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Kang H, Kim J, Kim M, Kim JH, Roh GS, Kim SK. Prediction model for mild cognitive impairment in patients with type 2 diabetes using the autonomic function test. Neurol Sci 2024; 45:3757-3766. [PMID: 38520638 DOI: 10.1007/s10072-024-07451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) is a risk factor for cognitive impairment, and reduced heart rate variability (HRV) has been correlated with cognitive impairment in elderly individuals. This study investigated risk factors and validated a predictive model for mild cognitive impairment (MCI) in patients with T2DM using an autonomic function test. METHODS Patients with T2DM, 50-85 years of age, who attended the diabetes clinic at Gyeongsang National University Hospital between March 2018 and December 2019, were included. A total of 201 patients had been screened; we enrolled 124 patients according to the inclusion and exclusion criteria in this study. Cognitive function was assessed using the Montreal Cognitive Assessment-Korean version (MOCA-K); MCI was defined as a total MOCA-K score ≤ 23. Risk factors for MCI in patients with T2DM, including demographic- and diabetes-related factors, and autonomic function test results, were analyzed. Based on multivariate logistic regression, a nomogram was developed as a prediction model for MCI. RESULTS Thirty-nine of 124 patients were diagnosed with MCI. Age, education, and decreased cardiovagal function were associated with a high risk for MCI, with cardiovagal function exerting the greatest influence. However, diabetes-related factors, such as glycemic control, duration of diabetes, or medications, were not associated with the risk for MCI. The nomogram demonstrated excellent discrimination (area under the curve, 0.832) and was well calibrated. CONCLUSION Approximately one-third of patients had MCI; as such, carefully evaluating cognitive function in elderly T2DM patients with reduced HRV is important to prevent progression to dementia.
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Affiliation(s)
- Heeyoung Kang
- Department of Neurology, College of Medicine, Institute of Medical Science, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, 52727, Korea
| | - Juhyeon Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin Hyun Kim
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
| | - Gu Seob Roh
- Department of Anatomy, College of Medicine, Institute of Medical Science, Gyeongsang National University, Jinju, Korea
| | - Soo Kyoung Kim
- Department of Internal Medicine, College of Medicine, Institute of Medical Science, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, 52727, Korea.
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Marino FR, Wu HT, Etzkorn L, Rooney MR, Soliman EZ, Deal JA, Crainiceanu C, Spira AP, Wanigatunga AA, Schrack JA, Chen LY. Associations of Physical Activity and Heart Rate Variability from a Two-Week ECG Monitor with Cognitive Function and Dementia: The ARIC Neurocognitive Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4060. [PMID: 39000839 PMCID: PMC11244549 DOI: 10.3390/s24134060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024]
Abstract
Low physical activity (PA) measured by accelerometers and low heart rate variability (HRV) measured from short-term ECG recordings are associated with worse cognitive function. Wearable long-term ECG monitors are now widely used, and some devices also include an accelerometer. The objective of this study was to evaluate whether PA or HRV measured from long-term ECG monitors was associated with cognitive function among older adults. A total of 1590 ARIC participants had free-living PA and HRV measured over 14 days using the Zio® XT Patch [aged 72-94 years, 58% female, 32% Black]. Cognitive function was measured by cognitive factor scores and adjudicated dementia or mild cognitive impairment (MCI) status. Adjusted linear or multinomial regression models examined whether higher PA or higher HRV was cross-sectionally associated with higher factor scores or lower odds of MCI/dementia. Each 1-unit increase in the total amount of PA was associated with higher global cognition (β = 0.30, 95% CI: 0.16-0.44) and executive function scores (β = 0.38, 95% CI: 0.22-0.53) and lower odds of MCI (OR = 0.38, 95% CI: 0.22-0.67) or dementia (OR = 0.25, 95% CI: 0.08-0.74). HRV (i.e., SDNN and rMSSD) was not associated with cognitive function. More research is needed to define the role of wearable ECG monitors as a tool for digital phenotyping of dementia.
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Affiliation(s)
- Francesca R. Marino
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Hau-Tieng Wu
- Courant Institute of Mathematical Sciences, New York University, New York, NY 10012, USA
| | - Lacey Etzkorn
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Mary R. Rooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Welch Center for Prevention, Epidemiologic, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Elsayed Z. Soliman
- Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27109, USA
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Adam P. Spira
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 20205, USA
| | - Amal A. Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Lin Yee Chen
- Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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López-Cuenca I, Salobrar-García E, Sánchez-Puebla L, Espejel E, García del Arco L, Rojas P, Elvira-Hurtado L, Fernández-Albarral JA, Ramírez-Toraño F, Barabash A, Salazar JJ, Ramírez JM, de Hoz R, Ramírez AI. Retinal Vascular Study Using OCTA in Subjects at High Genetic Risk of Developing Alzheimer's Disease and Cardiovascular Risk Factors. J Clin Med 2022; 11:3248. [PMID: 35683633 PMCID: PMC9181641 DOI: 10.3390/jcm11113248] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023] Open
Abstract
In 103 subjects with a high genetic risk of developing Alzheimer's disease (AD), family history (FH) of AD and ApoE ɛ4 characterization (ApoE ɛ4) were analyzed for changes in the retinal vascular network by OCTA (optical coherence tomography angiography), and AngioTool and Erlangen-Angio-Tool (EA-Tool) as imaging analysis software. Retinal vascularization was analyzed by measuring hypercholesterolemia (HCL) and high blood pressure (HBP). Angio-Tool showed a statistically significant higher percentage of area occupied by vessels in the FH+ ApoE ɛ4- group vs. in the FH+ ApoE ɛ4+ group, and EA-Tool showed statistically significant higher vascular densities in the C3 ring in the FH+ ApoE ɛ4+ group when compared with: i)FH- ApoE ɛ4- in sectors H3, H4, H10 and H11; and ii) FH+ ApoE ɛ4- in sectors H4 and H12. In participants with HCL and HBP, statistically significant changes were found, in particular using EA-Tool, both in the macular area, mainly in the deep plexus, and in the peripapillary area. In conclusion, OCTA in subjects with genetic risk factors for the development of AD showed an apparent increase in vascular density in some sectors of the retina, which was one of the first vascular changes detectable. These changes constitute a promising biomarker for monitoring the progression of pathological neuronal degeneration.
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Affiliation(s)
- Inés López-Cuenca
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
| | - Elena Salobrar-García
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
- Department of Immunology, Ophthalmology and ENT, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Lidia Sánchez-Puebla
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
| | - Eva Espejel
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
| | - Lucía García del Arco
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
| | - Pilar Rojas
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
- Madrid Eye Institute, Gregorio Marañón General University Hospital, 28007 Madrid, Spain
| | - Lorena Elvira-Hurtado
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
| | - José A. Fernández-Albarral
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
| | - Federico Ramírez-Toraño
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Technical University of Madrid, 28233 Madrid, Spain;
- Department of Experimental Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | - Ana Barabash
- Department of Endocrinology and Nutrition, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
- Diabetes and Associated Metabolic Diseases Networking Biomedical Research Centre, Carlos III Health Institute, 28029 Madrid, Spain
- Department of Medicine II, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Juan J. Salazar
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
- Department of Immunology, Ophthalmology and ENT, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - José M. Ramírez
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Rosa de Hoz
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
- Department of Immunology, Ophthalmology and ENT, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Ana I. Ramírez
- Ramon Castroviejo Institute of Ophthalmologic Research, Group UCM 920105, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, 28040 Madrid, Spain; (I.L.-C.); (E.S.-G.); (L.S.-P.); (E.E.); (L.G.d.A.); (P.R.); (L.E.-H.); (J.A.F.-A.); (J.J.S.); (J.M.R.)
- Department of Immunology, Ophthalmology and ENT, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
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