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Kiselica AM, Kaser AN, Weitzner DS, Mikula CM, Boone A, Woods SP, Wolf TJ, Webber TA. Development and Validity of Norms for Cognitive Dispersion on the Uniform Data Set 3.0 Neuropsychological Battery. Arch Clin Neuropsychol 2024; 39:732-746. [PMID: 38364295 PMCID: PMC11345113 DOI: 10.1093/arclin/acae005] [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: 05/16/2023] [Revised: 11/14/2023] [Accepted: 12/15/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Cognitive dispersion indexes intraindividual variability in performance across a battery of neuropsychological tests. Measures of dispersion show promise as markers of cognitive dyscontrol and everyday functioning difficulties; however, they have limited practical applicability due to a lack of normative data. This study aimed to develop and evaluate normed scores for cognitive dispersion among older adults. METHOD We analyzed data from 4,283 cognitively normal participants aged ≥50 years from the Uniform Data Set (UDS) 3.0. We describe methods for calculating intraindividual standard deviation (ISD) and coefficient of variation (CoV), as well as associated unadjusted scaled scores and demographically adjusted z-scores. We also examined the ability of ISD and CoV scores to differentiate between cognitively normal individuals (n = 4,283) and those with cognitive impairment due to Lewy body disease (n = 282). RESULTS We generated normative tables to map raw ISD and CoV scores onto a normal distribution of scaled scores. Cognitive dispersion indices were associated with age, education, and race/ethnicity but not sex. Regression equations were used to develop a freely accessible Excel calculator for deriving demographically adjusted normed scores for ISD and CoV. All measures of dispersion demonstrated excellent diagnostic utility when evaluated by the area under the curve produced from receiver operating characteristic curves. CONCLUSIONS Results of this study provide evidence for the clinical utility of sample-based and demographically adjusted normative standards for cognitive dispersion on the UDS 3.0. These standards can be used to guide interpretation of intraindividual variability among older adults in clinical and research settings.
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Affiliation(s)
- Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Alyssa N Kaser
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Cynthia M Mikula
- Institute of Human Nutrition, Columbia University, New York, NY, USA
| | - Anna Boone
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | | | - Timothy J Wolf
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | - Troy A Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Hamrick P, Sanborn V, Ostrand R, Gunstad J. Lexical Speech Features of Spontaneous Speech in Older Persons With and Without Cognitive Impairment: Reliability Analysis. JMIR Aging 2023; 6:e46483. [PMID: 37819025 PMCID: PMC10583496 DOI: 10.2196/46483] [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: 02/14/2023] [Revised: 06/19/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023] Open
Abstract
Background Speech analysis data are promising digital biomarkers for the early detection of Alzheimer disease. However, despite its importance, very few studies in this area have examined whether older adults produce spontaneous speech with characteristics that are sufficiently consistent to be used as proxy markers of cognitive status. Objective This preliminary study seeks to investigate consistency across lexical characteristics of speech in older adults with and without cognitive impairment. Methods A total of 39 older adults from a larger, ongoing study (age: mean 81.1, SD 5.9 years) were included. Participants completed neuropsychological testing and both picture description tasks and expository tasks to elicit speech. Participants with T-scores of ≤40 on ≥2 cognitive tests were categorized as having mild cognitive impairment (MCI). Speech features were computed automatically by using Python and the Natural Language Toolkit. Results Reliability indices based on mean correlations for picture description tasks and expository tasks were similar in persons with and without MCI (with r ranging from 0.49 to 0.65 within tasks). Intraindividual variability was generally preserved across lexical speech features. Speech rate and filler rate were the most consistent indices for the cognitively intact group, and speech rate was the most consistent for the MCI group. Conclusions Our findings suggest that automatically calculated lexical properties of speech are consistent in older adults with varying levels of cognitive impairment. These findings encourage further investigation of the utility of speech analysis and other digital biomarkers for monitoring cognitive status over time.
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Affiliation(s)
- Phillip Hamrick
- Department of Psychological Sciences, Kent State University, KentOH, United States
| | | | | | - John Gunstad
- Department of Psychological Sciences, Kent State University, KentOH, United States
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Fischer B, Van Hulle CA, Langhough R, Norton D, Zuelsdorff M, Gooding DC, Wyman MF, Johnson A, Lambrou N, James T, Bouges S, Carter FP, Salazar H, Kirmess K, Holubasch M, Meyer M, Venkatesh V, West T, Verghese P, Yarasheski K, Carlsson CM, Johnson SC, Asthana S, Gleason CE. Plasma Aβ42/40 and cognitive variability are associated with cognitive function in Black Americans: Findings from the AA-FAIM cohort. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12414. [PMID: 37752907 PMCID: PMC10519622 DOI: 10.1002/trc2.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/25/2023] [Indexed: 09/28/2023]
Abstract
Introduction It is critical to develop more inclusive Alzheimer's disease (AD) research protocols to ensure that historically excluded groups are included in preclinical research and have access to timely diagnosis and treatment. If validated in racialized groups, plasma AD biomarkers and measures of subtle cognitive dysfunction could provide avenues to expand diversity in preclinical AD research. We sought to evaluate the utility of two easily obtained, low-burden disease markers, plasma amyloid beta (Aβ)42/40, and intra-individual cognitive variability (IICV), to predict concurrent and longitudinal cognitive performance in a sample of Black adults. Methods Two hundred fifty-seven Black participants enrolled in the African Americans Fighting Alzheimer's in Midlife (AA-FAIM) study underwent at least one cognitive assessment visit; a subset of n = 235 had plasma samples. Baseline IICV was calculated as the standard deviation across participants' z scores on five cognitive measures: Rey Auditory Verbal Learning Test Delayed Recall, Trail Making Test Parts A and B (Trails A and B), and Boston Naming Test. Using mixed effects regression models, we compared concurrent and longitudinal models to baseline plasma Aβ42/40 or IICV by age interactions. PrecivityAD assays quantified baseline plasma Aβ42/40. Results IICV was associated with concurrent/baseline performance on several outcomes but did not modify associations between age and cognitive decline. In contrast, plasma Aβ42/40 was unrelated to baseline cognitive performance, but a pattern emerged in interactions with age in longitudinal models of Trails A and B and Rey Auditory Verbal Learning Test total learning trials. Although not significant after correcting for multiple comparisons, low Aβ42/40 was associated with faster cognitive declines over time. Discussion Our results are promising as they extend existing findings to an Black American sample using low-cost, low-burden methods that can be implemented outside of a research center, thus supporting efforts for inclusive AD biomarker research.
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Affiliation(s)
- Barbara Fischer
- Madison VA GRECCWilliam S. Middleton Memorial HospitalMadisonWisconsinUSA
- Department of NeurologyUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Carol Ann Van Hulle
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rebecca Langhough
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of WisconsinMadisonWisconsinUSA
| | - Derek Norton
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Biostatistics and Medical InformaticsUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- School of NursingUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Diane Carol Gooding
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Department of PsychologyUniversity of Wisconsin–MadisonMadison, WisconsinUSA
- Department of PsychiatryUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Mary F. Wyman
- Madison VA GRECCWilliam S. Middleton Memorial HospitalMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Adrienne Johnson
- Center for Tobacco Research and InterventionSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Nickolas Lambrou
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Taryn James
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Shenikqua Bouges
- Madison VA GRECCWilliam S. Middleton Memorial HospitalMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Fabu Phillis Carter
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Hector Salazar
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | | | | | | | | | - Tim West
- C2N DiagnosticsSt. LouisMissouriUSA
| | | | | | - Cynthia M. Carlsson
- Madison VA GRECCWilliam S. Middleton Memorial HospitalMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of WisconsinMadisonWisconsinUSA
| | - Sterling C. Johnson
- Madison VA GRECCWilliam S. Middleton Memorial HospitalMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of WisconsinMadisonWisconsinUSA
| | - Sanjay Asthana
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of WisconsinMadisonWisconsinUSA
| | - Carey E. Gleason
- Madison VA GRECCWilliam S. Middleton Memorial HospitalMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin–Madison School of Medicine and Public HealthMadisonWisconsinUSA
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Davis JJ, Sivaramakrishnan A, Rolin S, Subramanian S. Intra-individual variability in cognitive performance predicts functional decline in Parkinson's disease. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 36628434 PMCID: PMC10330935 DOI: 10.1080/23279095.2022.2157276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cognitive deficits contribute to disability in Parkinson's disease (PD). Cognitive intra-individual variability (IIV) is associated with cognitive decline in age-related disorders, but IIV has not been related to functional ability in PD. We examined IIV in predicting functional ability in participants with PD. METHODS De-identified National Alzheimer's Coordinating Center data (N = 1,228) from baseline and follow-up visits included participants with PD propensity score matched to control participants at baseline on age (M = 72), education (M = 15), and gender (28% female). PD symptom duration averaged 6 years. Outcome measures included the Functional Ability Questionnaire (FAQ), overall test battery mean (OTBM) of ten cognitive variables, IIV calculated as the standard deviation of cognitive data for each participant, Geriatric Depression Scale (GDS), and Unified PD Rating Scale gait and posture items. Baseline FAQ status in the PD group was predicted using logistic regression with age, education, cognition, GDS, and motor function as predictors. We compared baseline characteristics of PD participants with and without functional impairment at follow up. RESULTS PD participants showed lower OTBM and greater IIV, GDS, and motor dysfunction than controls (p < .0001). Education, OTBM, IIV, GDS, and gait predicted functional status (77% overall classification; AUC = .84). PD participants with functional impairment at follow up showed significantly lower OTBM and greater IIV, GDS, and motor dysfunction at baseline (p < .001). CONCLUSION IIV independently predicts functional status in participants with PD while controlling for other variables. PD participants with functional impairment at follow up showed greater IIV than those without functional impairment at follow up.
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Affiliation(s)
- Jeremy J. Davis
- Department of Neurology, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio
| | | | - Summer Rolin
- Department of Rehabilitation Medicine, Long School of Medicine, UT Health San Antonio
| | - Sandeep Subramanian
- Department of Physical Therapy, UT Health San Antonio
- Department of Rehabilitation Medicine, Long School of Medicine, UT Health San Antonio
- Department of Physician Assistant Studies, UT Health San Antonio
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Mascarenhas Fonseca L, Sage Chaytor N, Olufadi Y, Buchwald D, Galvin JE, Schmitter-Edgecombe M, Suchy-Dicey A. Intraindividual Cognitive Variability and Magnetic Resonance Imaging in Aging American Indians: Data from the Strong Heart Study. J Alzheimers Dis 2023; 91:1395-1407. [PMID: 36641671 PMCID: PMC9974814 DOI: 10.3233/jad-220825] [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: 01/15/2023]
Abstract
BACKGROUND American Indians have high prevalence of risk factors for Alzheimer's disease and related dementias (ADRD) compared to the general population, yet dementia onset and frequency in this population are understudied. Intraindividual cognitive variability (IICV), a measure of variability in neuropsychological test performance within a person at a single timepoint, may be a novel, noninvasive biomarker of neurodegeneration and early dementia. OBJECTIVE To characterize the cross-sectional associations between IICV and hippocampal, total brain volume, and white matter disease measured by magnetic resonance imaging (MRI) among older American Indians. METHODS IICV measures for memory, executive function, and processing speed, and multidomain cognition were calculated for 746 American Indians (aged 64-95) who underwent MRI. Regression models were used to examine the associations of IICV score with hippocampal volume, total brain volume, and graded white matter disease, adjusting for age, sex, education, body mass index, intracranial volume, diabetes, stroke, hypertension, hypercholesterolemia, alcohol use, and smoking. RESULTS Higher memory IICV measure was associated with lower hippocampal volume (Beta = -0.076; 95% CI -0.499, -0.023; p = 0.031). After adjustment for Bonferroni or IICV mean scores in the same tests, the associations were no longer significant. No IICV measures were associated with white matter disease or total brain volume. CONCLUSION These findings suggest that the IICV measures used in this research cannot be robustly associated with cross-sectional neuroimaging features; nonetheless, the results encourage future studies investigating the associations between IICV and other brain regions, as well as its utility in the prediction of neurodegeneration and dementia in American Indians.
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Affiliation(s)
- Luciana Mascarenhas Fonseca
- Elson S Floyd College of Medicine, Washington State University, United States
- Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Naomi Sage Chaytor
- Elson S Floyd College of Medicine, Washington State University, United States
| | - Yunusa Olufadi
- Elson S Floyd College of Medicine, Washington State University, United States
| | - Dedra Buchwald
- Elson S Floyd College of Medicine, Washington State University, United States
- Institute for Research and Education to Advance Community Health, Washington State University, United States
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, United States
| | | | - Astrid Suchy-Dicey
- Elson S Floyd College of Medicine, Washington State University, United States
- Institute for Research and Education to Advance Community Health, Washington State University, United States
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Bouges S, Fischer B, Norton DL, Wyman MF, Lambrou N, Zuelsdorff M, Van Hulle CA, Ennis GE, James TT, Johnson AL, Chin N, Carlsson CM, Gleason CE. Effect of Metabolic Syndrome Risk Factors on Processing Speed and Executive Function in Three Racialized Groups. J Alzheimers Dis 2023; 92:285-294. [PMID: 36744341 PMCID: PMC10211459 DOI: 10.3233/jad-220920] [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: 02/05/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) has been associated with increased risk for Alzheimer's disease and related dementias (ADRD). Understanding the association of MetS risk factors to processing speed and executive function in the pre-clinical stages of ADRD in under-represented groups would offer insight on potential mechanisms through which MetS associates with ADRD risk. OBJECTIVE Examine association of MetS features and processing speed and executive function across three racial groups. METHODS Cognitively unimpaired adults from the Wisconsin Alzheimer's Disease Research Center and the Wisconsin Registry for Alzheimer's Disease Prevention completed blood-draws and neuropsychological testing. Six cognitive outcomes were assessed in association to MetS risk factors: Trailmaking Tests A and B, Animal Fluency, Digit Symbol, and composite scores for Processing Speed and Executive Function. Linear mixed effect models were used to assess the relationship between MetS risk factor count and longitudinal cognitive performance across three racialized groups. RESULTS Participant sample sizes varied by outcome analyzed (N = 714-1,088). African American and Native American groups exhibited higher rates of MetS than non-Hispanic Whites. MetS was associated with processing speed and executive function across all racialized groups. Three-way interaction by racialized group was limited to one cognitive outcome: Trailmaking Test A. CONCLUSION Metabolic dysfunction incrementally affects cognitive trajectory, with generally similar associations across racial groups. Since racialized groups exhibit higher levels of both MetS and ADRD, MetS may represent a driving factor for increased ADRD risk experience by racialized group and an important and modifiable target through which to reduce risk of ADRD.
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Affiliation(s)
- Shenikqua Bouges
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
| | - Barbara Fischer
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Neurology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Derek L. Norton
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Mary F. Wyman
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine & Public Health, Department of Psychiatry, Madison, WI, USA
| | - Nickolas Lambrou
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, UW School of Medicine & Public Health, Madison, WI, USA
- University of Wisconsin – Madison School of Nursing
| | - Carol A. Van Hulle
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
| | - Gilda E. Ennis
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
| | - Taryn T. James
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
| | - Adrienne L. Johnson
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- University of Wisconsin School of Medicine & Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
| | - Nathaniel Chin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, UW School of Medicine & Public Health, Madison, WI, USA
| | - Cynthia M. Carlsson
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, UW School of Medicine & Public Health, Madison, WI, USA
| | - Carey E. Gleason
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin (UW) School of Medicine & Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, UW School of Medicine & Public Health, Madison, WI, USA
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Wyman MF, Van Hulle CA, Umucu E, Livingston S, Lambrou NH, Carter FP, Johnson SC, Asthana S, Gleason CE, Zuelsdorff M. Psychological well-being and cognitive aging in Black, Native American, and White Alzheimer's Disease Research Center participants. Front Hum Neurosci 2022; 16:924845. [PMID: 35967004 PMCID: PMC9372578 DOI: 10.3389/fnhum.2022.924845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/05/2022] [Indexed: 01/25/2023] Open
Abstract
Psychological well-being is associated with cognition in later life but has not been examined across diverse populations-including minoritized communities at disproportionately high risk of dementia. Further, most previous work has not been able to examine links between specific facets of psychological well-being and performance within distinct cognitive domains that can capture subclinical impairment. Using a well-characterized sample followed through enrollment in an NIH-funded Alzheimer's Disease Center, we sought to test these associations within three racial groups at baseline. Participants were N = 529 cognitively unimpaired Black, American Indian/Alaska Native (AI/AN), and white middle-aged and older adults (mean age = 63.6, SD = 8.1, range = 45-88 years) enrolled in the Wisconsin Alzheimer's Disease Research Center's Clinical Core. Predictors included validated NIH Toolbox Emotion Battery scales assessing positive affect, general life satisfaction, and meaning and purpose. Outcomes included performance on widely used tests of executive functioning and episodic memory. We conducted race-stratified regression models to assess within-group relationships. Black and AI/AN participants reported lower life satisfaction than white participants. Racial disparities were not observed for positive affect or meaning and purpose scores. Across groups, life satisfaction predicted better executive functioning. Similar associations were observed for positive affect in Black and AI/AN samples but not among whites. In general, well-being measures were not related to performance on tests of episodic memory. Our results highlight well-being as a potentially important determinant of late-life cognitive health, particularly executive functioning, that is modifiable if older adults are connected with appropriate resources and supports. Further, psychological well-being may represent a potent target for brain health interventions tailored for Black and Native communities.
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Affiliation(s)
- Mary F. Wyman
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Carol A. Van Hulle
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Emre Umucu
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, Lansing, MI, United States
| | - Sydnee Livingston
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
| | - Nickolas H. Lambrou
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
| | - Fabu P. Carter
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Sterling C. Johnson
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Sanjay Asthana
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Carey E. Gleason
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Megan Zuelsdorff
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
- School of Nursing, University of Wisconsin, Madison, WI, United States
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Lin SSH, McDonough IM. Intra-individual cognitive variability in neuropsychological assessment: a sign of neural network dysfunction. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:375-399. [PMID: 34963423 DOI: 10.1080/13825585.2021.2021134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intra-Individual Cognitive Variability (IICV) predicts progression in neurocognitive disorders . Given important clinical applications, we investigated the association between IICV and multiple brain metrics across 17 networks to better understand the brain mechanisms underlying this performance measure. Sixty-three middle-aged and older adults without dementia underwent a neuropsychological battery, resting-state fMRI, and structural MRI scans. In a linear mixed effect model, higher IICV was associated with lower functional connectivity in control C network relative to medial occipital network (the reference). A multivariate partial least squares analysis revealed that lower mean and higher variability were both associated with lower connectivity in sensorimotor and default mode networks, while higher mean and higher variability were associated with lower volume in default mode and limbic networks. This study suggests that IICV signals widespread network dysfunction across multiple brain networks. These brain abnormalities offer new insights into mechanisms of early cognitive dysfunction. Clinical implications are discussed.
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Affiliation(s)
- Shayne S-H Lin
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Ian M McDonough
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
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LaPlume AA, Paterson TSE, Gardner S, Stokes KA, Freedman M, Levine B, Troyer AK, Anderson ND. Interindividual and intraindividual variability in amnestic mild cognitive impairment (aMCI) measured with an online cognitive assessment. J Clin Exp Neuropsychol 2021; 43:796-812. [PMID: 34556008 DOI: 10.1080/13803395.2021.1982867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mean cognitive performance is worse in amnestic mild cognitive impairment (aMCI) compared to control groups. However, studies on variability of cognitive performance in aMCI have yielded inconclusive results, with many differences in variability measures and samples from one study to another. METHODS We examined variability in aMCI using an existing older adult sample (n = 91; 51 with aMCI, 40 with normal cognition for age), measured with an online self-administered computerized cognitive assessment (Cogniciti's Brain Health Assessment). Our methodology extended past findings by using pure measures of variability (controlling for confounding effects of group performance or practice), and a clinically representative aMCI sample (reflecting the continuum of cognitive performance between normal cognition and aMCI). RESULTS Between-group t-tests showed significantly greater between-person variability (interindividual variability or diversity) in overall cognitive performance in aMCI than controls, although the effect size was with a small to moderate effect size, d = 0.44. No significant group differences were found in within-person variability (intraindividual variability) across cognitive tasks (dispersion) or across trials of a response time task (inconsistency), which may be because we used a sample measuring the continuum of cognitive performance. Exploratory correlation analyses showed that a worse overall score was associated with greater inter- and intraindividual variability, and that variability measures were correlated with each other, indicating people with worse cognitive performance were more variable. DISCUSSION The current study demonstrates that self-administered online tests can be used to remotely assess different types of variability in people at risk of Alzheimer`s. Our findings show small but significantly more interindividual differences in people with aMCI. This diversity is considered as "noise" in standard assessments of mean performance, but offers an interesting and cognitively informative "signal" in itself.
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Affiliation(s)
- Annalise A LaPlume
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada
| | - Theone S E Paterson
- Department of Psychology, University of Victoria, Victoria, Canada.,Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Canada
| | - Sandra Gardner
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kathryn A Stokes
- Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Division of Neurology, Baycrest, Toronto, Canada.,Department of Medicine, Division of Neurology, Mt. Sinai Hospital, Toronto, ON, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, Canada
| | - Brian Levine
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
| | - Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
| | - Nicole D Anderson
- Rotman Research Institute, Baycrest (Fully Affiliated with the University of Toronto), Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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10
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Lu P, Colliot O. Multilevel Survival Modeling with Structured Penalties for Disease Prediction from Imaging Genetics data. IEEE J Biomed Health Inform 2021; 26:798-808. [PMID: 34329174 DOI: 10.1109/jbhi.2021.3100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper introduces a framework for disease prediction from multimodal genetic and imaging data. We propose a multilevel survival model which allows predicting the time of occurrence of a future disease state in patients initially exhibiting mild symptoms. This new multilevel setting allows modeling the interactions between genetic and imaging variables. This is in contrast with classical additive models which treat all modalities in the same manner and can result in undesirable elimination of specific modalities when their contributions are unbalanced. Moreover, the use of a survival model allows overcoming the limitations of previous approaches based on classification which consider a fixed time frame. Furthermore, we introduce specific penalties taking into account the structure of the different types of data, such as a group lasso penalty over the genetic modality and a L2-penalty over the imaging modality. Finally, we propose a fast optimization algorithm, based on a proximal gradient method. The approach was applied to the prediction of Alzheimer's disease (AD) among patients with mild cognitive impairment (MCI) based on genetic (single nucleotide polymorphisms - SNP) and imaging (anatomical MRI measures) data from the ADNI database. The experiments demonstrate the effectiveness of the method for predicting the time of conversion to AD. It revealed how genetic variants and brain imaging alterations interact in the prediction of future disease status. The approach is generic and could potentially be useful for the prediction of other diseases.
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11
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Watermeyer T, Goerdten J, Johansson B, Muniz-Terrera G. Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old. Age Ageing 2021; 50:868-874. [PMID: 33196771 DOI: 10.1093/ageing/afaa232] [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] [Received: 04/21/2020] [Revised: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. OBJECTIVE The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. METHODS Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. RESULTS Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. CONCLUSIONS The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.
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Affiliation(s)
- Tam Watermeyer
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Faculty of Health and Life Sciences, Department of Psychology, Northumbria University, Newcastle, UK
| | - Jantje Goerdten
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
| | - Boo Johansson
- Department of Psychology, Centre for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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12
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Manning KJ, Preciado-Pina J, Wang L, Fitzgibbon K, Chan G, Steffens DC. Cognitive variability, brain aging, and cognitive decline in late-life major depression. Int J Geriatr Psychiatry 2021; 36:665-676. [PMID: 33169874 DOI: 10.1002/gps.5465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/07/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Older adults with late-life major depression (LLMD) are at increased risk of dementia. Dispersion, or within-person performance variability across cognitive tests, is a potential marker of cognitive decline. This study examined group differences in dispersion between LLMD and nondepressed healthy controls (HC) and investigated whether dispersion was a predictor of cognitive performance 1 year later in LLMD. We also explored demographic, clinical, and structural imaging correlates of dispersion in LLMD and HC. We hypothesized that dispersion would be greater in LLMD compared with HC and would be associated with worse cognitive performance 1 year later in LLMD. DESIGN Participants were enrolled in the Neurobiology of Late-Life Depression, a naturalistic longitudinal investigation of the predictors of poor illness course in LLMD. PARTICIPANTS The baseline sample consisted of 121 older adults with LLMD and 39 HC; of these subjects, 94 LLMD and 35 HC underwent magnetic resonance imaging (MRI). One-year cognitive data were available for 107 LLMD patients. MEASUREMENTS All participants underwent detailed clinical and structural MRI at baseline. LLMD participants also completed a comprehensive cognitive evaluation 1 year later. RESULTS Higher test dispersion was evident in LLMD when compared with nondepressed controls. Greater baseline dispersion predicted 1-year cognitive decline in LLMD patients even when controlling for baseline cognitive functioning and demographic and clinical confounders. Dispersion was correlated with white matter lesions in LLMD but not HC. Dispersion was also correlated with anxiety in both LLMD and HC. CONCLUSIONS Dispersion is a marker of neurocognitive integrity that requires further exploration in LLMD.
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Affiliation(s)
- Kevin J Manning
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Joshua Preciado-Pina
- Department of Psychology, The University of Texas at El Paso, El Paso, Texas, USA
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kimberly Fitzgibbon
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Grace Chan
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - David C Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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13
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Meeker KL, Ances BM, Gordon BA, Rudolph CW, Luckett P, Balota DA, Morris JC, Fagan AM, Benzinger TL, Waring JD. Cerebrospinal fluid Aβ42 moderates the relationship between brain functional network dynamics and cognitive intraindividual variability. Neurobiol Aging 2020; 98:116-123. [PMID: 33264709 DOI: 10.1016/j.neurobiolaging.2020.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022]
Abstract
As Alzheimer's disease (AD) pathology accumulates, resting-state functional connectivity (rs-fc) within and between brain networks decreases, and fluctuations in cognitive performance known as intraindividual variability (IIV) increase. Here, we assessed the relationship between IIV and anticorrelations in rs-fc between the default mode network (DMN)-dorsal attention network (DAN) in cognitively normal older adults and symptomatic AD participants. We also evaluated the relationship between cerebrospinal fluid (CSF) biomarkers of AD (amyloid-beta [Aβ42] and tau) and IIV-anticorrelation in rs-fc. We observed that cognitive IIV and anticorrelations between DMN × DAN were higher in individuals with AD compared with cognitively normal participants. As DMN × DAN relationship became more positive, cognitive IIV increased, indicating that stronger anticorrelations between networks support more consistent cognitive performance. Moderation analyses indicated that continuous CSF Aβ42, but not CSF total tau, moderated the relationship between cognitive IIV and DMN × DAN, collectively demonstrating that greater amyloid burden and alterations in functional network dynamics are associated with cognitive changes seen in AD. These findings are valuable, as they suggest that amyloid affects cognitive functioning during the early stages of AD.
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Affiliation(s)
- Karin L Meeker
- Department of Psychology, Saint Louis University, St. Louis, MO, USA; Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Beau M Ances
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian A Gordon
- Department of Radiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Cort W Rudolph
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - Patrick Luckett
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - David A Balota
- Department of Psychology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Anne M Fagan
- Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Tammie L Benzinger
- Department of Radiology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Jill D Waring
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
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14
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Watermeyer T, Marroig A, Ritchie CW, Ritchie K, Blennow K, Muniz-Terrera G. Cognitive Dispersion Is Not Associated with Cerebrospinal Fluid Biomarkers of Alzheimer's Disease: Results from the European Prevention of Alzheimer's Dementia (EPAD) v500.0 Cohort. J Alzheimers Dis 2020; 78:185-194. [PMID: 32955462 DOI: 10.3233/jad-200514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive dispersion, variation in performance across cognitive domains, is posited as a non-invasive and cost-effective marker of early neurodegeneration. Little work has explored associations between cognitive dispersion and Alzheimer's disease (AD) biomarkers in healthy older adults. Even less is known about the influence or interaction of biomarkers reflecting brain pathophysiology or other risk factors on cognitive dispersion scores. OBJECTIVE The main aim of this study was to examine whether higher cognitive dispersion was associated with cerebrospinal fluid (CSF) levels of amyloid-β (Aβ42), total tau (t-tau), phosphorylated tau (p-tau), and amyloid positivity in a cohort of older adults at various severities of AD. A secondary aim was to explore which AD risk factors were associated with cognitive dispersion scores. METHODS Linear and logistic regression analyses explored the associations between dispersion and CSF levels of Aβ42, t-tau, and p-tau and amyloid positivity (Aβ42 < 1000 pg/ml). Relationships between sociodemographics, APOEɛ4 status, family history of dementia, and levels of depression and dispersion were also assessed. RESULTS Dispersion did not emerge as associated with any of the analytes nor amyloid positivity. Older (β= -0.007, SE = 0.002, p = 0.001) and less educated (β= -0.009, SE = 0.003, p = 0.009) individuals showed greater dispersion. CONCLUSION Dispersion was not associated with AD pathology, but was associated with age and years of education, highlighting individual differences in cognitive aging. The use of this metric as a screening tool for existing AD pathology is not supported by our analyses. Follow-up work will determine if dispersion scores can predict changes in biomarker levels and/or positivity status longitudinally.
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Affiliation(s)
- Tam Watermeyer
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | | | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Karen Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,French National Institute of Medical Research INSERM Unit Neuropsychiatry, Montpellier, France
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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15
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Devanarayan P, Devanarayan V, Llano DA. Identification of a Simple and Novel Cut-Point Based Cerebrospinal Fluid and MRI Signature for Predicting Alzheimer's Disease Progression that Reinforces the 2018 NIA-AA Research Framework. J Alzheimers Dis 2020; 68:537-550. [PMID: 30775985 DOI: 10.3233/jad-180905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 2018 NIA-AA research framework proposes a classification system with Amyloid-β deposition, pathologic Tau, and Neurodegeneration (ATN) for diagnosis and staging of Alzheimer's disease (AD). Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database can be utilized to identify diagnostic signatures for predicting AD progression, and to determine the utility of this NIA-AA research framework. Profiles of 320 peptides from baseline cerebrospinal fluid (CSF) samples of 287 normal, mild cognitive impairment (MCI), and AD subjects followed over a 3-10-year period were measured via multiple reaction monitoring mass spectrometry. CSF Aβ42, total-Tau (tTau), phosphorylated-Tau (pTau-181), and hippocampal volume were also measured. From these candidate markers, optimal signatures with decision thresholds to separate AD and normal subjects were first identified via unbiased regression and tree-based algorithms. The best performing signature determined via cross-validation was then tested in an independent group of MCI subjects to predict future progression. This multivariate analysis yielded a simple diagnostic signature comprising CSF pTau-181 to Aβ42 ratio, MRI hippocampal volume, and low CSF levels of a novel PTPRN peptide, with a decision threshold on each marker. When applied to a separate MCI group at baseline, subjects meeting these signature criteria experience 4.3-fold faster progression to AD compared to a 2.2-fold faster progression using only conventional markers. This novel 4-marker signature represents an advance over the current diagnostics based on widely used markers, and is easier to use in practice than recently published complex signatures. This signature also reinforces the ATN construct from the 2018 NIA-AA research framework.
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Affiliation(s)
| | - Viswanath Devanarayan
- Charles River Laboratories, Horsham, PA, USA.,Department of Mathematics, Statistics and Computer Science, University of Illinois at Chicago, IL, USA
| | - Daniel A Llano
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Carle Neuroscience Institute, Urbana, IL, USA
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16
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Koscik RL, Norton DL, Allison SL, Jonaitis EM, Clark LR, Mueller KD, Hermann BP, Engelman CD, Gleason CE, Sager MA, Chappell RJ, Johnson SC. Characterizing the Effects of Sex, APOE ɛ4, and Literacy on Mid-life Cognitive Trajectories: Application of Information-Theoretic Model Averaging and Multi-model Inference Techniques to the Wisconsin Registry for Alzheimer's Prevention Study. J Int Neuropsychol Soc 2019; 25:119-133. [PMID: 30522545 PMCID: PMC6374172 DOI: 10.1017/s1355617718000954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Prior research has identified numerous genetic (including sex), education, health, and lifestyle factors that predict cognitive decline. Traditional model selection approaches (e.g., backward or stepwise selection) attempt to find one model that best fits the observed data, risking interpretations that only the selected predictors are important. In reality, several predictor combinations may fit similarly well but result in different conclusions (e.g., about size and significance of parameter estimates). In this study, we describe an alternative method, Information-Theoretic (IT) model averaging, and apply it to characterize a set of complex interactions in a longitudinal study on cognitive decline. METHODS Here, we used longitudinal cognitive data from 1256 late-middle aged adults from the Wisconsin Registry for Alzheimer's Prevention study to examine the effects of sex, apolipoprotein E (APOE) ɛ4 allele (non-modifiable factors), and literacy achievement (modifiable) on cognitive decline. For each outcome, we applied IT model averaging to a set of models with different combinations of interactions among sex, APOE, literacy, and age. RESULTS For a list-learning test, model-averaged results showed better performance for women versus men, with faster decline among men; increased literacy was associated with better performance, particularly among men. APOE had less of an association with cognitive performance in this age range (∼40-70 years). CONCLUSIONS These results illustrate the utility of the IT approach and point to literacy as a potential modifier of cognitive decline. Whether the protective effect of literacy is due to educational attainment or intrinsic verbal intellectual ability is the topic of ongoing work. (JINS, 2019, 25, 119-133).
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Affiliation(s)
- Rebecca L Koscik
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Derek L Norton
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Samantha L Allison
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Erin M Jonaitis
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Lindsay R Clark
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Kimberly D Mueller
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Bruce P Hermann
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Corinne D Engelman
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Carey E Gleason
- 3Geriatric Research Education and Clinical Center,William S. Middleton Memorial Veterans Hospital,Madison,Wisconsin
| | - Mark A Sager
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Richard J Chappell
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Sterling C Johnson
- 1Wisconsin Alzheimer's Institute,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
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17
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Costa AS, Dogan I, Schulz JB, Reetz K. Going beyond the mean: Intraindividual variability of cognitive performance in prodromal and early neurodegenerative disorders. Clin Neuropsychol 2019; 33:369-389. [PMID: 30663511 DOI: 10.1080/13854046.2018.1533587] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Intraindividual variability (IIV), generally defined as short-term variations in behavior, has been proposed as a sign of subtle early impairment in neurodegenerative disorders, presumably associated with the disintegration of neuronal network connectivity. We aim to provide a review of IIV as a sensitive cognitive marker in prodromal neurodegenerative disorders. METHOD A narrative review focusing not only on theoretical and methodological definitions, including an overview on the neural correlates of IIV, but mainly on results from population-based and clinical-based studies on the role of IIV as a reliable predictor of mild cognitive impairment (MCI) and conversion to dementia in neurodegenerative disorders, mostly Alzheimer's and Parkinson's disease. RESULTS Most studies focus on MCI and Alzheimer's disease and demonstrate that IIV is a reliable cognitive marker. IIV is partly more sensitive than mean performance in the prediction of cognitive impairment or progressive deterioration and is independent of socio-demographic variables and disease mediators (e.g., genetic susceptibility). Neuroimaging data, mostly from healthy subjects, suggest a relationship between IIV and dysfunction of the default mode network, presumably mediated by white matter disintegration in frontal and parietal areas. CONCLUSIONS IIV measures may provide valuable information about diagnosis and progression in prodromal stages of neurodegenerative disorders. Thus, further conceptual and methodological clarifications are needed to justify the inclusion of IIV as a sensible cognitive marker in routine clinical neuropsychological assessment.
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Affiliation(s)
- Ana Sofia Costa
- a Neurocognition Unit, Department of Neurology , Hospital de Braga , Braga , Portugal.,b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
| | - Imis Dogan
- b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
| | - Jörg B Schulz
- b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
| | - Kathrin Reetz
- b Department of Neurology , RWTH Aachen University , Aachen , Germany.,c JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University , Aachen , Germany
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18
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Ba M, Ng KP, Gao X, Kong M, Guan L, Yu L. The combination of apolipoprotein E4, age and Alzheimer's Disease Assessment Scale - Cognitive Subscale improves the prediction of amyloid positron emission tomography status in clinically diagnosed mild cognitive impairment. Eur J Neurol 2019; 26:733-e53. [PMID: 30561868 DOI: 10.1111/ene.13881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/06/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Randomized clinical trials involving anti-amyloid interventions focus on the early stages of Alzheimer's disease (AD) with proven amyloid pathology, using amyloid positron emission tomography (amyloid-PET) imaging or cerebrospinal fluid analysis. However, these investigations are either expensive or invasive and are not readily available in resource-limited centres. Hence, the identification of cost-effective clinical alternatives to amyloid-PET is highly desirable. This study aimed to investigate the accuracy of combined clinical markers in predicting amyloid-PET status in mild cognitive impairment (MCI) individuals. METHODS In all, 406 MCI participants from the Alzheimer's Disease Neuroimaging Initiative database were dichotomized into amyloid-PET(+) and amyloid-PET(-) using a cut-off of >1.11. The accuracies of single clinical markers [apolipoprotein E4 (ApoE4) genotype, demographics, cognitive measures and cerebrospinal fluid analysis] in predicting amyloid-PET status were evaluated using receiver operating characteristic curve analysis. A logistic regression model was then used to determine the optimal model with combined clinical markers to predict amyloid-PET status. RESULTS Cerebrospinal fluid amyloid-β (Aβ) showed the best predictive accuracy of amyloid-PET status [area under the curve (AUC) = 0.927]. Whilst ApoE4 genotype (AUC = 0.737) and Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog) 13 (AUC = 0.724) independently discriminated amyloid-PET(+) and amyloid-PET(-) MCI individuals, the combination of clinical markers (ApoE4 carrier, age >60 years and ADAS-Cog 13 > 13.5) improved the predictive accuracy of amyloid-PET status (AUC = 0.827, P < 0.001). CONCLUSIONS Cerebrospinal fluid Aβ, which is an invasive procedure, is most accurate in predicting amyloid-PET status in MCI individuals. The combination of ApoE4, age and ADAS-Cog 13 also accurately predicts amyloid-PET status. As this combination of clinical markers is cheap, non-invasive and readily available, it offers an attractive surrogate assessment for amyloid status amongst MCI individuals in resource-limited settings.
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Affiliation(s)
- M Ba
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - K P Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - X Gao
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - M Kong
- Department of Neurology, Yantaishan Hospital, Yantai City, China
| | - L Guan
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - L Yu
- Department of Neurology, Yantaishan Hospital, Yantai City, China
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19
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Babenko VN, Afonnikov DA, Ignatieva EV, Klimov AV, Gusev FE, Rogaev EI. Haplotype analysis of APOE intragenic SNPs. BMC Neurosci 2018; 19:16. [PMID: 29745836 PMCID: PMC5998902 DOI: 10.1186/s12868-018-0413-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background APOE ε4 allele is most common genetic risk factor for Alzheimer’s disease (AD) and cognitive decline. However, it remains poorly understood why only some carriers of APOE ε4 develop AD and how ethnic variabilities in APOE locus contribute to AD risk. Here, to address the role of APOE haplotypes, we reassessed the diversity of APOE locus in major ethnic groups and in Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset on patients with AD, and subjects with mild cognitive impairment (MCI), and control non-demented individuals. Results We performed APOE gene haplotype analysis for a short block of five SNPs across the gene using the ADNI whole genome sequencing dataset. The compilation of ADNI data with 1000 Genomes identified the APOE ε4 linked haplotypes, which appeared to be distant for the Asian, African and European populations. The common European ε4-bearing haplotype is associated with AD but not with MCI, and the Africans lack this haplotype. Haplotypic inference revealed alleles that may confer protection against AD. By assessing the DNA methylation profile of the APOE haplotypes, we found that the AD-associated haplotype features elevated APOE CpG content, implying that this locus can also be regulated by genetic-epigenetic interactions. Conclusions We showed that SNP frequency profiles within APOE locus are highly skewed to population-specific haplotypes, suggesting that the ancestral background within different sites at APOE gene may shape the disease phenotype. We propose that our results can be utilized for more specific risk assessment based on population descent of the individuals and on higher specificity of five site haplotypes associated with AD. Electronic supplementary material The online version of this article (10.1186/s12868-018-0413-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vladimir N Babenko
- The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences, Center of Neurobiology and Neurogenetics, Lavrentieva str. 10, Novosibirsk, Russia, 630090. .,Novosibirsk State University, Pirogova Str, 2, Novosibirsk, Russia, 630090.
| | - Dmitry A Afonnikov
- The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences, Center of Neurobiology and Neurogenetics, Lavrentieva str. 10, Novosibirsk, Russia, 630090.,Novosibirsk State University, Pirogova Str, 2, Novosibirsk, Russia, 630090
| | - Elena V Ignatieva
- The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences, Center of Neurobiology and Neurogenetics, Lavrentieva str. 10, Novosibirsk, Russia, 630090.,Novosibirsk State University, Pirogova Str, 2, Novosibirsk, Russia, 630090
| | - Anton V Klimov
- The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences, Center of Neurobiology and Neurogenetics, Lavrentieva str. 10, Novosibirsk, Russia, 630090.,Novosibirsk State University, Pirogova Str, 2, Novosibirsk, Russia, 630090
| | - Fedor E Gusev
- Vavilov Institute of General Genetics RAS, Gubkina str. 3, Moscow, Russia, 119991
| | - Evgeny I Rogaev
- The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences, Center of Neurobiology and Neurogenetics, Lavrentieva str. 10, Novosibirsk, Russia, 630090.,Vavilov Institute of General Genetics RAS, Gubkina str. 3, Moscow, Russia, 119991.,Department of Psychiatry, University of Massachusetts Medical School, BNRI, Worcester, MA, 15604, USA.,Faculty of Biology, Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia, 119234
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20
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Sánchez-Moguel SM, Alatorre-Cruz GC, Silva-Pereyra J, González-Salinas S, Sanchez-Lopez J, Otero-Ojeda GA, Fernández T. Two Different Populations within the Healthy Elderly: Lack of Conflict Detection in Those at Risk of Cognitive Decline. Front Hum Neurosci 2018; 11:658. [PMID: 29375352 PMCID: PMC5768990 DOI: 10.3389/fnhum.2017.00658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/22/2017] [Indexed: 11/26/2022] Open
Abstract
During healthy aging, inhibitory processing is affected at the sensorial, perceptual, and cognitive levels. The assessment of event-related potentials (ERPs) during the Stroop task has been used to study age-related decline in the efficiency of inhibitory processes. Studies using ERPs have found that the P300 amplitude increases and the N500 amplitude is attenuated in healthy elderly adults compared to those in young adults. On the other hand, it has been reported that theta excess in resting EEG with eyes closed is a good predictor of cognitive decline during aging 7 years later, while a normal EEG increases the probability of not developing cognitive decline. The behavioral and ERP responses during a Counting-Stroop task were compared between 22 healthy elderly subjects with normal EEG (Normal-EEG group) and 22 healthy elderly subjects with an excess of EEG theta activity (Theta-EEG group). Behaviorally, the Normal-EEG group showed a higher behavioral interference effect than the Theta-EEG group. ERP patterns were different between the groups, and two facts are highlighted: (a) the P300 amplitude was higher in the Theta-EEG group, with both groups showing a P300 effect in almost all electrodes, and (b) the Theta-EEG group did not show an N500 effect. These results suggest that the diminishment in inhibitory control observed in the Theta-EEG group may be compensated by different processes in earlier stages, which would allow them to perform the task with similar efficiency to that of participants with a normal EEG. This study is the first to show that healthy elderly subjects with an excess of theta EEG activity not only are at risk of developing cognitive decline but already have a cognitive impairment.
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Affiliation(s)
- Sergio M Sánchez-Moguel
- Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico.,Escuela Superior de Atotonilco de Tula, Universidad Autónoma del Estado de Hidalgo, Atotonilco de Tula, Mexico
| | - Graciela C Alatorre-Cruz
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Juan Silva-Pereyra
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Sofía González-Salinas
- Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico.,Escuela Superior de Tepeji del Río, Universidad Autónoma del Estado de Hidalgo, Tepeji del Río, Mexico
| | - Javier Sanchez-Lopez
- Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico.,Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Thalía Fernández
- Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico
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21
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Gleason CE, Norton D, Anderson ED, Wahoske M, Washington DT, Umucu E, Koscik RL, Dowling NM, Johnson SC, Carlsson CM, Asthana S. Cognitive Variability Predicts Incident Alzheimer's Disease and Mild Cognitive Impairment Comparable to a Cerebrospinal Fluid Biomarker. J Alzheimers Dis 2018; 61:79-89. [PMID: 29125485 PMCID: PMC5714663 DOI: 10.3233/jad-170498] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) biomarkers are emerging as critically important for disease detection and monitoring. Most biomarkers are obtained through invasive, resource-intense procedures. A cognitive marker, intra-individual cognitive variability (IICV) may provide an alternative or adjunct marker of disease risk for individuals unable or disinclined to undergo lumbar puncture. OBJECTIVE To contrast risk of incident AD and mild cognitive impairment (MCI) associated with IICV to risk associated with well-established biomarkers: cerebrospinal fluid (CSF) phosphorylated tau protein (p-tau181) and amyloid-β 42 (Aβ42) peptide. METHODS Dispersion in cognitive performance, IICV, was estimated with a published algorithm, and included Trail Making Test A and B, Rey Auditory Verbal Learning Test (RAVLT), and the American National Adult Reading Test (ANART). CSF biomarkers were expressed as a ratio: p-tau181/Aβ42, wherein high values signified pathognomonic profiles. Logistic regression models included longitudinal data from 349 Alzheimer's Disease Neuroimaging Initiative (ADNI) participants who completed lumbar puncture. All subjects were cognitively healthy (n = 105) or diagnosed with MCI (n = 244) at baseline. We examined odds of conversion associated with baseline elevations in IICV and/or ratio of CSF p-tau181/Aβ42. RESULTS When included in models alone or in combination with CSF p-tau181/Aβ42, one standard IICV unit higher was associated with an estimated odds ratio for incident AD or MCI of 2.81 (95% CI: 1.83-4.33) in the most inclusive sample, and an odds ratio of 3.41 (95% CI: 2.03-5.73) when restricted to participants with MCI. Iterative analyses suggested that IICV independently improved model fit even when individual index components were included in comparative models. CONCLUSIONS These analyses provide preliminary support for IICV as a marker of incident AD and MCI. This easily-disseminated, non-invasive marker compared favorably to well-established CSF biomarkers.
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Affiliation(s)
- Carey E Gleason
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Derek Norton
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
- University of Wisconsin, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Eric D Anderson
- Wright State University, School of Education and Human Services, Dayton, OH, USA
| | - Michelle Wahoske
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Danielle T Washington
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
| | - Emre Umucu
- Department of Rehabilitation Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Rebecca L Koscik
- Wisconsin Alzheimer's Institute, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - N Maritza Dowling
- George Washington University, School of Nursing, Washington, DC, USA
| | - Sterling C Johnson
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
- George Washington University, School of Nursing, Washington, DC, USA
| | - Cynthia M Carlsson
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
- George Washington University, School of Nursing, Washington, DC, USA
| | - Sanjay Asthana
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, USA
- George Washington University, School of Nursing, Washington, DC, USA
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