGermany
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia (GNA)Universidad de AntioquiaMedellinColombia
| | - Hiroshi Mori
- Department of Clinical NeuroscienceOsaka Metropolitan University Medical SchoolNagaoka Sutoku UniversityOsakaJapan
| | - James M. Noble
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Raquel Sánchez‐Valle
- Department of NeurologyHospital Clínic de Barcelona (IDIBAPS)University of BarcelonaBarcelonaSpain
| | - Peter R. Schofield
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Biomedical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - John C. Morris
- Department of NeurologyWashington University St. LouisSt. LouisMissouriUSA
| | - Alisha Daniels
- Department of NeurologyWashington University St. LouisSt. LouisMissouriUSA
| | - Johannes Levin
- Department of NeurologyLudwig‐Maximilians‐Universität MünchenMunichGermany
- German Center for Neurodegenerative Diseases (DZNE)MunichGermany
- Munich Cluster for Systems Neurology (SyNergy)MunichGermany
| | - Randall J. Bateman
- Department of NeurologyWashington University St. LouisSt. LouisMissouriUSA
| | - Eric McDade
- Department of NeurologyWashington University St. LouisSt. LouisMissouriUSA
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Hainsworth AH, Markus HS, Schneider JA. Cerebral Small Vessel Disease, Hypertension, and Vascular Contributions to Cognitive Impairment and Dementia. Hypertension 2024; 81:75-86. [PMID: 38044814 PMCID: PMC10734789 DOI: 10.1161/hypertensionaha.123.19943] [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] [Indexed: 12/05/2023]
Abstract
Hypertension-associated cerebral small vessel disease is a common finding in older people. Strongly associated with age and hypertension, small vessel disease is found at autopsy in over 50% of people aged ≥65 years, with a spectrum of clinical manifestations. It is the main cause of lacunar stroke and a major source of vascular contributions to cognitive impairment and dementia. The brain areas affected are subcortical and periventricular white matter and deep gray nuclei. Neuropathological sequelae are diffuse white matter lesions (seen as white matter hyperintensities on T2-weighted magnetic resonance imaging), small ischemic foci (lacunes or microinfarcts), and less commonly, subcortical microhemorrhages. The most common form of cerebral small vessel disease is concentric, fibrotic thickening of small penetrating arteries (up to 300 microns outer diameter) termed arteriolosclerosis. Less common forms are small artery atheroma and lipohyalinosis (the lesions described by C. Miller Fisher adjacent to lacunes). Other microvascular lesions that are not reviewed here include cerebral amyloid angiopathy and venous collagenosis. Here, we review the epidemiology, neuropathology, clinical management, genetics, preclinical models, and pathogenesis of hypertensive small vessel disease. Knowledge gaps include initiating factors, molecular pathogenesis, relationships between arterial pathology and tissue damage, possible reversibility, pharmacological targets, and molecular biomarkers. Progress is anticipated from multicell transcriptomic and proteomic profiling, novel experimental models and further target-finding and interventional clinical studies.
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Affiliation(s)
- Atticus H. Hainsworth
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.H.H.)
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (A.H.H.)
| | - Hugh S. Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M.)
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Departments of Pathology and Neurological Sciences, Rush University Medical Center, Chicago, IL (J.A.S.)
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Ichimata S, Yoshida K, Li J, Rogaeva E, Lang AE, Kovacs GG. The molecular spectrum of amyloid-beta (Aβ) in neurodegenerative diseases beyond Alzheimer's disease. Brain Pathol 2024; 34:e13210. [PMID: 37652560 PMCID: PMC10711260 DOI: 10.1111/bpa.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
This study investigated the molecular spectrum of amyloid-beta (Aβ) in neurodegenerative diseases beyond Alzheimer's disease (AD). We analyzed Aβ deposition in the temporal cortex and striatum in 116 autopsies, including Lewy body disease (LBD; N = 51), multiple system atrophy (MSA; N = 10), frontotemporal lobar degeneration-TDP-43 (FTLD-TDP; N = 16), and progressive supranuclear palsy (PSP; N = 39). The LBD group exhibited the most Aβ deposition in the temporal cortex and striatum (90/76%, respectively), followed by PSP (69/28%), FTLD-TDP (50/25%), and the MSA group (50/10%). We conducted immunohistochemical analysis using antibodies targeting eight Aβ epitopes in the LBD and PSP groups. Immunohistochemical findings were evaluated semi-quantitatively and quantitatively using digital pathology. Females with LBD exhibited significantly more severe Aβ deposition, particularly Aβ42 and Aβ43 , along with significantly more severe tau pathology. Furthermore, a quantitative analysis of all Aβ peptides in the LBD group revealed an association with the APOE-ε4 genotypes. No significant differences were observed between males and females in the PSP group. Finally, we compared striatal Aβ deposition in cases with LBD (N = 15), AD without α-synuclein pathology (N = 6), and PSP (N = 5). There were no differences in the pan-Aβ antibody (6F/3D)-immunolabeled deposition burden among the three groups, but the deposition burden of peptides with high aggregation capacity, especially Aβ43 , was significantly higher in the AD and LBD groups than in the PSP group. Furthermore, considerable heterogeneity was observed in the composition of Aβ peptides on a case-by-case basis in the AD and LBD groups, whereas it was relatively uniform in the PSP group. Cluster analysis further supported these findings. Our data suggest that the type of concomitant proteinopathies influences the spectrum of Aβ deposition, impacted also by sex and APOE genotypes.
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Affiliation(s)
- Shojiro Ichimata
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Department of Legal Medicine, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Koji Yoshida
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Department of Legal Medicine, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Jun Li
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Anthony E. Lang
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Edmond J Safra Program in Parkinson's Disease and Rossy Program in Progressive Supranuclear PalsyToronto Western HospitalTorontoOntarioCanada
| | - Gabor G. Kovacs
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Edmond J Safra Program in Parkinson's Disease and Rossy Program in Progressive Supranuclear PalsyToronto Western HospitalTorontoOntarioCanada
- Laboratory Medicine Program and Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
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Babaei P, Javer S, Abedinzade M. Therapeutic Effects Of Combined and Chronic Treatment of Tat-GluA23y and D-Serine on Cognitive Dysfunction in Postmenopausal Rats. Exp Aging Res 2023:1-19. [PMID: 37660354 DOI: 10.1080/0361073x.2023.2254660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The incidence of Alzheimer's disease (AD) in female gender compared with male has been addressed as a health concern, particularly in menopausal age. We here hypothesized that co-administration of NMDARs agonist (D-serine) and AMPARs endocytosis inhibitor (Tat-GluA23y) might be a potential target for alleviating memory impairment in sporadic Alzheimer model of rats. METHODS Forty-eight female Wistar rats weighing 200-220 randomly divided into six groups. One month later, ovariectomized rats underwent stereotaxic surgery and were cannulated into the brain lateral ventricles. Streptozotocin was injected (3 mg/kg), then animals received the related treatments until the day 51, which experienced acquisition of spatial memory in Morris Water Maze test. Finally, the level of phosphorylated cAMP response element binding protein (CREB) in the hippocampus was measured by Western blotting. RESULTS Co-administration of D-serine and GluA23y significantly enhanced the acquisition and retrieval of impaired spatial memory in ovariectomized rats with AD (p < .001). Compared to Glu-A 23, D-serine caused more improvement in the mentioned parameters above, however, these values for both groups were still significantly different from the control group (P < .05). CONCLUSION Simultaneous treatment with D-serine and GluA23y synergistically improved STZ induced spatial memory impairment in OVX rat, probably partly via increase in phosphorylated CREB protein.
