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Wang S, Zheng X, Huang J, Liu J, Li C, Shang H. Sleep characteristics and risk of Alzheimer's disease: a systematic review and meta-analysis of longitudinal studies. J Neurol 2024; 271:3782-3793. [PMID: 38656621 DOI: 10.1007/s00415-024-12380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Alzheimer's disease (AD) is on the rise in our aging society, making it crucial to identify additional risk factors to mitigate its increasing incidence. This systematic review and meta-analysis aimed to provide updated evidence regarding the association between sleep and AD. METHODS We conducted a comprehensive search of MEDLINE, EMBASE, and Web of Science databases from inception to July 2023 to identify longitudinal studies. Adjusted relative risks were pooled for each sleep characteristic, and a dose-response analysis was performed specifically for sleep duration. RESULTS A total of 15,278 records were initially retrieved, and after screening, 35 records were ultimately included in the final analysis. The results showed that insomnia (RR, 1.43; 95%CI, 1.17-1.74), sleep-disordered breathing (RR, 1.22; 95%CI, 1.07-1.39), as well as other sleep problems, including sleep fragmentation and sleep-related movement disorders, were associated with a higher risk of developing AD, while daytime napping or excessive daytime sleepiness (RR, 1.18; 95%CI, 1.00-1.40) only exhibited a trend toward a higher risk of AD development. Furthermore, our analysis revealed a significant association between self-reported sleep problems (RR, 1.34; 95%CI, 1.26-1.42) and the incidence of AD, whereas this association was not observed with sleep problems detected by objective measurements (RR, 1.14; 95%CI, 0.99-1.31). Moreover, both quite short sleep duration (< 4 h) and long duration (> 8 h) were identified as potential risk factors for AD. CONCLUSIONS Our study found the association between various types of sleep problems and an increased risk of AD development. However, these findings should be further validated through additional objective device-based assessments. Additional investigation is required to establish a definitive causal connection between sleep problems and AD.
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Affiliation(s)
- Shichan Wang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China
| | - Xiaoting Zheng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China
| | - Jingxuan Huang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China
| | - Jiyong Liu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China
| | - Chunyu Li
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China.
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China.
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2
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Chen Y, Al-Nusaif M, Li S, Tan X, Yang H, Cai H, Le W. Progress on early diagnosing Alzheimer's disease. Front Med 2024; 18:446-464. [PMID: 38769282 DOI: 10.1007/s11684-023-1047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/15/2023] [Indexed: 05/22/2024]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder that affects both cognition and non-cognition functions. The disease follows a continuum, starting with preclinical stages, progressing to mild cognitive and behavioral impairment, ultimately leading to dementia. Early detection of AD is crucial for better diagnosis and more effective treatment. However, the current AD diagnostic tests of biomarkers using cerebrospinal fluid and/or brain imaging are invasive or expensive, and mostly are still not able to detect early disease state. Consequently, there is an urgent need to develop new diagnostic techniques with higher sensitivity and specificity during the preclinical stages of AD. Various non-cognitive manifestations, including behavioral abnormalities, sleep disturbances, sensory dysfunctions, and physical changes, have been observed in the preclinical AD stage before occurrence of notable cognitive decline. Recent research advances have identified several biofluid biomarkers as early indicators of AD. This review focuses on these non-cognitive changes and newly discovered biomarkers in AD, specifically addressing the preclinical stages of the disease. Furthermore, it is of importance to explore the potential for developing a predictive system or network to forecast disease onset and progression at the early stage of AD.
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Affiliation(s)
- Yixin Chen
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Murad Al-Nusaif
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Song Li
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Xiang Tan
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Huijia Yang
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Huaibin Cai
- Transgenic Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China.
- Institute of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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3
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Winer JR. The role of actigraphy in detecting and characterizing the early phases of Alzheimer's disease. Sleep 2024; 47:zsae076. [PMID: 38497688 PMCID: PMC11082468 DOI: 10.1093/sleep/zsae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Joseph R Winer
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA, USA
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4
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Li P, Gao C, Yu L, Gao L, Cai R, Bennett DA, Schneider JA, Buchman AS, Hu K. Delineating cognitive resilience using fractal regulation: Cross-sectional and longitudinal evidence from the Rush Memory and Aging Project. Alzheimers Dement 2024; 20:3203-3210. [PMID: 38497429 PMCID: PMC11095481 DOI: 10.1002/alz.13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Degradation of fractal patterns in actigraphy independently predicts dementia risk. Such observations motivated the study to understand the role of fractal regulation in the context of neuropathologies. METHODS We examined associations of fractal regulation with neuropathologies and longitudinal cognitive changes in 533 older participants who were followed annually with actigraphy and cognitive assessments until death with brain autopsy performed. Two measures for fractal patterns were extracted from actigraphy, namely, α1 (representing the fractal regulation at time scales of <90 min) and α2 (for time scales 2 to 10 h). RESULTS We found that larger α1 was associated with lower burdens of Lewy body disease or cerebrovascular disease pathologies; both α1 and α2 were associated with cognitive decline. They explained an additional significant portion of the variance in the rate of cognitive decline above and beyond neuropathologies. DISCUSSION Fractal patterns may be used as a biomarker for cognitive resilience against dementia-related neuropathologies.
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Affiliation(s)
- Peng Li
- Department of AnesthesiaCritical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Medical Biodynamics Program, Division of Sleep and Circadian DisordersBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Broad Institute of MIT and HarvardCambridgeMassachusettsUSA
| | - Chenlu Gao
- Department of AnesthesiaCritical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Medical Biodynamics Program, Division of Sleep and Circadian DisordersBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Broad Institute of MIT and HarvardCambridgeMassachusettsUSA
| | - Lei Yu
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Lei Gao
- Department of AnesthesiaCritical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Medical Biodynamics Program, Division of Sleep and Circadian DisordersBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Broad Institute of MIT and HarvardCambridgeMassachusettsUSA
| | - Ruixue Cai
- Department of AnesthesiaCritical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Medical Biodynamics Program, Division of Sleep and Circadian DisordersBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - David A. Bennett
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Julie A. Schneider
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Aron S. Buchman
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Kun Hu
- Department of AnesthesiaCritical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Medical Biodynamics Program, Division of Sleep and Circadian DisordersBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Broad Institute of MIT and HarvardCambridgeMassachusettsUSA
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5
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Smagula SF, Zhang G, Krafty RT, Ramos A, Sotres-Alvarez D, Rodakowski J, Gallo LC, Lamar M, Gujral S, Fischer D, Tarraf W, Mossavar-Rahmani Y, Redline S, Stone KL, Gonzalez HM, Patel SR. Sleep-wake behaviors associated with cognitive performance in middle-aged participants of the Hispanic Community Health Study/Study of Latinos. Sleep Health 2024:S2352-7218(24)00027-5. [PMID: 38693044 DOI: 10.1016/j.sleh.2024.02.002] [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: 10/02/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Many sleep-wake behaviors have been associated with cognition. We examined a panel of sleep-wake/activity characteristics to determine which are most robustly related to having low cognitive performance in midlife. Secondarily, we evaluate the predictive utility of sleep-wake measures to screen for low cognitive performance. METHODS The outcome was low cognitive performance defined as being >1 standard deviation below average age/sex/education internally normalized composite cognitive performance levels assessed in the Hispanic Community Health Study/Study of Latinos. Analyses included 1006 individuals who had sufficient sleep-wake measurements about 2years later (mean age=54.9, standard deviation= 5.1; 68.82% female). We evaluated associations of 31 sleep-wake variables with low cognitive performance using separate logistic regressions. RESULTS In individual models, the strongest sleep-wake correlates of low cognitive performance were measures of weaker and unstable 24-hour rhythms; greater 24-hour fragmentation; longer time-in-bed; and lower rhythm amplitude. One standard deviation worse on these sleep-wake factors was associated with ∼20%-30% greater odds of having low cognitive performance. In an internally cross-validated prediction model, the independent correlates of low cognitive performance were: lower Sleep Regularity Index scores; lower pseudo-F statistics (modellability of 24-hour rhythms); lower activity rhythm amplitude; and greater time in bed. Area under the curve was low/moderate (64%) indicating poor predictive utility. CONCLUSION The strongest sleep-wake behavioral correlates of low cognitive performance were measures of longer time-in-bed and irregular/weak rhythms. These sleep-wake assessments were not useful to identify previous low cognitive performance. Given their potential modifiability, experimental trials could test if targeting midlife time-in-bed and/or irregular rhythms influences cognition.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Gehui Zhang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Alberto Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Linda C Gallo
- Department of Psychology, University of California San Diego, San Diego, California, USA
| | - Melissa Lamar
- Institute of Minority Health Research, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Swathi Gujral
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dorothee Fischer
- Department of Sleep and Human Factors Research, Institute for Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Hector M Gonzalez
- Department of Neurosciences and the Shiley-Marcos Alzheimer's Disease Research Center, UC San Diego, San Diego, California, USA
| | - Sanjay R Patel
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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6
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Lee MP, Hoang K, Park S, Song YM, Joo EY, Chang W, Kim JH, Kim JK. Imputing missing sleep data from wearables with neural networks in real-world settings. Sleep 2024; 47:zsad266. [PMID: 37819273 DOI: 10.1093/sleep/zsad266] [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: 05/15/2023] [Revised: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Sleep is a critical component of health and well-being but collecting and analyzing accurate longitudinal sleep data can be challenging, especially outside of laboratory settings. We propose a simple neural network model titled SOMNI (Sleep data restOration using Machine learning and Non-negative matrix factorIzation [NMF]) for imputing missing rest-activity data from actigraphy, which can enable clinicians to better handle missing data and monitor sleep-wake cycles of individuals with highly irregular sleep-wake patterns. The model consists of two hidden layers and uses NMF to capture hidden longitudinal sleep-wake patterns of individuals with disturbed sleep-wake cycles. Based on this, we develop two approaches: the individual approach imputes missing data based on the data from only one participant, while the global approach imputes missing data based on the data across multiple participants. Our models are tested with shift and non-shift workers' data from three independent hospitals. Both approaches can accurately impute missing data up to 24 hours of long dataset (>50 days) even for shift workers with extremely irregular sleep-wake patterns (AUC > 0.86). On the other hand, for short dataset (~15 days), only the global model is accurate (AUC > 0.77). Our approach can be used to help clinicians monitor sleep-wake cycles of patients with sleep disorders outside of laboratory settings without relying on sleep diaries, ultimately improving sleep health outcomes.
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Affiliation(s)
- Minki P Lee
- Department of Mathematics, University of Michigan, Ann Arbor, MI, USA
| | - Kien Hoang
- Institute of Mathematics, EPFL, Lausanne, Switzerland
| | - Sungkyu Park
- Department of Artificial Intelligence Convergence, Kangwon National University, Chuncheon, Republic of Korea
| | - Yun Min Song
- Department of Mathematical Sciences, KAIST, Daejeon, Republic of Korea
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chang
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Jee Hyun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jae Kyoung Kim
- Department of Mathematical Sciences, KAIST, Daejeon, Republic of Korea
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
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7
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Cerasa A. Fractals in Neuropsychology and Cognitive Neuroscience. ADVANCES IN NEUROBIOLOGY 2024; 36:761-778. [PMID: 38468062 DOI: 10.1007/978-3-031-47606-8_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The fractal dimension of cognition refers to the idea that the cognitive processes of the human brain exhibit fractal properties. This means that certain patterns of cognitive activity, such as visual perception, memory, language, or problem-solving, can be described using the mathematical concept of fractal dimension.The idea that cognition is fractal has been proposed by some researchers as a way to understand the complex, self-similar nature of the human brain. However, it's a relatively new idea and is still under investigation, so it's not yet clear to what extent cognitive processes exhibit fractal properties or what implications this might have for our understanding of the brain and clinical practice. Indeed, the mission of the "fractal neuroscience" field is to define the characteristics of fractality in human cognition in order to differently characterize the emergence of brain disorders.
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Affiliation(s)
- Antonio Cerasa
- Institute for Biomedical Research and Innovation, National Research Council, IRIB-CNR, Messina, Italy
- S. Anna Institute, Crotone, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Arcavacata, Italy
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8
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Sun H, Li P, Gao L, Yang J, Yu L, Buchman AS, Bennett DA, Westover MB, Hu K. Altered Motor Activity Patterns within 10-Minute Timescale Predict Incident Clinical Alzheimer's Disease. J Alzheimers Dis 2024; 98:209-220. [PMID: 38393904 PMCID: PMC10977378 DOI: 10.3233/jad-230928] [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] [Accepted: 12/30/2023] [Indexed: 02/25/2024]
Abstract
Background Fractal motor activity regulation (FMAR), characterized by self-similar temporal patterns in motor activity across timescales, is robust in healthy young humans but degrades with aging and in Alzheimer's disease (AD). Objective To determine the timescales where alterations of FMAR can best predict the clinical onset of AD. Methods FMAR was assessed from actigraphy at baseline in 1,077 participants who had annual follow-up clinical assessments for up to 15 years. Survival analysis combined with deep learning (DeepSurv) was used to examine how baseline FMAR at different timescales from 3 minutes up to 6 hours contributed differently to the risk for incident clinical AD. Results Clinical AD occurred in 270 participants during the follow-up. DeepSurv identified three potential regions of timescales in which FMAR alterations were significantly linked to the risk for clinical AD: <10, 20-40, and 100-200 minutes. Confirmed by the Cox and random survival forest models, the effect of FMAR alterations in the timescale of <10 minutes was the strongest, after adjusting for covariates. Conclusions Subtle changes in motor activity fluctuations predicted the clinical onset of AD, with the strongest association observed in activity fluctuations at timescales <10 minutes. These findings suggest that short actigraphy recordings may be used to assess the risk of AD.
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Affiliation(s)
- Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lei Gao
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jingyun Yang
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | | | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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9
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Blodgett JM, Ahmadi M, Stamatakis E, Rockwood K, Hamer M. Fractal complexity of daily physical activity and cognitive function in a midlife cohort. Sci Rep 2023; 13:20340. [PMID: 37990028 PMCID: PMC10663528 DOI: 10.1038/s41598-023-47200-x] [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: 06/02/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
High stability of fluctuation in physiological patterns across fixed time periods suggest healthy fractal complexity, while greater randomness in fluctuation patterns may indicate underlying disease processes. The importance of fractal stability in mid-life remains unexplored. We quantified fractal regulation patterns in 24-h accelerometer data and examined associations with cognitive function in midlife. Data from 5097 individuals (aged 46) from the 1970 British Cohort Study were analyzed. Participants wore thigh-mounted accelerometers for seven days and completed cognitive tests (verbal fluency, memory, processing speed; derived composite z-score). Detrended fluctuation analysis (DFA) was used to examine temporal correlations of acceleration magnitude across 25 time scales (range: 1 min-10 h). Linear regression examined associations between DFA scaling exponents (DFAe) and each standardised cognitive outcome. DFAe was normally distributed (mean ± SD: 0.90 ± 0.06; range: 0.72-1.25). In males, a 0.10 increase in DFAe was associated with a 0.30 (95% Confidence Interval: 0.14, 0.47) increase in composite cognitive z-score in unadjusted models; associations were strongest for verbal fluency (0.10 [0.04, 0.16]). Associations remained in fully-adjusted models for verbal fluency only (0.06 [0.00, 0.12]). There was no association between DFA and cognition in females. Greater fractal stability in men was associated with better cognitive function. This could indicate mechanisms through which fractal complexity may scale up to and contribute to cognitive clinical endpoints.
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Affiliation(s)
- Joanna M Blodgett
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Science, University College London, London, UK.
| | - Matthew Ahmadi
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Mackenzie Wearables Research Hub, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Emmanuel Stamatakis
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Mackenzie Wearables Research Hub, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Kenneth Rockwood
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mark Hamer
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Science, University College London, London, UK
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10
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Pruthviraja D, Nagaraju SC, Mudligiriyappa N, Raisinghani MS, Khan SB, Alkhaldi NA, Malibari AA. Detection of Alzheimer's Disease Based on Cloud-Based Deep Learning Paradigm. Diagnostics (Basel) 2023; 13:2687. [PMID: 37627946 PMCID: PMC10453097 DOI: 10.3390/diagnostics13162687] [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: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Deep learning is playing a major role in identifying complicated structure, and it outperforms in term of training and classification tasks in comparison to traditional algorithms. In this work, a local cloud-based solution is developed for classification of Alzheimer's disease (AD) as MRI scans as input modality. The multi-classification is used for AD variety and is classified into four stages. In order to leverage the capabilities of the pre-trained GoogLeNet model, transfer learning is employed. The GoogLeNet model, which is pre-trained for image classification tasks, is fine-tuned for the specific purpose of multi-class AD classification. Through this process, a better accuracy of 98% is achieved. As a result, a local cloud web application for Alzheimer's prediction is developed using the proposed architectures of GoogLeNet. This application enables doctors to remotely check for the presence of AD in patients.
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Affiliation(s)
- Dayananda Pruthviraja
- Department of Information Technology, Manipal Institute of Technology Bengaluru, Manipal Academy of Higher Education, Manipal 576104, India
| | - Sowmyarani C. Nagaraju
- Department of Computer Science and Engineering, R V College of Engineering, Bengaluru 560059, India
| | - Niranjanamurthy Mudligiriyappa
- Department of Artificial Intelligence and Machine Learning, BMS Institute of Technology and Management, Bengaluru 560064, India
| | | | - Surbhi Bhatia Khan
- Department of Data Science, School of Science, Engineering and Environment, University of Salford, Manchester M54WT, UK
| | - Nora A. Alkhaldi
- Department of Computer Science, College of Computer Science and Information Technology, King Faisal University, Al Ahsa 31982, Saudi Arabia
| | - Areej A. Malibari
- Department of Industrial and Systems Engineering, College of Engineering, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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11
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Buchman AS, Wang T, Oveisgharan S, Zammit AR, Yu L, Li P, Hu K, Hausdorff JM, Lim ASP, Bennett DA. Correlates of Person-Specific Rates of Change in Sensor-Derived Physical Activity Metrics of Daily Living in the Rush Memory and Aging Project. SENSORS (BASEL, SWITZERLAND) 2023; 23:4152. [PMID: 37112493 PMCID: PMC10142139 DOI: 10.3390/s23084152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023]
Abstract
This study characterized person-specific rates of change of total daily physical activity (TDPA) and identified correlates of this change. TDPA metrics were extracted from multiday wrist-sensor recordings from 1083 older adults (average age 81 years; 76% female). Thirty-two covariates were collected at baseline. A series of linear mixed-effect models were used to identify covariates independently associated with the level and annual rate of change of TDPA. Though, person-specific rates of change varied during a mean follow-up of 5 years, 1079 of 1083 showed declining TDPA. The average decline was 16%/year, with a 4% increased rate of decline for every 10 years of age older at baseline. Following variable selection using multivariate modeling with forward and then backward elimination, age, sex, education, and 3 of 27 non-demographic covariates including motor abilities, a fractal metric, and IADL disability remained significantly associated with declining TDPA accounting for 21% of its variance (9% non-demographic and 12% demographics covariates). These results show that declining TDPA occurs in many very old adults. Few covariates remained correlated with this decline and the majority of its variance remained unexplained. Further work is needed to elucidate the biology underlying TDPA and to identify other factors that account for its decline.
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Affiliation(s)
- Aron S. Buchman
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Tianhao Wang
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Shahram Oveisgharan
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Andrea R. Zammit
- Rush Alzheimer’s Disease Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Peng Li
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Kun Hu
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Jeffrey M. Hausdorff
- Rush Alzheimer’s Disease Center, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv 6492416, Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Andrew S. P. Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
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12
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Cai R, Gao L, Gao C, Yu L, Zheng X, Bennett D, Buchman A, Hu K, Li P. Circadian disturbances and frailty risk in older adults: a prospective cohort study. RESEARCH SQUARE 2023:rs.3.rs-2648399. [PMID: 37034594 PMCID: PMC10081385 DOI: 10.21203/rs.3.rs-2648399/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Frailty is characterized by diminished resilience to stressor events. It associates with adverse future health outcomes and impedes healthy aging. The circadian system orchestrates a ~24-h rhythm in bodily functions in synchrony with the day-night cycle, and disturbed circadian regulation plays an important role in many age-related health consequences. We investigated prospective associations of circadian disturbances with incident frailty in over 1,000 older adults who had been followed annually for up to 16 years. We found that decreased rhythm strength, reduced stability, or increased variation, were associated with a higher risk of incident frailty, and faster worsening of the overall frailty symptoms over time. Perturbed circadian rest-activity rhythms may be an early sign or risk factor for frailty in older adults.
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Affiliation(s)
| | - Lei Gao
- Brigham and Women's Hospital
| | | | - Lei Yu
- Rush University Medical Center
| | | | | | | | - Kun Hu
- Brigham and Women's Hospital
| | - Peng Li
- Brigham and Women's Hospital/ Harvard Medical School
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13
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Elgammal YM, Zahran MA, Abdelsalam MM. A new strategy for the early detection of alzheimer disease stages using multifractal geometry analysis based on K-Nearest Neighbor algorithm. Sci Rep 2022; 12:22381. [PMID: 36572791 PMCID: PMC9792538 DOI: 10.1038/s41598-022-26958-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022] Open
Abstract
Alzheimer's Disease (AD) is considered one of the most diseases that much prevalent among elderly people all over the world. AD is an incurable neurodegenerative disease affecting cognitive functions and were characterized by progressive and collective functions deteriorating. Remarkably, early detection of AD is essential for the development of new and invented treatment strategies. As Dementia causes irreversible damage to the brain neurons and leads to changes in its structure that can be described adequately within the framework of multifractals. Hence, the present work focus on developing a promising and efficient computing technique to pre-process and classify the AD disease especially in the early stages using multifractal geometry to extract the most changeable features due to AD. Then, A machine learning classification algorithm (K-Nearest Neighbor) has been implemented in order to classify and detect the main four early stages of AD. Two datasets have been used to ensure the validation of the proposed methodology. The proposed technique has achieved 99.4% accuracy and 100% sensitivity. The comparative results show that the proposed classification technique outperforms is recent techniques in terms of performance measures.
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Affiliation(s)
- Yasmina M Elgammal
- Theoretical Physics Group, Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - M A Zahran
- Theoretical Physics Group, Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Mohamed M Abdelsalam
- Computers Engineering and Control Systems Department, Faculty of Engineering, Mansoura University, Mansoura, Egypt.
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14
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Fragmentation, circadian amplitude, and fractal pattern of daily-living physical activity in people with multiple sclerosis: Is there relevant information beyond the total amount of physical activity? Mult Scler Relat Disord 2022; 68:104108. [PMID: 36063732 DOI: 10.1016/j.msard.2022.104108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Physical activity is lower in people with multiple sclerosis (pwMS) compared to healthy controls. Previous work focused on studying activity levels or activity volume, but studies of daily-living rest-activity fragmentation patterns, circadian rhythms, and fractal regulation in pwMS are limited. Based on findings in other cohorts, one could suggest that these aspects of daily-living physical activity will provide additional information about the health and well-being of pwMS. Therefore, here, we aimed to (1) identify which fragmentation, fractal, and circadian amplitude measures differ between pwMS and healthy controls, (2) evaluate the relationship between fragmentation, fractal, and circadian amplitude measures and disease severity, and (3) begin to evaluate the added value of those measures, as compared to more conventional measures of physical activity (e.g., mean signal vector magnitude (SVM). A global measure of the overall volume of physical activity). METHODS 132 people with relapsing-remitting MS (47±11 yrs, 69.7% female, Expanded Disability Status Scale, EDSS, median (IQR): 3 (2-4)) and 90 healthy controls (46±11 yrs, 47.8% female) were asked to wear a 3D accelerometer on their lower back for 7 days. Rest-activity fragmentation, circadian amplitude, fractal regulation, and mean SVM metrics were extracted. PwMS and healthy controls were compared using independent samples t-tests and linear regression, including comparisons adjusted for mean SVM to control for the effect of physical activity volume. Spearman correlations between measures and logistic regressions were used to identify the clinical condition based on the measures that differed significantly after adjusting for SVM. All analyses included adjustments for demographic and clinical parameters (e.g., age, sex). RESULTS Multiple measures of activity fragmentation significantly differed between pwMS and healthy controls, reflecting a more fragmented active behavior in pwMS. PwMS had a lower circadian rhythm amplitude, indicating a smaller amplitude in the circadian changes of daily activity, and weaker temporal correlations as based on the fractal analysis. When taking into account physical activity volume, one circadian amplitude measure and one fractal measure remained significantly different in pwMS and controls. Fragmentation measures and circadian amplitude measures were significantly associated with disability level as measured by the EDSS; the association with circadian amplitude remained significant, even after adjusting for the mean SVM. CONCLUSION The physical activity patterns of pwMS differ from those of healthy individuals in rest-activity fragmentation, the amplitude of the circadian rhythm, and fractal regulation. Measures describing these aspects of activity provide information that is not captured in the total volume of physical activity and could, perhaps, augment the monitoring of disease progression and evaluation of the response to interventions.
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15
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Reyt M, Deantoni M, Baillet M, Lesoinne A, Laloux S, Lambot E, Demeuse J, Calaprice C, LeGoff C, Collette F, Vandewalle G, Maquet P, Muto V, Hammad G, Schmidt C. Daytime rest: Association with 24-h rest-activity cycles, circadian timing and cognition in older adults. J Pineal Res 2022; 73:e12820. [PMID: 35906192 DOI: 10.1111/jpi.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
Growing epidemiological evidence points toward an association between fragmented 24-h rest-activity cycles and cognition in the aged. Alterations in the circadian timing system might at least partially account for these observations. Here, we tested whether daytime rest (DTR) is associated with changes in concomitant 24-h rest probability profiles, circadian timing and neurobehavioural outcomes in healthy older adults. Sixty-three individuals (59-82 years) underwent field actigraphy monitoring, in-lab dim light melatonin onset assessment and an extensive cognitive test battery. Actimetry recordings were used to measure DTR frequency, duration and timing and to extract 24-h rest probability profiles. As expected, increasing DTR frequency was associated not only with higher rest probabilities during the day, but also with lower rest probabilities during the night, suggesting more fragmented night-time rest. Higher DTR frequency was also associated with lower episodic memory performance. Moreover, later DTR timing went along with an advanced circadian phase as well as with an altered phase angle of entrainment between the rest-activity cycle and circadian phase. Our results suggest that different DTR characteristics, as reflective indices of wake fragmentation, are not only underlined by functional consequences on cognition, but also by circadian alteration in the aged.
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Affiliation(s)
- Mathilde Reyt
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), Faculty of Psychology, Speech and Language, University of Liège, Liège, Belgium
| | - Michele Deantoni
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Marion Baillet
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Alexia Lesoinne
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Sophie Laloux
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Eric Lambot
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Justine Demeuse
- Department of Clinical Chemistry, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Chiara Calaprice
- Department of Clinical Chemistry, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Caroline LeGoff
- Department of Clinical Chemistry, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Fabienne Collette
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), Faculty of Psychology, Speech and Language, University of Liège, Liège, Belgium
| | - Gilles Vandewalle
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Pierre Maquet
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
- Department of Neurology, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Vincenzo Muto
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Grégory Hammad
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
| | - Christina Schmidt
- Sleep & Chronobiology Group, GIGA-CRC-In Vivo Imaging Research Unit, University of Liège, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), Faculty of Psychology, Speech and Language, University of Liège, Liège, Belgium
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16
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Smagula SF, Zhang G, Gujral S, Covassin N, Li J, Taylor WD, Reynolds CF, Krafty RT. Association of 24-Hour Activity Pattern Phenotypes With Depression Symptoms and Cognitive Performance in Aging. JAMA Psychiatry 2022; 79:1023-1031. [PMID: 36044201 PMCID: PMC9434485 DOI: 10.1001/jamapsychiatry.2022.2573] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022]
Abstract
Importance Evidence regarding the nature and prevalence of 24-hour activity pattern phenotypes in older adults, especially those related to depression symptoms and cognition, is needed to guide the development of targeted mechanism research and behavioral interventions. Objectives To identify subgroups of older adults with similar 24-hour activity rhythm characteristics and characterize associated depression symptoms and cognitive performance. Design, Setting, and Participants From January to March 2022, a cross-sectional analysis of the 2011-2014 National Health and Nutrition Examination and Survey (NHANES) accelerometer study was conducted. The NHANES used a multistage probability sample that was designed to be representative of noninstitutionalized adults in the US. The main analysis included participants 65 years or older who had accelerometer and depression measures weighted to represent approximately 32 million older adults. Exposures Latent profile analysis identified subgroups with similar 24-hour activity pattern characteristics as measured using extended-cosine and nonparametric methods. Main Outcomes and Measures Covariate-adjusted sample-weighted regressions assessed associations of subgroup membership with (1) depression symptoms defined as 9-Item Patient Health Questionnaire (PHQ-9) scores of 10 or greater (PHQ-9) and (2) having at least psychometric mild cognitive impairment (p-MCI) defined as scoring less than 1 SD below the mean on a composite cognitive performance score. Results The actual clustering sample size was 1800 (weighted: mean [SD] age, 72.9 [7.3] years; 57% female participants). Clustering identified 4 subgroups: (1) 677 earlier rising/robust (37.6%), (2) 587 shorter active period/less modelable (32.6%), (3) 177 shorter active period/very weak (9.8%), and (4) 359 later settling/very weak (20.0%). The prevalence of a PHQ-9 score of 10 or greater differed significantly across groups (cluster 1, 3.5%; cluster 2, 4.7%; cluster 3, 7.5%; cluster 4, 9.0%; χ2 P = .004). The prevalence of having at least p-MCI differed significantly across groups (cluster 1, 7.2%; cluster 2, 12.0%; cluster 3, 21.0%; cluster 4, 18.0%; χ2 P < .001). Five of 9 depression symptoms differed significantly across subgroups. Conclusions and Relevance In this cross-sectional study, findings indicate that approximately 1 in 5 older adults in the US may be classified in a subgroup with weak activity patterns and later settling, and approximately 1 in 10 may be classified in a subgroup with weak patterns and shorter active duration. Future research is needed to investigate the biologic processes related to these behavioral phenotypes, including why earlier and robust activity patterns appear protective, and whether modifying disrupted patterns improves outcomes.
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Affiliation(s)
- Stephen F. Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, Pennsylvania
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gehui Zhang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Swathi Gujral
- Department of Psychiatry, School of Medicine, University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jingen Li
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Warren D. Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charles F. Reynolds
- Department of Psychiatry, School of Medicine, University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Robert T. Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
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17
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Marquez DX, Wilbur J, Hughes S, Wilson R, Buchner DM, Berbaum ML, McAuley E, Aguiñaga S, Balbim GM, Vásquez PM, Marques IG, Wang T, Kaushal N. BAILA: A Randomized Controlled Trial of Latin Dancing to Increase Physical Activity in Spanish-Speaking Older Latinos. Ann Behav Med 2022; 56:1231-1243. [PMID: 35445687 PMCID: PMC9672351 DOI: 10.1093/abm/kaac009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Latinos are the fastest growing minority group of the older adult population. Although physical activity (PA) has documented health benefits, older Latinos are less likely to engage in leisure time PA than older non-Latino whites. Dance, popular among Latinos, holds promise as a culturally relevant form of PA. PURPOSE To describe self-reported and device-assessed changes in PA as a result of a randomized controlled trial of BAILAMOS, a 4-month Latin dance program with a 4-month maintenance program, versus a health education control group. METHODS Adults, aged 55+, Latino/Hispanic, Spanish speaking, with low PA levels at baseline, and risk for disability were randomized to the dance program (n = 167) or health education condition (n = 166). Data were analyzed using multilevel modeling with full information maximum likelihood. RESULTS A series of multilevel models revealed significant time × group interaction effects for moderate-to-vigorous physical activity (MVPA), dance PA, leisure PA, and total PA. Exploring the interaction revealed the dance group to significantly increase their MVPA, dance PA, leisure PA, and total PA at months 4 and 8. Household PA and activity counts from accelerometry data did not demonstrate significant interaction effects. CONCLUSIONS The study supports organized Latin dance programs to be efficacious in promoting self-reported PA among older Latinos. Efforts are needed to make dancing programs available and accessible, and to find ways for older Latinos to add more PA to their daily lives. CLINICAL TRIAL INFORMATION NCT01988233.
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Affiliation(s)
- David X Marquez
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, MC 994, Chicago, IL 60612, USA.,University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA
| | - JoEllen Wilbur
- Department of Women, Children and Family Nursing, Rush University, College of Nursing, Chicago, IL, USA
| | - Susan Hughes
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA
| | - Robert Wilson
- Rush University Medical Center, Department of Neurological Sciences, Rush Alzheimer's Disease Center, Chicago, IL, USA.,Rush University Medical Center, Department of Psychiatry and Behavioral Sciences, Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - David M Buchner
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
| | - Michael L Berbaum
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
| | - Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
| | - Guilherme M Balbim
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, MC 994, Chicago, IL 60612, USA
| | - Priscilla M Vásquez
- Charles R. Drew University of Medicine and Science, Department of Urban Public Health, College of Science and Health, Los Angeles, CA, USA
| | - Isabela G Marques
- University of São Paulo, Department of Medicine, São Paulo, Estado de Sao Paulo, Brazil
| | - Tianxiu Wang
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA
| | - Navin Kaushal
- Indiana University Purdue University at Indianapolis, School of Health and Human Sciences, Department of Health Sciences, Indianapolis, IN, USA
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18
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Iso-Markku P, Kujala UM, Knittle K, Polet J, Vuoksimaa E, Waller K. Physical activity as a protective factor for dementia and Alzheimer's disease: systematic review, meta-analysis and quality assessment of cohort and case-control studies. Br J Sports Med 2022; 56:701-709. [PMID: 35301183 PMCID: PMC9163715 DOI: 10.1136/bjsports-2021-104981] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 01/20/2023]
Abstract
Objective Physical activity (PA) is associated with a decreased incidence of dementia, but much of the evidence comes from short follow-ups prone to reverse causation. This meta-analysis investigates the effect of study length on the association. Design A systematic review and meta-analysis. Pooled effect sizes, dose–response analysis and funnel plots were used to synthesise the results. Data sources CINAHL (last search 19 October 2021), PsycInfo, Scopus, PubMed, Web of Science (21 October 2021) and SPORTDiscus (26 October 2021). Eligibility criteria Studies of adults with a prospective follow-up of at least 1 year, a valid cognitive measure or cohort in mid-life at baseline and an estimate of the association between baseline PA and follow-up all-cause dementia, Alzheimer’s disease or vascular dementia were included (n=58). Results PA was associated with a decreased risk of all-cause dementia (pooled relative risk 0.80, 95% CI 0.77 to 0.84, n=257 983), Alzheimer’s disease (0.86, 95% CI 0.80 to 0.93, n=128 261) and vascular dementia (0.79, 95% CI 0.66 to 0.95, n=33 870), even in longer follow-ups (≥20 years) for all-cause dementia and Alzheimer’s disease. Neither baseline age, follow-up length nor study quality significantly moderated the associations. Dose–response meta-analyses revealed significant linear, spline and quadratic trends within estimates for all-cause dementia incidence, but only a significant spline trend for Alzheimer’s disease. Funnel plots showed possible publication bias for all-cause dementia and Alzheimer’s disease. Conclusion PA was associated with lower incidence of all-cause dementia and Alzheimer’s disease, even in longer follow-ups, supporting PA as a modifiable protective lifestyle factor, even after reducing the effects of reverse causation.
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Affiliation(s)
- Paula Iso-Markku
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland .,HUS Diagnostic Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Keegan Knittle
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juho Polet
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eero Vuoksimaa
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Katja Waller
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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19
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Backes A, Gupta T, Schmitz S, Fagherazzi G, van Hees V, Malisoux L. Advanced analytical methods to assess physical activity behavior using accelerometer time series: A scoping review. Scand J Med Sci Sports 2021; 32:18-44. [PMID: 34695249 PMCID: PMC9298329 DOI: 10.1111/sms.14085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
Physical activity (PA) is a complex human behavior, which implies that multiple dimensions need to be taken into account in order to reveal a complete picture of the PA behavior profile of an individual. This scoping review aimed to map advanced analytical methods and their summary variables, hereinafter referred to as wearable‐specific indicators of PA behavior (WIPAB), used to assess PA behavior. The strengths and limitations of those indicators as well as potential associations with certain health‐related factors were also investigated. Three databases (MEDLINE, Embase, and Web of Science) were screened for articles published in English between January 2010 and April 2020. Articles, which assessed the PA behavior, gathered objective measures of PA using tri‐axial accelerometers, and investigated WIPAB, were selected. All studies reporting WIPAB in the context of PA monitoring were synthesized and presented in four summary tables: study characteristics, details of the WIPAB, strengths, and limitations, and measures of association between those indicators and health‐related factors. In total, 7247 records were identified, of which 24 articles were included after assessing titles, abstracts, and full texts. Thirteen WIPAB were identified, which can be classified into three different categories specifically focusing on (1) the activity intensity distribution, (2) activity accumulation, and (3) the temporal correlation and regularity of the acceleration signal. Only five of the thirteen WIPAB identified in this review have been used in the literature so far to investigate the relationship between PA behavior and health, while they may provide useful additional information to the conventional PA variables.
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Affiliation(s)
- Anne Backes
- Physical Activity, Sport and Health Research Group, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Tripti Gupta
- Physical Activity, Sport and Health Research Group, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Susanne Schmitz
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Vincent van Hees
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Accelting, Almere, The Netherlands
| | - Laurent Malisoux
- Physical Activity, Sport and Health Research Group, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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20
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Knapen SE, Li P, Riemersma- van der Lek RF, Verkooijen S, Boks MP, Schoevers RA, Hu K, Scheer FA. Fractal biomarker of activity in patients with bipolar disorder. Psychol Med 2021; 51:1562-1569. [PMID: 32234100 PMCID: PMC8208237 DOI: 10.1017/s0033291720000331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The output of many healthy physiological systems displays fractal fluctuations with self-similar temporal structures. Altered fractal patterns are associated with pathological conditions. There is evidence that patients with bipolar disorder have altered daily behaviors. METHODS To test whether fractal patterns in motor activity are altered in patients with bipolar disorder, we analyzed 2-week actigraphy data collected from 106 patients with bipolar disorder type I in a euthymic state, 73 unaffected siblings of patients, and 76 controls. To examine the link between fractal patterns and symptoms, we analyzed 180-day actigraphy and mood symptom data that were simultaneously collected from 14 patients. RESULTS Compared to controls, patients showed excessive regularity in motor activity fluctuations at small time scales (<1.5 h) as quantified by a larger scaling exponent (α1 > 1), indicating a more rigid motor control system. α1 values of siblings were between those of patients and controls. Further examinations revealed that the group differences in α1 were only significant in females. Sex also affected the group differences in fractal patterns at larger time scales (>2 h) as quantified by scaling exponent α2. Specifically, female patients and siblings had a smaller α2 compared to female controls, indicating more random activity fluctuations; while male patients had a larger α2 compared to male controls. Interestingly, a higher weekly depression score was associated with a lower α1 in the subsequent week. CONCLUSIONS Our results show sex- and scale-dependent alterations in fractal activity regulation in patients with bipolar disorder. The mechanisms underlying the alterations are yet to be determined.
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Affiliation(s)
- Stefan E. Knapen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology and Emotion regulation (ICPE). Groningen, the Netherlands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States
| | - Rixt F. Riemersma- van der Lek
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology and Emotion regulation (ICPE). Groningen, the Netherlands
| | - Sanne Verkooijen
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Psychiatry, Utrecht, the Netherlands
| | - Marco P.M. Boks
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Psychiatry, Utrecht, the Netherlands
| | - Robert A. Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology and Emotion regulation (ICPE). Groningen, the Netherlands
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States
| | - Frank A.J.L. Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States
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21
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Gao L, Li P, Gaba A, Musiek E, Ju YS, Hu K. Fractal motor activity regulation and sex differences in preclinical Alzheimer's disease pathology. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12211. [PMID: 34189248 PMCID: PMC8220856 DOI: 10.1002/dad2.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Degradation in fractal motor activity regulation (FMAR), a measure of multiscale self-similarity of motor control, occurs in aging and accelerates with clinical progression to Alzheimer's disease (AD). Whether FMAR changes occur during the pre-symptomatic phase of the disease in women and men remains unknown. METHODS FMAR was assessed in cognitively normal participants (n = 178) who underwent 7 to 14 days of home actigraphy. Preclinical AD pathology was determined by amyloid imaging-Pittsburgh compound B (PiB) and cerebrospinal fluid (CSF) phosphorylated-tau181 (p-tau) to amyloid beta 42 (Aβ42) ratio. RESULTS Degradation in daytime FMAR was overall significantly associated with preclinical amyloid plaque pathology via PiB+ imaging (beta coefficient β = 0.217, standard error [SE] = 0.101, P = .034) and increasing CSF tau181-Aβ42 ratio (β = 0.220, SE = 0.084, P = .009). In subset analysis by sex, the effect sizes were significant in women for PiB+ (β = 0.279, SE = 0.112, P = .015) and CSF (β = 0.245, SE = 0.094, P = .011) but not in men (both Ps > .05). These associations remained after inclusion of daily activity level, apolipoprotein E ε4 carrier status, and rest/activity patterns. DISCUSSION Changes in daytime FMAR from actigraphy appear to be present in women early in preclinical AD. This may be a combination of earlier pathology changes in females reflected in daytime FMAR, and a relatively underpowered male group. Further studies are warranted to test FMAR as an early noncognitive physiological biomarker that precedes the onset of cognitive symptoms.
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Affiliation(s)
- Lei Gao
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Peng Li
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Arlen Gaba
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
| | - Erik Musiek
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Knight Alzheimer's Disease Research CenterWashington University School of MedicineSt. LouisMissouriUSA
- Hope Center for Neurological DisordersWashington University School of MedicineSt. LouisMissouriUSA
| | - Yo‐El S. Ju
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Hope Center for Neurological DisordersWashington University School of MedicineSt. LouisMissouriUSA
| | - Kun Hu
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
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22
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Ma Y, Zhou J, Kavousi M, Lipsitz LA, Mattace-Raso F, Westerhof BE, Wolters FJ, Wu JW, Manor B, Ikram MK, Goudsmit J, Hofman A, Ikram MA. Lower complexity and higher variability in beat-to-beat systolic blood pressure are associated with elevated long-term risk of dementia: The Rotterdam Study. Alzheimers Dement 2021; 17:1134-1144. [PMID: 33860609 DOI: 10.1002/alz.12288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We hypothesized that subclinical disruption in blood pressure (BP) dynamics, captured by lower complexity and higher variability, may contribute to dementia risk, above and beyond BP levels. METHODS This prospective cohort study followed 1835 older adults from 1997 to 2016, with BP complexity quantified by sample entropy and BP variability quantified by coefficient of variation using beat-to-beat BP measured at baseline. RESULTS Three hundred thirty-four participants developed dementia over 20 years. Reduced systolic BP (SBP) complexity was associated with a higher risk of dementia (hazard ratio [HR] comparing extreme quintiles: 1.55; 95% confidence interval [CI]: 1.09-2.20). Higher SBP variability was also associated with a higher risk of dementia (HR comparing extreme quintiles: 1.57; 95% CI: 1.11-2.22. These findings were observed after adjusting for age, sex, apolipoprotein E (APOE) genotype, mean SBP, and other confounding factors. DISCUSSIONS Our findings suggest that lower complexity and higher variability of beat-to-beat SBP are potential novel risk factors or biomarkers for dementia.
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Junhong Zhou
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Julia W Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Brad Manor
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jaap Goudsmit
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA.,Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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23
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Sleep, rest-activity rhythms and aging: a complex web in Alzheimer's disease? Neurobiol Aging 2021; 104:102-103. [PMID: 33902941 DOI: 10.1016/j.neurobiolaging.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
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24
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Li P, Gao L, Gaba A, Yu L, Cui L, Fan W, Lim ASP, Bennett DA, Buchman AS, Hu K. Circadian disturbances in Alzheimer's disease progression: a prospective observational cohort study of community-based older adults. THE LANCET. HEALTHY LONGEVITY 2020; 1:e96-e105. [PMID: 34179863 PMCID: PMC8232345 DOI: 10.1016/s2666-7568(20)30015-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Circadian disturbances are commonly seen in people with Alzheimer's disease and have been reported in individuals without symptoms of dementia but with Alzheimer's pathology. We aimed to assess the temporal relationship between circadian disturbances and Alzheimer's progression. METHODS We did a prospective cohort study of 1401 healthy older adults (aged >59 years) enrolled in the Rush Memory and Aging Project (Rush University Medical Center, Chicago, IL, USA) who had been followed up for up to 15 years. Participants underwent annual assessments of cognition (with a battery of 21 cognitive performance tests) and motor activities (with actigraphy). Four measures were extracted from actigraphy to quantify daily and circadian rhythmicity, which were amplitude of 24-h activity rhythm, acrophase (representing peak activity time), interdaily stability of 24-h activity rhythm, and intradaily variability for hourly fragmentation of activity rhythm. We used Cox proportional hazards models and logistic regressions to assess whether circadian disturbances predict an increased risk of incident Alzheimer's dementia and conversion of mild cognitive impairment to Alzheimer's dementia. We used linear mixed-effects models to investigate how circadian rhythms changed longitudinally and how the change integrated to Alzheimer's progression. FINDINGS Participants had a median age of 81·8 (IQR 76·3-85·7) years. Risk of developing Alzheimer's dementia was increased with lower amplitude (1 SD decrease, hazard ratio [HR] 1·39, 95% CI 1·19-1·62) and higher intradaily variability (1 SD increase, 1·22, 1·04-1·43). In participants with mild cognitive impairment, increased risk of Alzheimer's dementia was predicted by lower amplitude (1 SD decrease, HR 1·46, 95% CI 1·24-1·72), higher intradaily variability (1 SD increase, 1·36, 1·15-1·60), and lower interdaily stability (1 SD decrease, 1·21, 1·02-1·44). A faster transition to Alzheimer's dementia in participants with mild cognitive impairment was predicted by lower amplitude (1 SD decrease, odds ratio [OR] 2·08, 95% CI 1·53-2·93), increased intradaily variability (1 SD increase, 1·97, 1·43-2·79), and decreased interdaily stability (1 SD decrease, 1·35, 1·01-1·84). Circadian amplitude, acrophase, and interdaily stability progressively decreased over time, and intradaily variability progressively increased over time. Alzheimer's progression accelerated these aging effects by doubling or more than doubling the annual changes in these measures after the diagnosis of mild cognitive impairment, and further doubled them after the diagnosis of Alzheimer's dementia. The longitudinal change of global cognition positively correlated with the longitudinal changes in amplitude and interdaily stability and negatively correlated with the longitudinal change in intradaily variability. INTERPRETATION Our results indicate a link between circadian dysregulation and Alzheimer's progression, implying either a bidirectional relation or shared common underlying pathophysiological mechanisms. FUNDING National Institutes of Health, and the BrightFocus Foundation.
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Affiliation(s)
- Peng Li
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Lei Gao
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arlen Gaba
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Longchang Cui
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wenqing Fan
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Andrew S P Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Kun Hu
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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25
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Rodrigues J, Studer E, Streuber S, Meyer N, Sandi C. Locomotion in virtual environments predicts cardiovascular responsiveness to subsequent stressful challenges. Nat Commun 2020; 11:5904. [PMID: 33214564 PMCID: PMC7677550 DOI: 10.1038/s41467-020-19736-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Individuals differ in their physiological responsiveness to stressful challenges, and stress potentiates the development of many diseases. Heart rate variability (HRV), a measure of cardiac vagal break, is emerging as a strong index of physiological stress vulnerability. Thus, it is important to develop tools that identify predictive markers of individual differences in HRV responsiveness without exposing subjects to high stress. Here, using machine learning approaches, we show the strong predictive power of high-dimensional locomotor responses during novelty exploration to predict HRV responsiveness during stress exposure. Locomotor responses are collected in two ecologically valid virtual reality scenarios inspired by the animal literature and stress is elicited and measured in a third threatening virtual scenario. Our model's predictions generalize to other stressful challenges and outperforms other stress prediction instruments, such as anxiety questionnaires. Our study paves the way for the development of behavioral digital phenotyping tools for early detection of stress-vulnerable individuals.
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Affiliation(s)
- João Rodrigues
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland.
| | - Erik Studer
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland
| | - Stephan Streuber
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland
| | - Nathalie Meyer
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland
| | - Carmen Sandi
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, EPFL, Lausanne, 1015, Switzerland.
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26
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Mullins AE, Kam K, Parekh A, Bubu OM, Osorio RS, Varga AW. Obstructive Sleep Apnea and Its Treatment in Aging: Effects on Alzheimer's disease Biomarkers, Cognition, Brain Structure and Neurophysiology. Neurobiol Dis 2020; 145:105054. [PMID: 32860945 PMCID: PMC7572873 DOI: 10.1016/j.nbd.2020.105054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023] Open
Abstract
Here we review the impact of obstructive sleep apnea (OSA) on biomarkers of Alzheimer's disease (AD) pathogenesis, neuroanatomy, cognition and neurophysiology, and present the research investigating the effects of continuous positive airway pressure (CPAP) therapy. OSA is associated with an increase in AD markers amyloid-β and tau measured in cerebrospinal fluid (CSF), by Positron Emission Tomography (PET) and in blood serum. There is some evidence suggesting CPAP therapy normalizes AD biomarkers in CSF but since mechanisms for amyloid-β and tau production/clearance in humans are not completely understood, these findings remain preliminary. Deficits in the cognitive domains of attention, vigilance, memory and executive functioning are observed in OSA patients with the magnitude of impairment appearing stronger in younger people from clinical settings than in older community samples. Cognition improves with varying degrees after CPAP use, with the greatest effect seen for attention in middle age adults with more severe OSA and sleepiness. Paradigms in which encoding and retrieval of information are separated by periods of sleep with or without OSA have been done only rarely, but perhaps offer a better chance to understand cognitive effects of OSA than isolated daytime testing. In cognitively normal individuals, changes in EEG microstructure during sleep, particularly slow oscillations and spindles, are associated with biomarkers of AD, and measures of cognition and memory. Similar changes in EEG activity are reported in AD and OSA, such as "EEG slowing" during wake and REM sleep, and a degradation of NREM EEG microstructure. There is evidence that CPAP therapy partially reverses these changes but large longitudinal studies demonstrating this are lacking. A diagnostic definition of OSA relying solely on the Apnea Hypopnea Index (AHI) does not assist in understanding the high degree of inter-individual variation in daytime impairments related to OSA or response to CPAP therapy. We conclude by discussing conceptual challenges to a clinical trial of OSA treatment for AD prevention, including inclusion criteria for age, OSA severity, and associated symptoms, the need for a potentially long trial, defining relevant primary outcomes, and which treatments to target to optimize treatment adherence.
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Affiliation(s)
- Anna E Mullins
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Korey Kam
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ankit Parekh
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Andrew W Varga
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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27
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Li P, Lim ASP, Gao L, Hu C, Yu L, Bennett DA, Buchman AS, Hu K. More random motor activity fluctuations predict incident frailty, disability, and mortality. Sci Transl Med 2020; 11:11/516/eaax1977. [PMID: 31666398 DOI: 10.1126/scitranslmed.aax1977] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
Abstract
Mobile healthcare increasingly relies on analytical tools that can extract meaningful information from ambulatory physiological recordings. We tested whether a nonlinear tool of fractal physiology could predict long-term health consequences in a large, elderly cohort. Fractal physiology is an emerging field that aims to study how fractal temporal structures in physiological fluctuations generated by complex physiological networks can provide important information about system adaptability. We assessed fractal temporal correlations in the spontaneous fluctuations of ambulatory motor activity of 1275 older participants at baseline, with a follow-up period of up to 13 years. We found that people with reduced temporal correlations (more random activity fluctuations) at baseline had increased risk of frailty, disability, and all-cause death during follow-up. Specifically, for 1-SD decrease in the temporal activity correlations of this studied cohort, the risk of frailty increased by 31%, the risk of disability increased by 15 to 25%, and the risk of death increased by 26%. These incidences occurred on average 4.7 years (frailty), 3 to 4.2 years (disability), and 5.8 years (death) after baseline. These observations were independent of age, sex, education, chronic health conditions, depressive symptoms, cognition, motor function, and total daily activity. The temporal structures in daily motor activity fluctuations may contain unique prognostic information regarding wellness and health in the elderly population.
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Affiliation(s)
- Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew S P Lim
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Lei Gao
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Chelsea Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
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28
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Bringas S, Salomón S, Duque R, Lage C, Montaña JL. Alzheimer's Disease stage identification using deep learning models. J Biomed Inform 2020; 109:103514. [PMID: 32711124 DOI: 10.1016/j.jbi.2020.103514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this research is to identify the stage of Alzheimer's Disease (AD) patients through the use of mobility data and deep learning models. This process facilitates the monitoring of the disease and allows actions to be taken in order to provide the optimal treatment and the prevention of complications. MATERIALS AND METHODS We employed data from 35 patients with AD collected by smartphones for a week in a daycare center. The data sequences of each patient recorded the accelerometer changes while daily activities were performed and they were labeled with the stage of the disease (early, middle or late). Our methodology processes these time series and uses a Convolutional Neural Network (CNN) model to recognize the patterns that identify each stage. RESULTS The CNN-based method achieved a 90.91% accuracy and an F1-score of 0.897, greatly improving the results obtained by the traditional feature-based classifiers. DISCUSSION AND CONCLUSION In our research, we show that mobility data can be a valuable resource for the treatment of patients with AD as well as to study the progress of the disease. The use of our CNN-based method improves the accuracy of the identification of AD stages in comparison to common supervised learning models.
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Affiliation(s)
- Santos Bringas
- Fundación Centro Tecnológico de Componentes CTC, 39011 Santander, Spain.
| | | | - Rafael Duque
- Department of Mathematics, Statistics and Computer Science, Universidad de Cantabria, 39005 Santander, Spain.
| | - Carmen Lage
- Cognitive Disorders Unit, Department of Neurology, Marqués de Valdecilla University Hospital (HUMV), Valdecilla Biomedical Research Institute (IDIVAL), 39008 Santander, Spain.
| | - José Luis Montaña
- Department of Mathematics, Statistics and Computer Science, Universidad de Cantabria, 39005 Santander, Spain.
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29
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Lysen TS, Luik AI, Ikram MK, Tiemeier H, Ikram MA. Actigraphy-estimated sleep and 24-hour activity rhythms and the risk of dementia. Alzheimers Dement 2020; 16:1259-1267. [PMID: 32558256 PMCID: PMC7984295 DOI: 10.1002/alz.12122] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/24/2020] [Accepted: 04/30/2020] [Indexed: 12/17/2022]
Abstract
Introduction We investigated and compared associations of objective estimates of sleep and 24‐hour activity rhythms using actigraphy with risk of dementia. Methods We included 1322 non‐demented participants from the prospective, population‐based Rotterdam Study cohort with valid actigraphy data (mean age 66 ± 8 years, 53% women), and followed them for up to 11.2 years to determine incident dementia. Results During follow‐up, 60 individuals developed dementia, of which 49 had Alzheimer's disease (AD). Poor sleep as indicated by longer sleep latency, wake after sleep onset, and time in bed and lower sleep efficiency, as well as an earlier “lights out” time, were associated with increased risk of dementia, especially AD. We found no associations of 24‐hour activity rhythms with dementia risk. Discussion Poor sleep, but not 24‐hour activity rhythm disturbance, is associated with increased risk of dementia. Actigraphy‐estimated nighttime wakefulness may be further targeted in etiologic or risk prediction studies.
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Affiliation(s)
- Thom S. Lysen
- Department of Epidemiology, Erasmus MCUniversity Medical CenterRotterdamthe Netherlands
| | - Annemarie I. Luik
- Department of Epidemiology, Erasmus MCUniversity Medical CenterRotterdamthe Netherlands
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MCUniversity Medical CenterRotterdamthe Netherlands
- Department of Neurology, Erasmus MCUniversity Medical CenterRotterdamthe Netherlands
| | - Henning Tiemeier
- Department of Social and Behavioral ScienceHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MCUniversity Medical CenterRotterdamthe Netherlands
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30
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Ehsani H, Parvaneh S, Mohler J, Wendel C, Zamrini E, O'Connor K, Toosizadeh N. Can motor function uncertainty and local instability within upper-extremity dual-tasking predict amnestic mild cognitive impairment and early-stage Alzheimer's disease? Comput Biol Med 2020; 120:103705. [PMID: 32217286 DOI: 10.1016/j.compbiomed.2020.103705] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 01/10/2023]
Abstract
In this study, we examined the uncertainty and local instability of motor function for cognitive impairment screening using a previously validated upper-extremity function (UEF). This approach was established based upon the fact that elders with an impaired executive function have trouble in the simultaneous execution of a motor and a cognitive task (dual-tasking). Older adults aged 65 years and older were recruited and stratified into 1) cognitive normal (CN), 2) amnestic MCI of the Alzheimer's type (aMCI), and 3) early-stage Alzheimer's Disease (AD). Participants performed normal-paced repetitive elbow flexion without counting and while counting backward by ones and threes. The influence of cognitive task on motor function was measured using uncertainty (measured by Shannon entropy), and local instability (measured by the largest Lyapunov exponent) of elbow flexion and compared between cognitive groups using ANOVAs, while adjusting for age, sex, and BMI. We developed logistic ordinal regression models for predicting cognitive groups based on these nonlinear measures. A total of 81 participants were recruited, including 35 CN (age = 83.8 ± 6.9), 30 aMCI (age = 83.9 ± 6.9), and 16 early AD (age = 83.2 ± 6.6). Uncertainty of motor function demonstrated the strongest associations with cognitive impairment, with an effect size of 0.52, 0.88, and 0.51 for CN vs. aMCI, CN vs. AD, and aMCI vs. AD comparisons, respectively. Ordinal logistic models predicted cognitive impairment (aMCI and AD combined) with a sensitivity and specificity of 0.82. The findings accentuate the potential of employing nonlinear dynamical features of motor functions during dual-tasking, especially uncertainty, in detecting cognitive impairment.
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Affiliation(s)
- Hossein Ehsani
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA; Department of Kinesiology, University of Maryland, College Park, MD, USA.
| | | | - Jane Mohler
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA; Arizona Center on Aging (ACOA), Department of Medicine, University of Arizona, College of Medicine, Tucson, AZ, USA; Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Christopher Wendel
- Arizona Center on Aging (ACOA), Department of Medicine, University of Arizona, College of Medicine, Tucson, AZ, USA; Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Edward Zamrini
- Banner Sun Health Research Institute, Sun City, AZ, USA; Banner Alzheimer's Institute, University of Arizona, Tucson, AZ, USA; Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Kathy O'Connor
- Banner Sun Health Research Institute, Sun City, AZ, USA; Banner Alzheimer's Institute, University of Arizona, Tucson, AZ, USA
| | - Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA; Arizona Center on Aging (ACOA), Department of Medicine, University of Arizona, College of Medicine, Tucson, AZ, USA; Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
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Canazei M, Turiaux J, Huber SE, Marksteiner J, Papousek I, Weiss EM. Actigraphy for Assessing Light Effects on Sleep and Circadian Activity Rhythm in Alzheimer's Dementia: A Narrative Review. Curr Alzheimer Res 2020; 16:1084-1107. [DOI: 10.2174/1567205016666191010124011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/10/2019] [Accepted: 09/08/2019] [Indexed: 12/18/2022]
Abstract
Background:
Alzheimer's Disease (AD) is often accompanied by severe sleep problems and
circadian rhythm disturbances which may to some extent be attributed to a dysfunction in the biological
clock. The 24-h light/dark cycle is the strongest Zeitgeber for the biological clock. People with AD,
however, often live in environments with inappropriate photic Zeitgebers. Timed bright light exposure
may help to consolidate sleep- and circadian rest/activity rhythm problems in AD, and may be a low-risk
alternative to pharmacological treatment.
Objective & Method:
In the present review, experts from several research disciplines summarized the
results of twenty-seven light intervention studies which used wrist actigraphy to measure sleep and circadian
activity in AD patients.
Results:
Taken together, the findings remain inconclusive with regard to beneficial light effects. However,
the considered studies varied substantially with respect to the utilized light intervention, study design,
and usage of actigraphy. The paper provides a comprehensive critical discussion of these issues.
Conclusion:
Fusing knowledge across complementary research disciplines has the potential to critically
advance our understanding of the biological input of light on health and may contribute to architectural
lighting designs in hospitals, as well as our homes and work environments.
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Affiliation(s)
- Markus Canazei
- Research Department, Bartenbach LichtLabor GmbH Ringgold Standard Institution, Bartenbach GmbH, Rinnerstrasse 14, Aldrans 6071, Austria
| | - Julian Turiaux
- Department of Psychology, University of Graz, Graz, Austria
| | - Stefan E. Huber
- Institute of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Tirol, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital, Milserstrasse 10 , Hall Tirol 6060, Austria
| | - Ilona Papousek
- Department of Psychology, University of Graz, Graz, Austria
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Gao L, Lim ASP, Wong PM, Gaba A, Cui L, Yu L, Buchman AS, Bennett DA, Hu K, Li P. Fragmentation of Rest/Activity Patterns in Community-Based Elderly Individuals Predicts Incident Heart Failure. Nat Sci Sleep 2020; 12:299-307. [PMID: 32581616 PMCID: PMC7266944 DOI: 10.2147/nss.s253757] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY OBJECTIVES Heart failure has previously been linked to sleep disorders that are often associated with frequent disturbances to human rest/activity patterns. We tested whether fragmentation of sustained rest/activity patterns derived from actigraphic recordings at baseline predicts incident heart failure in community-based elderly individuals. METHODS We studied 1099 community-based elderly adults participating in the Rush Memory and Aging Project who had baseline motor activity monitoring up to 11 days and were followed annually for up to 14 years. Fragmentation was assessed using previously validated indexes, derived from the probability of transitions once sustained rest or activity has been established. Heart failure was recorded via a clinical interview during the annual follow-up. Cox proportional hazards models were constructed to examine the relationship between rest fragmentation index and incident heart failure. Covariates grouped in terms of demographics, lifestyle factors and co-morbidities and cardiovascular risk factors/diseases were included. RESULTS Increased rest fragmentation (but not activity fragmentation) was associated with higher risk for incident heart failure. Specifically, a subject with a rest fragmentation at the 90th percentile showed a 57% increased risk of developing incident heart failure compared to a subject at the 10th percentile in this cohort. This effect was equivalent to that of being over a decade older. These observations were consistent after adjusting for all covariates. CONCLUSION Increased rest fragmentation, a potential surrogate for sleep fragmentation, is independently associated with a higher risk of developing heart failure in community-based elderly adults during up to 14 years of follow-up. Further work is required to examine the specific contributions from daytime napping versus nighttime sleep periods in the elderly, as well as the underlying autonomic and cardio-dynamic pathways that may explain the effects on heart function.
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Affiliation(s)
- Lei Gao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Andrew S P Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, USA
| | - Patricia M Wong
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Arlen Gaba
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Longchang Cui
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
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Li P, Yu L, Yang J, Lo MT, Hu C, Buchman AS, Bennett DA, Hu K. Interaction between the progression of Alzheimer's disease and fractal degradation. Neurobiol Aging 2019; 83:21-30. [PMID: 31585364 PMCID: PMC6858962 DOI: 10.1016/j.neurobiolaging.2019.08.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 01/08/2023]
Abstract
Many outputs from healthy neurophysiological systems including motor activity display nonrandom fluctuations with fractal scaling behavior as characterized by similar temporal fluctuation patterns across a range of time scales. Degraded fractal regulation predicts adverse consequences including Alzheimer's dementia. We examined longitudinal changes in the scaling behavior of motor activity fluctuations during the progression of Alzheimer's disease (AD) in 1068 participants in the Rush Memory and Aging Project. Motor activity of up to 10 days was recorded annually for up to 13 years. Cognitive assessments and clinical diagnoses were administered annually in the same participants. We found that fractal regulation gradually degraded over time (p < 0.0001) even during the stage with no cognitive impairment. The degradation rate was more than doubled after the diagnosis of mild cognitive impairment and more than doubled further after the diagnosis of Alzheimer's dementia (p's ≤ 0.0005). Besides, the longitudinal degradation of fractal regulation significantly correlated with the decline in cognitive performance throughout the progression from no cognitive impairment to mild cognitive impairment, and to AD (p < 0.001). All effects remained the same in subsequent sensitivity analyses that included only 255 decedents with autopsy-confirmed Alzheimer's pathology. These results indicate that the progression of AD accelerates fractal degradation and that fractal degradation may be an integral part of the process of AD.
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Affiliation(s)
- Peng Li
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jingyun Yang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Men-Tzung Lo
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Chelsea Hu
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Huber SE, Sachse P, Mauracher A, Marksteiner J, Pohl W, Weiss EM, Canazei M. Assessment of Fractal Characteristics of Locomotor Activity of Geriatric In-Patients With Alzheimer's Dementia. Front Aging Neurosci 2019; 11:272. [PMID: 31636559 PMCID: PMC6787148 DOI: 10.3389/fnagi.2019.00272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many physiological signals yield fractal characteristics, i.e., finer details at higher magnifications resemble details of the whole. Evidence has been accumulating that such fractal scaling is basically a consequence of interaction-dominant feedback mechanisms that cooperatively generate those signals. Neurodegenerative diseases provide a natural framework to evaluate this paradigm when this cooperative function declines. However, methodological issues need to be cautiously taken into account in order to be able to provide reliable as well as valid interpretations of such signal analyses. METHODS Two conceptually different fractal analyses, i.e., detrended fluctuation analysis (DFA) and analysis of cumulative distributions of durations (CDDs), are applied to actigraphy data of 36 geriatric in-patients diagnosed with dementia. The impact of the used time resolution for data acquisition on the assessed fractal outcome parameters is particularly investigated. Moreover, associations between these parameters and scores from the Mini-Mental-State-Examination and circadian activity parameters are explored. RESULTS Both analyses yield significant deviations from (mono-)fractal scaling over the entire considered time range. DFA provides robust measures for the observed break-down of fractal scaling. In contrast, analysis of CDDs results in measures which highly fluctuate with respect to the time resolution of the assessed data which affects also further derived quantities such as scaling exponents or associations with other (clinically relevant) assessed parameters. DISCUSSION To scrutinize actigraphic signal characteristics and especially their (deviations from) fractal scaling may be a useful tool for aiding diagnosis, characterization, and monitoring of dementia. However, results may, besides contextual aspects, also substantially depend on specific methodological choices. In order to arrive at both reliable and valid interpretations, these complications need to be carefully elaborated in future research.
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Affiliation(s)
- Stefan E. Huber
- Institute of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Austria
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
- Bartenbach GmbH, Aldrans, Austria
| | - Pierre Sachse
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Andreas Mauracher
- Institute of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall in Tirol, Austria
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Shi B, Wang L, Yan C, Chen D, Liu M, Li P. Nonlinear heart rate variability biomarkers for gastric cancer severity: A pilot study. Sci Rep 2019; 9:13833. [PMID: 31554856 PMCID: PMC6761171 DOI: 10.1038/s41598-019-50358-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/11/2019] [Indexed: 12/24/2022] Open
Abstract
Identifying prognostic factors by affordable tools is crucial for guiding gastric cancer (GC) treatments especially at earlier stages for timing interventions. The autonomic function that is clinically assessed by heart rate variability (HRV) is involved in tumorigenesis. This pilot study was aimed to examine whether nonlinear indices of HRV can be biomarkers of GC severity. Sixty-one newly-diagnosed GC patients were enrolled. Presurgical serum fibrinogen (FIB), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA199) were examined. Resting electrocardiogram (ECG) of 5-min was collected prior to surgical treatments to enable the HRV analysis. Twelve nonlinear HRV indices covering the irregularity, complexity, asymmetry, and temporal correlation of heartbeat fluctuations were obtained. Increased short-range temporal correlations, decreased asymmetry, and increased irregularity of heartbeat fluctuations were associated with higher FIB level. Increased irregularity and decreased complexity were also associated with higher CEA level. These associations were independent of age, sex, BMI, alcohol consumption, history of diabetes, left ventricular ejection fraction, and anemia. The results support the hypothesis that perturbations in nonlinear dynamical patterns of HRV predict increased GC severity. Replication in larger samples as well as the examination of longitudinal associations of HRV nonlinear features with cancer prognosis/survival are warranted.
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Affiliation(s)
- Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, 233030, China
| | - Lili Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Chang Yan
- School of Control Science and Engineering, Shandong University, Jinan, Shandong, 250061, China
| | - Deli Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Mulin Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Peng Li
- School of Control Science and Engineering, Shandong University, Jinan, Shandong, 250061, China.
- Division of Sleep and Circadian Disorders, Brigham & Women's Hospital, Harvard Medical School, Boston, 02115, MA, USA.
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Wilson J, Allcock L, Mc Ardle R, Taylor JP, Rochester L. The neural correlates of discrete gait characteristics in ageing: A structured review. Neurosci Biobehav Rev 2019; 100:344-369. [PMID: 30552912 PMCID: PMC6565843 DOI: 10.1016/j.neubiorev.2018.12.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/01/2018] [Accepted: 12/12/2018] [Indexed: 11/03/2022]
Abstract
Gait is complex, described by diverse characteristics underpinned by widespread central nervous system networks including motor and cognitive functions. Despite this, neural substrates of discrete gait characteristics are poorly understood, limiting understanding of gait impairment in ageing and disease. This structured review aims to map gait characteristics, defined from a pre-specified model reflecting independent gait domains, to brain imaging parameters in older adults. Fifty-two studies of 38,029 yielded were reviewed. Studies showed inconsistent approaches when mapping gait assessment to neural substrates, limiting conclusions. Gait impairments typically associated with brain deterioration, specifically grey matter atrophy and white matter integrity loss. Gait velocity, a global measure of gait control, was most frequently associated with these imaging markers within frontal and basal ganglia regions, and its decline predicted from white matter volume and integrity measurements. Fewer studies assessed additional gait measures or functional imaging parameters. Future studies mapping regional neuroanatomical and functional correlates of gait are needed, including those which take a multi-process network perspective to better understand mobility in health and disease.
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Affiliation(s)
- Joanna Wilson
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK
| | - Liesl Allcock
- Geriatric Medicine, