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Royall DR, Palmer RF. Statin use moderates APOE's and CRP's associations with dementia and is associated with lesser dementia severity in ε4 carriers. Alzheimers Dement 2024; 20:1627-1636. [PMID: 38055626 PMCID: PMC10984456 DOI: 10.1002/alz.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION We tested the effect of statins on C-reactive protein (CRP) and apolipoprotein E (APOE)'s associations with dementia severity. METHODS A total of 1725 participants of the Alzheimer's Disease Neuroimaging Initiative (ADNI) were assigned from 12-month follow-up data into the following groups: (1) ε4 (-)/statin (-), (2) ε4 (-)/statin (+), (3) ε4 (+)/statin (-), and (4) ε4 (+)/statin (+). Dementia severity was assessed by a δ homolog: "dHABS." A mediation model was stratified on statin use and moderation effects tested by a chi-square difference. RESULTS Plasma CRP level decreased with ε4 allelic dose. Statins had no effect on the dHABS d-score in non-carriers but were associated with better scores in carriers. Treated carriers did not have more severe dementia than non-carriers. Statin use moderated the mutual adjusted effects of APOE and CRP. CRP was not a mediator of APOE's effect. DISCUSSION Statins may provide a protective effect on the dementia severity of ε4 carriers. HIGHLIGHTS δ is a dementia-specific phenotype related to general intelligence "g" and is assessed via a "d-score." Apolipoprotein E (APOE) and plasma C-reactive protein (CRP) are independently associated with δ. Plasma CRP decreases with ε4 allelic dose. Statins were associated with better (less demented) d-scores in ε4 carriers but had no effect in non-ε4 carriers. Treated ε4 carriers did not have more severe dementia than non-carriers. Statin use moderated the effects of APOE and CRP on δ. CRP was not a mediator of APOE's effect on δ.
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Affiliation(s)
- Donald R. Royall
- Department of PsychiatryUniversity of Texas Health Science CenterSan AntonioTexasUSA
- Department of MedicineUniversity of Texas Health Science CenterSan AntonioTexasUSA
- Department of Family and Community MedicineUniversity of Texas Health Science CenterSan AntonioTexasUSA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DisordersSan AntonioUSA
| | - Raymond F. Palmer
- Department of Family and Community MedicineUniversity of Texas Health Science CenterSan AntonioTexasUSA
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Briceño EM, Mehdipanah R, Gonzales XF, Langa KM, Levine DA, Garcia NM, Longoria R, Giordani BJ, Heeringa SG, Morgenstern LB. Neuropsychological assessment of mild cognitive impairment in Latinx adults: A scoping review. Neuropsychology 2020; 34:493-510. [PMID: 32281811 DOI: 10.1037/neu0000628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Latinx populations are rapidly growing and aging in the United States. There is a critical need to accurately and efficiently detect those at risk for dementia, particularly those with mild cognitive impairment (MCI). MCI diagnosis often relies on neuropsychological assessment, although cultural, demographic, and linguistic characteristics may impact test scores. This study provides a scoping review of neuropsychological studies on MCI in Hispanic/Latinx populations to evaluate how studies report and account for these factors in diagnosis of MCI. Method: Studies were identified using Web of Science, PubMed, and Scopus, using search terms (Hispanic* OR Latin* OR "Mexican American*" OR "Puerto Ric*" OR Caribbean) and ("Mild Cognitive Impairment" OR MCI). Studies using neuropsychological tests in diagnosis of MCI for Latinx individuals in the United States were identified. Sample characterization (e.g., country of origin, literacy, language preference and proficiency), neuropsychological testing methods (e.g., test selection and translation, normative data source), and method of MCI diagnosis were reviewed. Results: Forty-four articles met inclusion criteria. There was considerable variability in reporting of demographic, cultural and linguistic factors across studies of MCI in Latinx individuals. For example, only 5% of studies reported nativity status, 52% reported information on language preference and use, and 34% reported the method and/or source of test translation and adaptation. Conclusions: Future studies of diagnosis of MCI in Latinx individuals should report cultural details and use of appropriate neuropsychological assessment tools and normative data. This is important to accurately estimate the prevalence of MCI in Latinx individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Emily M Briceño
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School
| | | | | | - Kenneth M Langa
- Development Service (HSR&D), Center for Clinical Management Research (CCMR), University of Michigan
| | - Deborah A Levine
- Development Service (HSR&D), Center for Clinical Management Research (CCMR), University of Michigan
| | - Nelda M Garcia
- Department of Neurology, University of Michigan Medical School
| | - Ruth Longoria
- Department of Neurology, University of Michigan Medical School
| | - Bruno J Giordani
- Departments of Psychiatry, Neurology, and Psychology and School of Nursing, University of Michigan
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Royall DR, Bishnoi RJ, Palmer RF. Blood-based protein predictors of dementia severity as measured by δ: Replication across biofluids and cohorts. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:763-774. [PMID: 31909176 PMCID: PMC6939046 DOI: 10.1016/j.dadm.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dementia severity can be empirically described by the latent dementia phenotype "δ" and its various composite "homologs". We have explored δ's blood-based protein biomarkers in the Texas Alzheimer's Research and Care Consortium (TARCC) study. However, it would be convenient to replicate those associations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). To this end, we recently engineered a δ homolog from observed cognitive performance measures common to both projects (i.e., "dT2A"). METHODS We used nine rationally chosen peripheral blood-based protein biomarkers as indicators of a latent variable "INFLAMMATION". We then associated that construct with dT2A in structural equation models adjusted for age, gender, depressive symptoms, and apolipoprotein E (APOE) ε4 allelic burden. Significant factor loadings and INFLAMMATION's association with dT2A were confirmed in random splits of TARCC's relatively large sample, and across biofluids in the ADNI. RESULTS Nine proteins measured in serum (TARCC) or plasma (ADNI) explained ≅10% of dT2A's variance in both samples, independently of age, APOE, education, and gender. All loaded significantly on INFLAMMATION, and positively or negatively, depending on their known roles are PRO- or ANTI-inflammatory proteins, respectively. The parameters of interest were confirmed across random 50% splits of the TARCC's sample, and replicated across biofluids in the ADNI. DISCUSSION These results suggest that SEM can be used to replicate biomarker findings across samples and biofluids, and that a substantial fraction of dementia's variance is attributable to peripheral blood-based protein levels.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- The Biggs Institute for Alzheimer's and Neurodegenerative Disease, the University of Texas Health Science Center, San Antonio, TX, USA
| | - Ram J. Bishnoi
- The Department of Psychiatry, The Medical College of Georgia, Augusta, GA, USA
| | - Raymond F. Palmer
- Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
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Royall DR, Palmer RF. Selection for depression-specific dementia cases with replication in two cohorts. PLoS One 2019; 14:e0216413. [PMID: 31150419 PMCID: PMC6544211 DOI: 10.1371/journal.pone.0216413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/21/2019] [Indexed: 01/01/2023] Open
Abstract
The latent variable "δ" (for "dementia") provides an etiologically "agnostic" omnibus dementia severity metric capable of recognizing the dementing potential of any condition. Depressive symptoms are independent predictors of δ and are thereby implicated as "dementing". Serum resistin levels partially mediate the association between depressive symptoms and δ. We use a novel "off-diagonal" CHI SQ algorithm to demonstrate our ability to select individuals demented solely by depression's effect in both the Texas Alzheimer's Research and Care Consortium (TARCC) (N ≌ 3,500), and the Alzheimer's Disease Neuroimaging Initiative (ADNI (N ≌ 1,750), and demonstrate the higher resistin levels of such cases in TARCC. This approach can be adapted to any δ-related dementia risk factor or biomarker and used identify individuals who might revert back to non-demented states after its successful treatment.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- South Texas Veterans’ Health System Audie L. Murphy Division Geriatric Research Education and Clinical Care Center, San Antonio, Texas, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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Royall DR, Palmer RF. δ Scores Identify Subsets of "Mild Cognitive Impairment" with Variable Conversion Risks. J Alzheimers Dis 2019; 70:199-210. [PMID: 31127788 DOI: 10.3233/jad-190266] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The latent variable "δ" (for "dementia) is a transdiagnostic measure of dementia severity. δ can be reified and applied to individuals as a composite "d-score". Like Spearman's general intelligence factor "g", δ can be constructed from almost any cognitive battery. So many are available that we must further distinguish each composite as a δ "homolog". Fourteen have been validated. All are strongly associated with dementia severity and potentially with mild cognitive impairment (MCI) conversion. OBJECTIVES To assess δ's impact on MCI conversion risk. METHODS A new δ homolog (dDx) was constructed in 1,230 Mexican-American (MA) and 2,215 non-Hispanic White (NHW) participants in the Texas Alzheimer's Research and Care Consortium (TARCC). 1,445 normal controls (NC) and 723 MCI were followed annually for up to 6 years. RESULTS Each SD decrease in the dDx score increased the risk of conversion sixteen-fold [OR = 16.39 (CI: 5.0-52.6)]. Cases below the optimal diagnostic threshold for Alzheimer's disease (AD) versus NC were labeled as having a functionally salient cognitive impairment (FSCI). Such cases were at a 73-fold increase risk of a diagnosis of AD [OR = 73.19 (95% CI: 58.3-92.0)]. However, 25.6% of MCI cases were also FSCI(+). They accounted disproportionately for prospective conversions. Age <80 years, the absence of an ɛ4 allele, <12 years of education, and MA ethnicity independently increased the risk of diagnosing FSCI as MCI. CONCLUSION A sizable minority of MCI cases may be misdiagnosed and they account disproportionately for AD conversions.
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Affiliation(s)
- Donald R Royall
- Departments of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Departments of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- Departments of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans' Health System Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F Palmer
- Departments of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
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Royall DR, Al-Rubaye S, Bishnoi R, Palmer RF. Serum proteins mediate depression's association with dementia. PLoS One 2017; 12:e0175790. [PMID: 28594820 PMCID: PMC5464526 DOI: 10.1371/journal.pone.0175790] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/31/2017] [Indexed: 01/08/2023] Open
Abstract
The latent variable "δ" (for "dementia") uniquely explains dementia severity. Depressive symptoms are independent predictors of δ. We explored 115 serum proteins as potential causal mediators of the effect of depressive symptoms on δ in a large, ethnically diverse, longitudinal cohort. All models were adjusted for age, apolipoprotein E, education, ethnicity, gender, hemoglobin A1c, and homocysteine, and replicated in randomly selected 50% subsets. Alpha1-antitrypsin (A1AT), FAS, Heparin-binding EGF-like Growth Factor (HB-EGF), Insulin-like Growth Factor-1 (IGF-1), Luteinizing Hormone (LH), Macrophage Inflammatory Protein type 1 alpha (MIP-1α), Resitin, S100b, Tissue Inhibitor of Metalloproteinase type 1 (TIMP-1), and Vascular Cell Adhesion Molecule type 1 (VCAM-1) each were partial mediators of depression's association with δ. These proteins may offer targets for the treatment of depression's specific effect on dementia severity and Alzheimer's Disease (AD) conversion risk.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- South Texas Veterans’ Health System Audie L. Murphy Division Geriatric Research Education and Clinical Care Center, San Antonio, Texas, United States of America
| | - Safa Al-Rubaye
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Ram Bishnoi
- Department of Psychiatry, the Medical College of Georgia, Augusta, Georgia, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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