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Affiliation(s)
- Parvin Babaei
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Cellular &Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Department of physiology, School of Medicine, Guilan university of medical science, Rasht, Iran
| | - Shirin Javer
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Cellular &Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Department of physiology, School of Medicine, Guilan university of medical science, Rasht, Iran
| | - Mahmood Abedinzade
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Department of physiology, School of Medicine, Guilan university of medical science, Rasht, Iran
- medical biotechnology research center, School of Paramedicine, Guilan university of medical sciences, Rasht, Iran
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Bayat Z, Damirchi A, Hasannejad-Bibalan M, Babaei P. Concurrent high-intensity interval training and probiotic supplementation improve associative memory via increase in insulin sensitivity in ovariectomized rats. BMC Complement Med Ther 2023; 23:262. [PMID: 37488554 PMCID: PMC10364354 DOI: 10.1186/s12906-023-04097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Metabolic syndrome (MetS) is a serious concern among postmenopausal women which predisposes them to cardiovascular and cognitive disorders. Healthful diet and exercise training have been essential strategies to prevent the progress of MetS. The aim of this study was to evaluate the effect of supplementation with a native potential probiotic and high-intensity interval training (HIIT) for 8 weeks on retention of associative memory in rats with ovariectomy- induced metabolic syndrome. METHOD Thirty-two female ovariectomized Wistar rats were divided into four groups (n = 8/group): Control (OVX + Veh), exercise (OVX + Exe), probiotic (OVX + Pro), exercise with probiotic (OVX + Exe + Pro). One sham surgery group was included as a control group. Animals received 8 weeks interventions, and then were tested in a step through passive avoidance learning and memory paradigm, to assess long term memory. Then serum levels of adiponectin, insulin and glucose were measured by ELISA and colorimetry respectively. Data were analyzed by Kruskal-Wallis, Mann-Whitney and also One-way analysis of variance (ANOVA). RESULTS Eight weeks of HIIT and probiotic supplementation caused an increase in step through latency and shortening of total time spent in the dark compartment in OVX + Exe + Pro group compared with OVX + Veh group. Also significant increase in serum adiponectin levels, in parallel with a reduction in glucose, insulin and HOMA-IR were achieved by the group of OVX + Exe + Pro. CONCLUSION The present study indicates that HIIT combined with probiotics supplementation for 8 weeks effectively improves associative memory in MetS model of rats partly via improving insulin sensitivity and adiponectin level.
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Affiliation(s)
- Zeinab Bayat
- Department of exercise physiology, Faculty of Physical Education &sport sciences, The University of Guilan, Rasht, Iran
- Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Damirchi
- Department of exercise physiology, Faculty of Physical Education &sport sciences, The University of Guilan, Rasht, Iran
| | | | - Parvin Babaei
- Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
- Neuroscience Research center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
- Department of Physiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Calvo N, Einstein G. Steroid hormones: risk and resilience in women's Alzheimer disease. Front Aging Neurosci 2023; 15:1159435. [PMID: 37396653 PMCID: PMC10313425 DOI: 10.3389/fnagi.2023.1159435] [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: 02/05/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
More women have Alzheimer disease (AD) than men, but the reasons for this phenomenon are still unknown. Including women in clinical research and studying their biology is key to understand not just their increased risk but also their resilience against the disease. In this sense, women are more affected by AD than men, but their reserve or resilience mechanisms might delay symptom onset. The aim of this review was to explore what is known about mechanisms underlying women's risk and resilience in AD and identify emerging themes in this area that merit further research. We conducted a review of studies analyzing molecular mechanisms that may induce neuroplasticity in women, as well as cognitive and brain reserve. We also analyzed how the loss of steroid hormones in aging may be linked to AD. We included empirical studies with human and animal models, literature reviews as well as meta-analyses. Our search identified the importance of 17-b-estradiol (E2) as a mechanism driving cognitive and brain reserve in women. More broadly, our analysis revealed the following emerging perspectives: (1) the importance of steroid hormones and their effects on both neurons and glia for the study of risk and resilience in AD, (2) E2's crucial role in women's brain reserve, (3) women's verbal memory advantage as a cognitive reserve factor, and (4) E2's potential role in linguistic experiences such as multilingualism and hearing loss. Future directions for research include analyzing the reserve mechanisms of steroid hormones on neuronal and glial plasticity, as well as identifying the links between steroid hormone loss in aging and risk for AD.
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Affiliation(s)
- Noelia Calvo
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Women’s College Research Institute, Toronto, ON, Canada
- Centre for Life Course and Aging, University of Toronto, Toronto, ON, Canada
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Tremblay C, Choudhury P, Belden CM, Goldfarb D, Lorenzini I, Beach TG, Serrano GE. The role of sex differences in depression in pathologically defined Alzheimer's disease. Front Aging Neurosci 2023; 15:1156764. [PMID: 37234269 PMCID: PMC10206015 DOI: 10.3389/fnagi.2023.1156764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Sex differences in Alzheimer's disease (AD) may contribute to disease heterogeneity and affect prevalence, risk factors, disease trajectories and outcomes. Depression impacts a large number of patients with AD and has been reported to be more prevalent in women. We aimed to better understand the interaction between sex, depression and AD neuropathology, which could have implications for detection of symptoms, earlier diagnosis, therapeutic management, and enhanced quality of life. Methods We compared 338 cases with clinicopathologically confirmed AD (46% women) to 258 control cases (50% women), without dementia, parkinsonism or a significant pathological diagnosis. Depression was assessed both, using the Hamilton Depression Scale (HAM-D), and as being reported in their medical history combined with treatment with antidepressant medication. Results In the control group, women showed a higher depression severity, and a higher proportion of women were found to meet the cut-off score for depression on the HAM-D (32 vs. 16%) and having an history of depression (33 vs. 21%), while these sex differences were not observed in AD. Further, in both groups, female sex independently predicted the presence of depression, with covariates for age and cognitive status. AD subjects had higher mean HAM-D scores, were more likely to meet cutoff scores for depression (41 vs. 24%) and have a history of depression than controls (47 vs. 27%). When comparing the increase in frequency of depression in controls versus AD, the difference was significantly greater in men (AD men - control men: 24%) than in women (AD women - control women: 9%). Although subjects with depression were more likely to have higher levels of AD neuropathology, these differences were not observed when investigating the control or AD group separately. Discussion Control women had a higher likelihood and severity of depression than control men, but this sex difference was not noted when considering only those with pathologically defined AD, emphasizing the importance of considering sex in aging studies. AD was associated with higher rates of depression and men may be more likely to report or be diagnosed with depression once they develop AD indicating the importance of more frequent depression screenings in men.
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Affiliation(s)
- Cécilia Tremblay
- Department of Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, United States
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Vila-Castelar C, Udeh-Momoh C, Aggarwal NT, Mielke MM. Sex and gender considerations in dementia: a call for global research. NATURE AGING 2023; 3:463-465. [PMID: 37202511 PMCID: PMC10331726 DOI: 10.1038/s43587-023-00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Studies have identified sex and/or gender differences in Alzheimer’s disease, but few have examined other dementias. We highlight sex and gender differences in other dementias, discuss sociocultural factors and provide a framework for future global studies.
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Affiliation(s)
- Clara Vila-Castelar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chinedu Udeh-Momoh
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Global Brain Health Institute (GBHI), University of California, San Francisco, CA, USA
| | - Neelum T Aggarwal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Isik AT, Dost FS, Yavuz I, Ontan MS, Ates Bulut E, Kaya D. Orthostatic hypotension in dementia with Lewy bodies: a meta-analysis of prospective studies. Clin Auton Res 2023; 33:133-141. [PMID: 36862320 DOI: 10.1007/s10286-023-00933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Orthostatic hypotension (OH), one of the supportive clinical features in the diagnosis of dementia with Lewy bodies (DLB), is a significant problem in advanced age because of its severe negative consequences. The aim of this meta-analysis was to investigate the prevalence and risk of OH in patients with DLB. METHODS The indexes and databases cited to identify relevant studies were PubMed, ScienceDirect, Cochrane, and Web of Science. The keywords for the search were "Lewy body dementia" and "autonomic dysfunction" or "dysautonomia" or "postural hypotension" or "orthostatic hypotension." English-language articles published from January 1990 to April 2022 were searched. The Newcastle-Ottawa scale was applied to evaluate the quality of the studies. Odds ratios (OR) and risk ratios (RR) were extracted with 95% confidence intervals (CI) and combined using the random effects model after logarithmic transformation. The prevalence in the patients with DLB was also combined using the random effects model. RESULTS Eighteen studies (10 case controls and 8 case series) were included to evaluate the prevalence of OH in patients with DLB. Higher rates of OH were found to be associated with DLB (OR 7.71, 95% CI 4.42, 13.44; p < 0.001), and 50.8% of 662 patients had OH. CONCLUSION DLB increased the risk of OH by 3.62- to 7.71-fold compared to healthy controls. Therefore, it will be useful to evaluate postural blood pressure changes in the follow-up and treatment of patients with DLB.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey.
| | - Fatma Sena Dost
- Department of Geriatric Medicine, Darica State Hospital, Kocaeli, Turkey
| | - Idil Yavuz
- Department of Statistics, Faculty of Science, Dokuz Eylul University, Izmir, Turkey
| | - Mehmet Selman Ontan
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Adana State Hospital, Adana, Turkey
| | - Derya Kaya
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
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Caminiti SP, Boccalini C, Nicastro N, Garibotto V, Perani D. Sex differences in brain metabolic connectivity architecture in probable dementia with Lewy bodies. Neurobiol Aging 2023; 126:14-24. [PMID: 36905876 DOI: 10.1016/j.neurobiolaging.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
We investigated how sex modulates metabolic connectivity alterations in probable dementia with Lewy bodies (pDLB). We included 131 pDLB patients (males/females: 58/73) and similarly aged healthy controls (HC) (male/female: 59/75) with available (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans. We assessed (1) sex differences in the whole-brain connectivity, identifying pathological hubs, (2) connectivity alterations in functional pathways of the neurotransmitter systems, (3) Resting State Networks (RSNs) integrity. Both pDLBM (males) and pDLBF (females) shared dysfunctional hubs in the insula, Rolandic operculum, and inferior parietal lobule, but the pDLBM group showed more severe and diffuse whole-brain connectivity alterations. Neurotransmitters connectivity analysis revealed common alterations in dopaminergic and noradrenergic pathways. Sex differences emerged particularly in the Ch4-perisylvian division, with pDLBM showing more severe alterations than pDLBF. The RSNs analysis showed no sex differences, with decreased connectivity strength in the primary visual, posterior default mode, and attention networks in both groups. Extensive connectivity changes characterize both males and females in the dementia stage, with a major vulnerability of cholinergic neurotransmitter systems in males, possibly contributing to the observed different clinical phenotypes.
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Affiliation(s)
- Silvia Paola Caminiti
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cecilia Boccalini
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Nicastro
- Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland; Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - Daniela Perani
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Chiu SY, Wyman-Chick KA, Ferman TJ, Bayram E, Holden SK, Choudhury P, Armstrong MJ. Sex differences in dementia with Lewy bodies: Focused review of available evidence and future directions. Parkinsonism Relat Disord 2023; 107:105285. [PMID: 36682958 PMCID: PMC10024862 DOI: 10.1016/j.parkreldis.2023.105285] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/07/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
In this review, we summarize the current knowledge on sex differences in dementia with Lewy bodies (DLB) relating to epidemiology, clinical features, neuropathology, biomarkers, disease progression, and caregiving. While many studies show a higher DLB prevalence in men, this finding is inconsistent and varies by study approach. Visual hallucinations may be more common and occur earlier in women with DLB, whereas REM sleep behavior disorder may be more common and occur earlier in men. Several studies report a higher frequency of parkinsonism in men with DLB, while the frequency of fluctuations appears similar between sexes. Women tend to be older, have greater cognitive impairment at their initial visit, and are delayed in meeting DLB criteria compared to men. Women are also more likely to have Lewy body disease with co-existing AD-related pathology than so-called "pure" Lewy body disease, while men may present with either. Research is mixed regarding the impact of sex on DLB progression. Biomarker and treatment research assessing for sex differences is lacking. Women provide the majority of caregiving in DLB but how this affects the caregiving experience is uncertain. Gaining a better understanding of sex differences will be instrumental in aiding future development of sex-specific strategies in DLB for early diagnosis, care, and drug development.
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Affiliation(s)
- Shannon Y Chiu
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, FL, USA.
| | - Kathryn A Wyman-Chick
- Center for Memory and Aging, Department of Neurology, HealthPartners, Saint Paul, MN, USA
| | - Tanis J Ferman
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Parichita Choudhury
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA; Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, FL, USA
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Ichimata S, Kim A, Nishida N, Kovacs GG. Lack of difference between amyloid-beta burden at gyral crests and sulcal depths in diverse neurodegenerative diseases. Neuropathol Appl Neurobiol 2023; 49:e12869. [PMID: 36527296 DOI: 10.1111/nan.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
AIMS The aim of this study is to clarify whether there is a difference in amyloid-beta burden between gyral crests (GCs) and sulcal depths (SDs) in different neurodegenerative proteinopathies. METHODS We analysed the burden and distribution of amyloid-beta deposition in post-mortem brain samples from 138 autopsies, including Alzheimer's disease (n = 30), Down's syndrome (n = 11), Lewy body disease (LBD; n = 53), multiple system atrophy (n = 8) and progressive supranuclear palsy (n = 36). We applied quantitative amyloid-beta burden analysis to compare amyloid-beta deposition in both GCs and SDs. We also evaluated the prevalence of amyloid-beta plaques in both regions in samples exhibiting high or low amounts of amyloid-beta pathology. RESULTS Amyloid-beta burden was evaluated in 67 and 84 samples of the frontal and temporal cortices, respectively. We did not find significant differences in the amyloid-beta burden between GCs and SDs in these regions in any examined disease. In addition, amyloid-beta plaques were almost evenly distributed in both regions in cases with low amounts of amyloid-beta pathology. Females in the LBD group showed significantly higher amyloid-beta burden than males (temporal cortex, p < 0.01). Furthermore, only one LBD case showed SD-predominant deposition associated with the coarse-grained plaques. CONCLUSIONS We have shown that amyloid-beta is almost evenly distributed in both GCs and SDs in the frontal and temporal lobes from the early stage, in diverse neurodegenerative diseases. Sex may contribute to differences in the amyloid-beta burden. The coarse-grained plaque may show SD-predominant neuritic tau deposition that must be carefully distinguished from chronic traumatic encephalopathy-related SD tau pathology.
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Affiliation(s)
- Shojiro Ichimata
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Ain Kim
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.,Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, ON, Canada
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Glebov OO, Williamson D, Owen DM, Hortobágyi T, Troakes C, Aarsland D. Structural synaptic signatures of Alzheimer's disease and dementia with Lewy bodies in the male brain. Neuropathol Appl Neurobiol 2023; 49:e12852. [PMID: 36181001 PMCID: PMC10092423 DOI: 10.1111/nan.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Oleg O Glebov
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, Shandong, China.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Williamson
- Randall Centre for Cell and Molecular Biophysics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Dylan M Owen
- Institute of Immunology and Immunotherapy, School of Mathematics and Centre of Membrane Proteins and Receptors (COMPARE), University of Birmingham, Birmingham, UK
| | - Tibor Hortobágyi
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ELKH-DE Cerebrovascular and Neurodegenerative Research Group and Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
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22
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Habich A, Oltra J, Schwarz CG, Przybelski SA, Oppedal K, Inguanzo A, Blanc F, Lemstra AW, Hort J, Westman E, Lowe VJ, Boeve BF, Dierks T, Aarsland D, Kantarci K, Ferreira D. Sex differences in grey matter networks in dementia with Lewy bodies. RESEARCH SQUARE 2023:rs.3.rs-2519935. [PMID: 36778448 PMCID: PMC9915801 DOI: 10.21203/rs.3.rs-2519935/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives Sex differences permeate many aspects of dementia with Lewy bodies (DLB), including epidemiology, pathogenesis, disease progression, and symptom manifestation. However, less is known about potential sex differences in patterns of neurodegeneration in DLB. Here, we test whether grey matter networks also differ between female and male DLB patients. To assess the specificity of these sex differences to DLB, we additionally investigate sex differences in healthy controls (HCs). Methods A total of 119 (68.7 ± 8.4 years) male and 45 female (69.9 ± 9.1 years) DLB patients from three European centres and the Mayo Clinic were included in this study. Additionally, we included 119 male and 45 female age-matched HCs from the Mayo Clinic. Grey matter volumes of 58 cortical, subcortical, cerebellar, and pontine brain regions derived from structural magnetic resonance images were corrected for age, intracranial volume, and centre. Sex-specific grey matter networks for DLB patients and HCs were constructed by correlating each pair of brain regions. Network properties of the correlation matrices were compared between sexes and groups. Additional analyses were conducted on W-scored data to identify DLB-specific findings. Results Networks of male HCs and male DLB patients were characterised by a lower nodal strength compared to their respective female counterparts. In comparison to female HCs, the grey matter networks of male HCs showed a higher global efficiency, modularity, and a lower number of modules. None of the global and nodal network measures showed significant sex differences in DLB. Conclusions The disappearance of sex differences in the structural grey matter networks of DLB patients compared to HCs may indicate a sex-dependent network vulnerability to the alpha-synuclein pathology in DLB. Future studies might investigate whether the differences in structural network measures are associated with differences in cognitive scores and clinical symptoms between the sexes.
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Affiliation(s)
- Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Javier Oltra
- Medical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | | | | | - Ketil Oppedal
- Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Anna Inguanzo
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Frédéric Blanc
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Afina W Lemstra
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Jakub Hort
- Motol University Hospital, Prague, Czech Republic
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, USA
| | | | - Thomas Dierks
- University Hospital of Psychiatry and Psychotherapy Bern, University of Bern, Bern, Switzerland
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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23
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Oltra J, Habich A, Schwarz CG, Nedelska Z, Przybelski SA, Inguanzo A, Diaz-Galvan P, Lowe VJ, Oppedal K, Blanc F, Lemstra AW, Hort J, Padovani A, Rektorova I, Bonanni L, Massa F, Kramberge MG, Taylor JP, Snædal J, Walker Z, Antonini A, Segura B, Junque C, Westman E, Boeve BF, Aarsland D, Kantarci K, Ferreira D. Sex differences in brain atrophy in dementia with Lewy bodies. RESEARCH SQUARE 2023:rs.3.rs-2516427. [PMID: 36747755 PMCID: PMC9901042 DOI: 10.21203/rs.3.rs-2516427/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background and objectives Sex is an important contributing factor to neuroimaging phenotypes in brain disorders. However, little is known about the contribution of sex differences to the neurodegeneration in dementia with Lewy bodies (DLB). We investigated sex differences in probable DLB patients by using both visual rating scales of lobar atrophy and automated estimations of regional atrophy. Methods We included 442 probable DLB patients from the European-DLB consortium and the Mayo Clinic who have magnetic resonance imaging (MRI) data available. We assessed sex differences and the sex-by-age interaction in two largely independent samples through visual rating scales of lobar atrophy (n = 333; mean age 73 ± 8 years, 62% males) and automated regional estimations of gray matter (GM) volume and mean cortical thickness (CTh) (n = 165; mean age 69 ± 9 years, 72% males). We used binary logistic regression and ANOVA for statistical analysis. Results We found a statistically significantly higher likelihood of frontal atrophy measured by the global cortical atrophy-frontal subscale (GCA-F) in males (40% of males had an abnormal GCA-F score versus 29% of females, P-value = 0.006). Using automated estimations, we found smaller GM volumes in 6 cortical regions in males compared with females, as well as smaller GM volume in the entorhinal cortex and thinner olfactory cortices in females, compared with males. The sex-by-age interaction showed statistically significant results in 6 cortical volumes and 7 mean CTh estimations (P-value ≤ 0.05), accentuated in the right middle frontal gyrus (FDR-adjusted P-value = 0.047). These cross-sectional interactions indicated that while females have statistically significantly less atrophy than males at younger ages, differences become non-significant at older ages, with females showing the same level of atrophy than males around the age of 75. Conclusions This study demonstrates sex differences on brain atrophy in probable DLB. While male DLB patients have a more widespread pattern of cortical atrophy at younger ages, these sex differences tend to disappear with increasing age. Longitudinal studies will help establish these cross-sectional findings and inform on sex and age considerations to the use of MRI in clinical routine, as the field moves towards precision medicine.
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24
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Weigand AJ, Hamlin AM, Breton J, Clark AL. Cerebral blood flow, tau imaging, and memory associations in cognitively unimpaired older adults. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100153. [PMID: 36353072 PMCID: PMC9637859 DOI: 10.1016/j.cccb.2022.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Objective Cerebral blood flow (CBF) has been independently linked to cognitive impairment and traditional Alzheimer's disease (AD) pathology (e.g., amyloid-beta [Aβ], tau) in older adults. However, less is known about the possible interactive effects of CBF, Aβ, and tau on memory performance. The present study examined whether CBF moderates the effect of Aβ and tau on objective and subjective memory within cognitively unimpaired (CU) older adults. Methods Participants included 54 predominately white CU older adults from the Alzheimer's Disease Neuroimaging Initiative. Multiple linear regression models examined meta-temporal CBF associations with (1) meta-temporal tau PET adjusting for cortical Aβ PET and (2) and cortical Aβ PET adjusting for tau PET. The CBF and tau meta region was an average of 5 distinct temporal lobe regions. CBF interactions with Aβ or tau PET on memory performance were also examined. Covariates for all models included age, sex, education, pulse pressure, APOE-ε4 positivity, and imaging acquisition date differences. Results CBF was significantly negatively associated with tau PET (t = -2.16, p = .04) but not Aβ PET (t = 0.98, p = .33). Results revealed a CBF by tau PET interaction such that there was a stronger effect of tau PET on objective (t = 2.51, p = .02) and subjective (t = -2.67, p = .01) memory outcomes among individuals with lower levels of CBF. Conclusions Cerebrovascular and tau pathologies may interact to influence cognitive performance. This study highlights the need for future vascular risk interventions, which could offer a scalable and cost-effective method for AD prevention.
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Affiliation(s)
- Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States
| | - Abbey M. Hamlin
- Department of Psychology, College of Liberal Arts, University of Texas at Austin, 108 East Dean Keeton, SEA 3.234, Austin, TX 78712, United States
| | - Jordana Breton
- Department of Psychology, College of Liberal Arts, University of Texas at Austin, 108 East Dean Keeton, SEA 3.234, Austin, TX 78712, United States
| | - Alexandra L. Clark
- Department of Psychology, College of Liberal Arts, University of Texas at Austin, 108 East Dean Keeton, SEA 3.234, Austin, TX 78712, United States
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25
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Gan J, Chen Z, Shi Z, Li X, Liu S, Liu Y, Zhu H, Shen L, Zhang G, You Y, Guo Q, Zhang N, Lv Y, Gang B, Yuan J, Ji Y. Sex differences in clinical cognitive impairment with Lewy bodies: a Chinese multicenter study. Biol Sex Differ 2022; 13:55. [PMID: 36183142 PMCID: PMC9526942 DOI: 10.1186/s13293-022-00464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background Research on sex ratios of Lewy body dementia is controversial, established in small samples, and rarely focused on prodromal stage. The objective is to investigate the clinical sex ratios (men/women) and their associations with clinical features among individuals with mild cognitive impairment with Lewy bodies (MCI-LB), dementia with Lewy bodies (DLB), Parkinson’s disease with mild cognitive impairment (PD-MCI), and Parkinson’s disease with dementia (PDD) in China. Methods We conducted a multicenter cohort study, including 1038 individuals with probable MCI-LB, DLB, PD-MCI, or PDD diagnosis from 22 memory clinics in China from January 2018 to March 2022, and recorded their demographic and clinical data by reviewing medical records. Descriptive and regression analyses were used to calculate the sex ratio (men/women), and its associations with demographic and clinical data. Results In this study, men comprised 35.14% (men/women sex ratio = 0.54) for MCI-LB, 46.72% (men/women sex ratio = 0.88) for DLB, 63.56% (men/women sex ratio = 1.74) for PD-MCI, and 52.40% (men/women sex ratio = 1.10) for PDD. Sex ratios roughly increased with age. Men had more parkinsonism (p = 0.000) and less fluctuating cognition (p = 0.024) in MCI-LB, and those with PD-MCI had more RBD (p = 0.001). Women with PD-MCI had lower MMSE scores (β ± standard error = − 1.24 ± 0.58, p = 0.04), more irritability (0.95 ± 0.46, p = 0.04) and fluctuating cognition (− 3.41 ± 1.31, p = 0.01), and less parkinsonism (− 2.10 ± 0.97, p = 0.03) than men after adjusting for demographic and cardiometabolic conditions. Conclusion There were more women in DLB and MCI-LB, and more men in PD-MCI and PDD. The sex distribution, demographic, and clinical characteristics differed, which strengthened the independence and heterogeneity of the four diseases, and indicated sex-sensitive strategies for management of dementia necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-022-00464-w. There are significant sex differences in Chinese population with cognitive impairment in Lewy body disease. Women were more common in dementia with Lewy bodies and mild cognitive impairment with Lewy bodies cases, had more frequent and severe neuropsychiatric symptoms, and poorer cognition than men. Men predominant in Parkinson’s disease with mild cognitive impairment and Parkinson’s disease with dementia cases, and performed more frequent RBD and parkinsonism than women. Dementia with Lewy bodies vs. Parkinson’s disease with dementia, and mild cognitive impairment with Lewy bodies vs. Parkinson’s disease with mild cognitive impairment are distinct disease forms and should not be confused.
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Affiliation(s)
- Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China
| | - Zhichao Chen
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan, Tianjin, 300350, China
| | - Xudong Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan, Tianjin, 300350, China
| | - Yiming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Shandong, China
| | - Hongcan Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, China
| | - Guili Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China
| | - Yong You
- Department of Neurology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Lv
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Baozhi Gang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junliang Yuan
- Department of Neurology, Peking University Sixth Hospital, Beijing, China
| | - Yong Ji
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 Nansihuan Xilu, Fengtai, Beijing, 100070, China. .,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, 6 Jizhao Road, Jinnan, Tianjin, 300350, China.
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Shaaban CE, Tudorascu DL, Glymour MM, Cohen AD, Thurston RC, Snyder HM, Hohman TJ, Mukherjee S, Yu L, Snitz BE. A guide for researchers seeking training in retrospective data harmonization for population neuroscience studies of Alzheimer's disease and related dementias. FRONTIERS IN NEUROIMAGING 2022; 1:978350. [PMID: 37464990 PMCID: PMC10353763 DOI: 10.3389/fnimg.2022.978350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Due to needs surrounding rigor and reproducibility, subgroup specific disease knowledge, and questions of external validity, data harmonization is an essential tool in population neuroscience of Alzheimer's disease and related dementias (ADRD). Systematic harmonization of data elements is necessary to pool information from heterogeneous samples, and such pooling allows more expansive evaluations of health disparities, more precise effect estimates, and more opportunities to discover effective prevention or treatment strategies. The key goal of this Tutorial in Population Neuroimaging Curriculum, Instruction, and Pedagogy article is to guide researchers in creating a customized population neuroscience of ADRD harmonization training plan to fit their needs or those of their mentees. We provide brief guidance for retrospective data harmonization of multiple data types in this area, including: (1) clinical and demographic, (2) neuropsychological, and (3) neuroimaging data. Core competencies and skills are reviewed, and resources are provided to fill gaps in training as well as data needs. We close with an example study in which harmonization is a critical tool. While several aspects of this tutorial focus specifically on ADRD, the concepts and resources are likely to benefit population neuroscientists working in a range of research areas.
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Affiliation(s)
- C. Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dana L. Tudorascu
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ann D. Cohen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca C. Thurston
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heather M. Snyder
- Medical and Scientific Relations, Alzheimer’s Association, Chicago, IL, United States
| | - Timothy J. Hohman
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Lan Yu
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Beth E. Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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27
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Asken BM, Tanner JA, VandeVrede L, Casaletto KB, Staffaroni AM, Mundada N, Fonseca C, Iaccarino L, La Joie R, Tsuei T, Mladinov M, Grant H, Shankar R, Wang KKW, Xu H, Cobigo Y, Rosen H, Gardner RC, Perry DC, Miller BL, Spina S, Seeley WW, Kramer JH, Grinberg LT, Rabinovici GD. Multi-Modal Biomarkers of Repetitive Head Impacts and Traumatic Encephalopathy Syndrome: A Clinicopathological Case Series. J Neurotrauma 2022; 39:1195-1213. [PMID: 35481808 PMCID: PMC9422800 DOI: 10.1089/neu.2022.0060] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Traumatic encephalopathy syndrome (TES) criteria were developed to aid diagnosis of chronic traumatic encephalopathy (CTE) pathology during life. Interpreting clinical and biomarker findings in patients with TES during life necessitates autopsy-based determination of the neuropathological profile. We report a clinicopathological series of nine patients with previous repetitive head impacts (RHI) classified retrospectively using the recent TES research framework (100% male and white/Caucasian, age at death 49-84) who completed antemortem neuropsychological evaluations, T1-weighted magnetic resonance imaging, diffusion tensor imaging (n = 6), (18)F-fluorodeoxyglucose-positron emission tomography (n = 5), and plasma measurement of neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and total tau (n = 8). Autopsies were performed on all patients. Cognitively, low test scores and longitudinal decline were relatively consistent for memory and executive function. Medial temporal lobe atrophy was observed in all nine patients. Poor white matter integrity was consistently found in the fornix. Glucose hypometabolism was most common in the medial temporal lobe and thalamus. Most patients had elevated plasma GFAP, NfL, and total tau at their initial visit and a subset showed longitudinally increasing concentrations. Neuropathologically, five of the nine patients had CTE pathology (n = 4 "High CTE"/McKee Stage III-IV, n = 1 "Low CTE"/McKee Stage I). Primary neuropathological diagnoses (i.e., the disease considered most responsible for observed symptoms) were frontotemporal lobar degeneration (n = 2 FTLD-TDP, n = 1 FTLD-tau), Alzheimer disease (n = 3), CTE (n = 2), and primary age-related tauopathy (n = 1). In addition, hippocampal sclerosis was a common neuropathological comorbidity (n = 5) and associated with limbic-predominant TDP-43 proteinopathy (n = 4) or FTLD-TDP (n = 1). Memory and executive function decline, limbic system brain changes (atrophy, decreased white matter integrity, hypometabolism), and plasma biomarker alterations are common in RHI and TES but may reflect multiple neuropathologies. In particular, the neuropathological differential for patients with RHI or TES presenting with medial temporal atrophy and memory loss should include limbic TDP-43. Researchers and clinicians should be cautious in attributing cognitive, neuroimaging, or other biomarker changes solely to CTE tau pathology based on previous RHI or a TES diagnosis alone.
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Affiliation(s)
- Breton M. Asken
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy A. Tanner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Lawren VandeVrede
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kaitlin B. Casaletto
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Nidhi Mundada
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Corrina Fonseca
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Torie Tsuei
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Miho Mladinov
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Harli Grant
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Ranjani Shankar
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kevin K. W. Wang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, Neuroscience, Psychiatry and Chemistry, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Haiyan Xu
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, Neuroscience, Psychiatry and Chemistry, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Raquel C. Gardner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - David C. Perry
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Lea T. Grinberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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28
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Bayram E, Coughlin DG, Litvan I. Sex Differences for Clinical Correlates of Alzheimer's Pathology in People with Lewy Body Pathology. Mov Disord 2022; 37:1505-1515. [PMID: 35531707 PMCID: PMC9308759 DOI: 10.1002/mds.29044] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Lewy body (LB) dementias have limited clinical diagnostic accuracy because of frequent copathologies contributing to clinical heterogeneity. Although sex differences in clinical prevalence and frequency of pure LB pathology were shown, differences for clinicopathological correlations are less known. OBJECTIVE The aim of this study was to determine sex differences for clinical associations of Alzheimer's disease (AD) copathology in those with LB pathology. METHODS Data were from National Alzheimer's Coordinating Center for 223 women and 468 men with limbic or neocortical LB, separated into two groups as those with high likelihood and low/intermediate likelihood for LB clinical phenotype based on pathology. Clinical associations of sex and interaction of sex and pathology for the clinical phenotype were analyzed. RESULTS More severe AD copathology was associated with worse cognitive decline and lower likelihood of LB disease clinical phenotype. Women with more severe AD copathology and tau had worse cognitive decline and higher likelihood of AD clinical phenotype than men. Men with more severe AD copathology had lower likelihood of LB clinical phenotype than women. Interaction of sex and pathology was more pronounced in those aged between 70 and 80 years. CONCLUSIONS AD copathology reduces the likelihood of LB clinical phenotype for both women and men; however, men may be at higher risk for LB disease underdiagnosis and women at higher risk for dementia. The use of both LB and AD biomarkers, even when LB or AD pathology is not clinically expected, is necessary for the accurate clinical diagnosis of both LB diseases and AD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego
| | - David G. Coughlin
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego
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Abdelnour C, Ferreira D, van de Beek M, Cedres N, Oppedal K, Cavallin L, Blanc F, Bousiges O, Wahlund LO, Pilotto A, Padovani A, Boada M, Pagonabarraga J, Kulisevsky J, Aarsland D, Lemstra AW, Westman E. Parsing heterogeneity within dementia with Lewy bodies using clustering of biological, clinical, and demographic data. Alzheimers Res Ther 2022; 14:14. [PMID: 35063023 PMCID: PMC8783432 DOI: 10.1186/s13195-021-00946-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) includes various core clinical features that result in different phenotypes. In addition, Alzheimer's disease (AD) and cerebrovascular pathologies are common in DLB. All this increases the heterogeneity within DLB and hampers clinical diagnosis. We addressed this heterogeneity by investigating subgroups of patients with similar biological, clinical, and demographic features. METHODS We studied 107 extensively phenotyped DLB patients from the European DLB consortium. Factorial analysis of mixed data (FAMD) was used to identify dimensions in the data, based on sex, age, years of education, disease duration, Mini-Mental State Examination (MMSE), cerebrospinal fluid (CSF) levels of AD biomarkers, core features of DLB, and regional brain atrophy. Subsequently, hierarchical clustering analysis was used to subgroup individuals based on the FAMD dimensions. RESULTS We identified 3 dimensions using FAMD that explained 38% of the variance. Subsequent hierarchical clustering identified 4 clusters. Cluster 1 was characterized by amyloid-β and cerebrovascular pathologies, medial temporal atrophy, and cognitive fluctuations. Cluster 2 had posterior atrophy and showed the lowest frequency of visual hallucinations and cognitive fluctuations and the worst cognitive performance. Cluster 3 had the highest frequency of tau pathology, showed posterior atrophy, and had a low frequency of parkinsonism. Cluster 4 had virtually normal AD biomarkers, the least regional brain atrophy and cerebrovascular pathology, and the highest MMSE scores. CONCLUSIONS This study demonstrates that there are subgroups of DLB patients with different biological, clinical, and demographic characteristics. These findings may have implications in the diagnosis and prognosis of DLB, as well as in the treatment response in clinical trials.
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Affiliation(s)
- Carla Abdelnour
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
- Department of Medicine of the Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marleen van de Beek
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nira Cedres
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Sensory Cognitive Interaction Laboratory (SCI-lab), Stockholm University, Stockholm, Sweden
| | - Ketil Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Lena Cavallin
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology Karolinska University Hospital, Stockholm, Sweden
| | - Frédéric Blanc
- Service, Memory Resources and Research Centre, University Hospital of Strasbourg, Strasbourg, France
- Team IMIS/Neurocrypto, French National Center for Scientific Research, ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Strasbourg, France
| | - Olivier Bousiges
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Strasbourg, France
- Laboratory of Biochemistry and Molecular Biology, CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives, UMR7364, University Hospital of Strasbourg, Strasbourg, France
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mercè Boada
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute (IIB-Sant Pau), Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau. Biomedical Research Institute (IIB-Sant Pau), Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eric Westman
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Suanrueang P, Peltzer K, Suen MW, Lin HF, Er TK. Trends and Gender Differences in Mental Disorders in Hospitalized Patients in Thailand. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221092827. [PMID: 35420043 PMCID: PMC9019317 DOI: 10.1177/00469580221092827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous studies have shown that gender differences play a substantial role in the influence of mental disorders. This study was designed to investigate gender differences in mental disorders by presenting odd ratio (OR) trends and cumulative effects over a period of 13 years in Thailand. This observational study used hospital data from the Ministry of Public Health on selected patients admitted to inpatient departments in public hospitals with mental disorders, according to ICD-10 cause groups from 2007 to 2019, counting from more than 1,90,000 cases in 2007 to more than 4,00,000 cases in 2019. Data were collected from the Thailand Ministry of Public Health website. The results indicate that compared to women, men were positively related to five mental disorders revealed by the OR and the ratio per 100,000 population (mean and SD): psychoactive alcohol use (OR = 7.31-9.07, 271.19 (59.26)), substance abuse (OR = 5.06-7.82, 59.25 (33.71)), schizophrenia (OR = 1.64-1.93, 108.32 (19.62)), mental retardation (OR = 1.15-1.58, 10.64 (1.88)), and other mental and behavioral disorders (OR = 1.10-1.55, 70.67 (22.75)). Three mental disorders in men were found to be negatively related: neurotic and related disorders (OR=.34-.46, 27.98 (3.26)), mood (affective) disorders (OR = .44-.56, 31.91 (9.59)), and dementia (OR = .78-10.82, 13.75 (2.73)). Gender can become a key biological element that contributes to the dissimilarity of mental illness. Preventive care for men and women should, therefore, be prioritized for health conditions separately. More specifically, screening and detection, and providing appropriate intervention.
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Affiliation(s)
- Passakorn Suanrueang
- Department of Healthcare Administration Specialty in Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Hsiao-Fang Lin
- Department and Graduate Institute of Early Childhood Development and Education, Chaoyang University of Technology, Taichung, Taiwan
| | - Tze-Kiong Er
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
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31
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Choudhury P, Graff-Radford J, Aakre JA, Wurtz L, Knopman DS, Graff-Radford NR, Kantarci K, Forsberg LK, Fields JA, Pedraza O, Chen Q, Miyagawa T, Day GS, Tipton P, Savica R, Botha H, Lachner C, Dredla B, Reichard RR, Petersen RC, Dickson DW, Boeve BF, Ferman TJ. The temporal onset of the core features in dementia with Lewy bodies. Alzheimers Dement 2021; 18:591-601. [PMID: 34761850 PMCID: PMC8986606 DOI: 10.1002/alz.12411] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
Introduction We examined the temporal sequence of the core features in probable dementia with Lewy bodies (DLB). Methods In 488 patients with probable DLB, the onset of each core feature and time to diagnosis was determined for men and women, and a pathologic subgroup (n = 209). Results REM sleep behavior disorder (RBD) developed before the other core features in men and women. Men were more likely to have RBD and were diagnosed with probable DLB earlier than women. Visual hallucinations developed after the other core features in men, but in women, they appeared earlier and concurrently with fluctuations and parkinsonism. Women were older and more cognitively impaired at first visit, were less likely to have RBD, more likely to be diagnosed with probable DLB later than men, and more likely to have neocortical tangles. Discussion An earlier latency to probable DLB was associated with men, RBD, and Lewy body disease without neocortical tangles.
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Affiliation(s)
| | | | - Jeremiah A Aakre
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Lincoln Wurtz
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leah K Forsberg
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Otto Pedraza
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Qin Chen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, West China Hospital of Sichuan University, Sichuan, China
| | - Toji Miyagawa
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Philip Tipton
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christian Lachner
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Brynn Dredla
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
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Agrawal S, Yu L, Nag S, Arfanakis K, Barnes LL, Bennett DA, Schneider JA. The association of Lewy bodies with limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes and their role in cognition and Alzheimer's dementia in older persons. Acta Neuropathol Commun 2021; 9:156. [PMID: 34563269 PMCID: PMC8466680 DOI: 10.1186/s40478-021-01260-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
Lewy bodies (LBs) and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) are common in older persons and associated with cognitive impairment. However, little is known about the relationship between LBs and LATE-NC and their combined roles in cognitive impairment and Alzheimer's dementia in community-dwelling participants. The study included 1670 community-based participants (mean age-at-death, 89.5 years (SD = 6.65); 69% females) who underwent annual assessments of cognition to create summary measures of global cognition and cognitive domains and evaluation for Alzheimer's dementia. Systematic neuropathologic evaluations were performed to assess LBs, LATE-NC, and Alzheimer's disease (AD) pathology. We excluded cases with pathologically confirmed frontotemporal lobar degeneration in this study. Logistic and linear regression analyses were used, adjusted for demographics and AD pathology. LBs were present in 428 (25.6%) decedents (29 nigra-predominant, 165 limbic-type, and 234 neocortical-type) while 865 (51.7%) decedents exhibited LATE-NC (307 stage 1, 167 stage 2, and 391 stage 3). LBs combined with LATE-NC were common (15% of all participants) and in those with Alzheimer's dementia (25%). Neocortical-type, but not nigral-predominant or limbic-type LBs increased the odds of stage 2/3 LATE-NC (odds ratio = 1.70; 95% confidence interval = 1.26-2.30). The association between neocortical-type LBs and stage 2/3 LATE-NC was stronger in those under 90 years of age and in women. In analyses of cognition and Alzheimer's dementia, LATE-NC and neocortical-type LBs, separately, were related to lower global cognition, five specific cognitive domains, and an increased odds of Alzheimer's dementia, above and beyond the AD pathology. Limbic-type LBs were related to lower global cognition, and the domains of episodic, working, and semantic memory, and increased odds of Alzheimer's dementia. Furthermore, there was no interaction between limbic/neocortical-type LBs and LATE-NC on cognitive function, cognitive domains, or Alzheimer's dementia. These findings suggest that neocortical-type LBs are associated with LATE-NC, specifically in the younger old and in women. Limbic/neocortical-type LBs and LATE-NC have separate and additive effects on cognitive function and odds of Alzheimer's dementia.
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Affiliation(s)
- Sonal Agrawal
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA.
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sukriti Nag
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W. Harrison street, Suite 1000, Chicago, IL, 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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33
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Luckey AM, Robertson IH, Lawlor B, Mohan A, Vanneste S. Sex Differences in Locus Coeruleus: A Heuristic Approach That May Explain the Increased Risk of Alzheimer's Disease in Females. J Alzheimers Dis 2021; 83:505-522. [PMID: 34334399 DOI: 10.3233/jad-210404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article aims to reevaluate our approach to female vulnerability to Alzheimer's disease (AD) and put forth a new hypothesis considering how sex differences in the locus coeruleus-noradrenaline (LC-NA) structure and function could account for why females are more likely to develop AD. We specifically focus our attention on locus coeruleus (LC) morphology, the paucity of estrogens, neuroinflammation, blood-brain barrier permeability, apolipoprotein ɛ4 polymorphism (APOEɛ4), and cognitive reserve. The role of the LC-NA system and sex differences are two of the most rapidly emerging topics in AD research. Current literature either investigates the LC due to it being one of the first brain areas to develop AD pathology or acknowledges the neuroprotective effects of estrogens and how the loss of these female hormones have the capacity to contribute to the sex differences seen in AD; however, existing research has neglected to concurrently examine these two rationales and therefore leaving our hypothesis undetermined. Collectively, this article should assist in alleviating current challenges surrounding female AD by providing thought-provoking connections into the interrelationship between the disruption of the female LC-NA system, the decline of estrogens, and AD vulnerability. It is therefore likely that treatment for this heterogeneous disease may need to be distinctly developed for females and males separately, and may require a precision medicine approach.
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Affiliation(s)
- Alison M Luckey
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Ian H Robertson
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Anusha Mohan
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sven Vanneste
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland
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Bayram E, Coughlin DG, Banks SJ, Litvan I. Sex differences for phenotype in pathologically defined dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2021; 92:745-750. [PMID: 33563809 PMCID: PMC8530264 DOI: 10.1136/jnnp-2020-325668] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/14/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Sex differences in dementia with Lewy bodies (DLB) have been reported in clinically defined cohorts; however, clinical diagnostic accuracy in DLB is suboptimal and phenotypic differences have not been assessed in pathologically confirmed participants. METHODS Core DLB features were compared across 55 women and 156 men with pathologically defined DLB in the National Alzheimer's Coordinating Center. These analyses were repeated for 55 women and 55 men matched for age, education and tau burden. RESULTS In the total sample, women died older, had fewer years of education, had higher tau burden but were less likely to be diagnosed with dementia and clinical DLB. In the matched sample, visual hallucinations continued to be less common in women, and fewer women met clinical DLB criteria. DISCUSSION Sex impacts clinical manifestations of underlying pathologies in DLB. Despite similar underlying Lewy body pathology, women are less likely to manifest core DLB features and may be clinically underdiagnosed.
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Affiliation(s)
- Ece Bayram
- Neurosciences, University of California San Diego, La Jolla, California, USA
| | - David G Coughlin
- Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Sarah J Banks
- Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Irene Litvan
- Neurosciences, University of California San Diego, La Jolla, California, USA
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35
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Mielke MM. Consideration of Sex Differences in the Measurement and Interpretation of Alzheimer Disease-Related Biofluid-Based Biomarkers. J Appl Lab Med 2021; 5:158-169. [PMID: 31811073 DOI: 10.1373/jalm.2019.030023] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The development of cerebrospinal fluid and blood-based biomarkers for Alzheimer disease (AD) and related disorders is rapidly progressing. Such biomarkers may be used clinically to screen the population, to enhance diagnosis, or to help determine prognosis. Although the use of precision medicine methods has contributed to enhanced understanding of the AD pathophysiological changes and development of assays, one aspect not commonly considered is sex differences. CONTENT There are several ways in which sex can affect the concentration or interpretation of biofluid biomarkers. For some markers, concentrations will vary by sex. For others, the concentrations might not vary by sex, but the impact or interpretation may vary by sex depending on the context of use (e.g., diagnostic vs prognostic). Finally, for others, there will be no sex differences in concentrations or their interpretation. This review will first provide a basis for sex differences, including differences in brain structure and function, and the means by which these differences could contribute to sex differences in biomarker concentrations. Next, the current state of sex differences in AD-related biofluid markers (i.e., amyloid-β, phosphorylated τ, total τ, neurofilament light chain, and neurogranin) will be reviewed. Lastly, factors that can lead to the misinterpretation of observed sex differences in biomarkers (either providing evidence for or against) will be considered. SUMMARY This review is intended to provide an impetus to consider sex differences in the measurement and interpretation of AD-related biofluid-based biomarkers.
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Affiliation(s)
- Michelle M Mielke
- Departments of Health Sciences Research and Neurology, Mayo Clinic, Rochester, MN
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36
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Multimodal neuroimaging of sex differences in cognitively impaired patients on the Alzheimer's continuum: greater tau-PET retention in females. Neurobiol Aging 2021; 105:86-98. [PMID: 34049062 DOI: 10.1016/j.neurobiolaging.2021.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022]
Abstract
We assessed sex differences in amyloid- and tau-PET retention in 119 amyloid positive patients with mild cognitive impairment or Alzheimer's disease (AD) dementia. Patients underwent 3T-MRI, 11C-PIB amyloid-PET and 18F-Flortaucipir tau-PET. Linear ordinary least squares regression models tested sex differences in Flortaucipir-PET SUVR in a summary temporal region of interest as well as global PIB-PET. No sex differences were observed in demographics, Clinical Dementia Rating Sum of Boxes (CDR-SoB), Mini-Mental State Exam (MMSE), raw episodic memory scores, or cortical thickness. Females had higher global PIB SUVR (ηp²=.043, p=.025) and temporal Flortaucipir SUVR (ηp²=.070, p=.004), adjusting for age and CDR-SoB. Sex differences in temporal Flortaucipir-PET remained significant when controlling additionally for PIB SUVR and APOE4 status (ηp²=.055, p=.013), or when using partial volume-corrected data. No sex differences were present in areas of known Flortaucipir off-target binding. Overall, females demonstrated greater AD regional tau-PET burden than males despite clinical comparability. Further characterization of sex differences will provide insight into AD pathogenesis and support development of personalized therapeutic strategies.
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Spina S, La Joie R, Petersen C, Nolan AL, Cuevas D, Cosme C, Hepker M, Hwang JH, Miller ZA, Huang EJ, Karydas AM, Grant H, Boxer AL, Gorno-Tempini ML, Rosen HJ, Kramer JH, Miller BL, Seeley WW, Rabinovici GD, Grinberg LT. Comorbid neuropathological diagnoses in early versus late-onset Alzheimer's disease. Brain 2021; 144:2186-2198. [PMID: 33693619 DOI: 10.1093/brain/awab099] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/21/2020] [Accepted: 01/03/2021] [Indexed: 12/14/2022] Open
Abstract
Copathologies play an important role in the expression of the AD clinical phenotype and may influence treatment efficacy. Early-onset AD (EOAD), defined as manifesting before age 65, is viewed as a relatively pure form of AD with a more homogeneous neuropathological substrate. We sought to compare the frequency of common neuropathological diagnoses in a consecutive autopsy series of 96 patients with EOAD (median age of onset = 55 years, 44 females) and 48 with late-onset AD (LOAD) (median age of onset = 73 years, 14 females). The UCSF Neurodegenerative Disease Brain Bank database was reviewed to identify patients with a primary pathological diagnosis of AD. Prevalence and stage of Lewy body disease (LBD), limbic age-related TDP-43 encephalopathy (LATE), argyrophilic grain disease (AGD), hippocampal sclerosis (HS), cerebral amyloid angiopathy (CAA), and vascular brain injury (VBI) were compared between the two cohorts. We found at least one non-AD pathological diagnosis in 98% of patients with EOAD (versus 100% of LOAD), and the number of comorbid diagnoses per patient was lower in EOAD than in LOAD (median=2 versus 3, Mann-Whitney Z = 3.00, p = 0.002). LBD and CAA were common in both EOAD and LOAD (CAA: 86% versus 79%, Fisher exact p = 0.33; LBD: 49% versus 42%, p = 0.48, respectively), although amygdala-predominant LBD was more commonly found in EOAD than LOAD (22% versus 6%, p = 0.02). In contrast, LATE (35% versus 8%, p < 0.001), HS (15% versus 3%, p = 0.02), AGD (58% versus 41%, p = 0.052), and VBI (65% versus 39%, p = 0.004) were more common in LOAD than EOAD, respectively. The number of copathologies predicted worse cognitive performance at the time of death on MMSE (1.4 points/pathology (95%CI [-2.5, -0.2]) and Clinical Dementia Rating - Sum of Boxes (1.15 point/pathology, 95%CI [0.45, 1.84]), across the EOAD and the LOAD cohorts. The effect of sex on the number of copathologies was not significant (p = 0.17). Prevalence of at least one APOE ε4 allele was similar across the two cohorts (52% and 54%) and was associated with a greater number of copathologies (+0.40, 95%CI [0.01, 0.79], p = 0.047), independent of age of symptom onset, sex, and disease duration. Females showed higher density of neurofibrillary tangles compared to men, controlling for age of onset, APOE ε4, and disease duration. Our findings suggest that non-AD pathological diagnoses play an important role in the clinical phenotype of EOAD with potentially significant implications for clinical practice and clinical trials design.
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Affiliation(s)
- Salvatore Spina
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Cathrine Petersen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Amber L Nolan
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Deion Cuevas
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Celica Cosme
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mackenzie Hepker
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ji-Hye Hwang
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Eric J Huang
- Department of Pathology; University of California, San Francisco, San Francisco, CA, USA
| | - Anna M Karydas
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Harli Grant
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Pathology; University of California, San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Radiology and Biomedical Imaging; University of California, San Francisco, San Francisco, CA, USA
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Pathology; University of California, San Francisco, San Francisco, CA, USA
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What is 'Alzheimer's disease'? The neuropathological heterogeneity of clinically defined Alzheimer's dementia. Curr Opin Neurol 2021; 34:237-245. [PMID: 33591030 DOI: 10.1097/wco.0000000000000912] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Beta-amyloid with paired helical filaments (PHF)-tau neurofibrillary tangles define hallmark Alzheimer's disease neuropathologic changes (AD-NC). Yet persons with Alzheimer's dementia, defined broadly as an amnestic multidomain progressive dementia, often exhibit postmortem evidence of other neuropathologies including other neurodegenerative (Lewy body disease and transactive response DNA-binding protein disease) and vascular-related brain lesions. Clinicopathologic and epidemiologic analyses demonstrate the significance of these substrates, as coinciding neuropathologies mitigate the threshold for diagnosis of Alzheimer's dementia. In addition, other biologic processes may also independently underlie a progressive amnestic dementia. Advances in research on the relationship between age-related cognitive decline and the underlying neuropathologic substrates indicate that consensus neuropathologic criteria or disease nomenclature may need new considerations or refinement. This review appraises seminal literature as well as mixed pathologies and biological factors that may be determinants of clinical and pathologic disease. RECENT FINDINGS Cognition in aging (spanning from normal cognition to dementia) represents a clinical continuum. Traditional neuropathologic substrates of dementia however do not explain the variability of cognitive decline. Conversely, not all patients with AD-NC exhibit symptomatology of Alzheimer's dementia. In addition to diagnostic plaques and tangles, other neurodegenerative, cerebrovascular, and perivascular substrates manifest through discrete tissue lesions. Factors related to energetics, neurogenetics, neuroimmunology, resilience, proteinopathies, and waste clearance are increasingly suggested to be general drivers of disease. Recognition of novel neuroimmune pathways and brain-body connections further suggest there may be broader extracranial determinants of person-specific disease. SUMMARY Alzheimer's dementia is a pathologically heterogeneous and biologically multilayered disease. Recent studies and exercises in nomenclature reveal shortcomings in existing terminologies. Recognizing and overcoming these limitations is required for experts to effectively communicate about and ultimately prevent and treat Alzheimer's dementia.
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van de Beek M, Babapour Mofrad R, van Steenoven I, Vanderstichele H, Scheltens P, Teunissen CE, Lemstra AW, van der Flier WM. Sex-specific associations with cerebrospinal fluid biomarkers in dementia with Lewy bodies. ALZHEIMERS RESEARCH & THERAPY 2020; 12:44. [PMID: 32303272 PMCID: PMC7165383 DOI: 10.1186/s13195-020-00610-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/31/2020] [Indexed: 02/08/2023]
Abstract
Background Dementia with Lewy bodies (DLB) is more prevalent in men than in women. In addition, post-mortem studies found sex differences in underlying pathology. It remains unclear whether these differences are also present antemortem in in vivo biomarkers, and whether sex differences translate to variability in clinical manifestation. The objective of this study was to evaluate sex differences in cerebrospinal fluid (CSF) biomarker concentrations (i.e., alpha-synuclein (α-syn), amyloid β1-42 (Aβ42), total tau (Tau), phosphorylated tau at threonine 181 (pTau)) and clinical characteristics in DLB. Methods We included 223 DLB patients from the Amsterdam Dementia Cohort, of which 39 were women (17%, age 70 ± 6, MMSE 21 ± 6) and 184 men (83%, age 68 ± 7, MMSE 23 ± 4). Sex differences in CSF biomarker concentrations (i.e., α-syn, Aβ42, Tau, and pTau) were evaluated using age-corrected general linear models (GLM). In addition, we analyzed sex differences in core clinical features (i.e., visual hallucinations, parkinsonism, cognitive fluctuations, and REM sleep behavior disorder (RBD) and cognitive test scores using age- and education-adjusted GLM. Results Women had lower CSF α-syn levels (F 1429 ± 164 vs M 1831 ± 60, p = 0.02) and CSF Aβ42 levels (F 712 ± 39 vs M 821 ± 18, p = 0.01) compared to men. There were no sex differences for (p) Tau concentrations (p > 0.05). Clinically, women were older, had a shorter duration of complaints (F 2 ± 1 vs M 4 ± 3, p < 0.001), more frequent hallucinations (58% vs 38%, p = 0.02), and scored lower on MMSE and a fluency task (MMSE, p = 0.02; animal fluency, p = 0.006). Men and women did not differ on fluctuations, RBD, parkinsonism, or other cognitive tests. Conclusions Women had lower Aβ42 and α-syn levels than men, alongside a shorter duration of complaints. Moreover, at the time of diagnosis, women had lower cognitive test scores and more frequent hallucinations. Based on our findings, one could hypothesize that women have a more aggressive disease course in DLB compared to men. Future research should investigate whether women and men with DLB might benefit from sex-specific treatment strategies.
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Affiliation(s)
- M van de Beek
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
| | - R Babapour Mofrad
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - I van Steenoven
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - P Scheltens
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - C E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - A W Lemstra
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - W M van der Flier
- Alzheimer Center Amsterdam & Department of Neurology, Neuroscience Campus Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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Kurasz AM, Smith GE, McFarland MG, Armstrong MJ. Ethnoracial Differences in Lewy Body Diseases with Cognitive Impairment. J Alzheimers Dis 2020; 77:165-174. [PMID: 32804137 PMCID: PMC7553012 DOI: 10.3233/jad-200395] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increasing research focuses on ethnic differences in Alzheimer's disease, but such efforts in other neurodegenerative dementias are lacking. Currently, data on the ethnic profile of cognitively impaired persons with Lewy body disease (LBD) is limited, despite Lewy body dementia being the second most common neurodegenerative dementia. OBJECTIVE The study aimed to investigate presenting characteristics among ethnoracially diverse individuals with cognitive impairment secondary to LBD using the National Alzheimer's Coordinating Center database. METHODS Participants self-identified as African American, Hispanic, or White. We used Kruskal-Wallis and Pearson χ2 analyses to investigate group differences in presenting characteristics and linear regression to compare neuropsychological test performance. RESULTS Presentation age was similar between groups (median 74-75 years). Compared to Whites (n = 1782), African Americans (n = 130) and Hispanics (n = 122) were more likely to be female and single, have less educational attainment, report more cardiovascular risk factors, describe less medication use, and perform worse on select cognitive tests. Hispanics reported more depressive symptoms. CONCLUSION Cohorts differences highlight the need for population-based LBD studies with racial-ethnic diversity. Culturally-sensitive neuropsychological tests are needed to determine whether observed differences relate to cultural, social, testing, or disease-related factors. More research is needed regarding how social and biological factors impact LBD care among diverse populations.
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Affiliation(s)
- Andrea M. Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Glenn E. Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
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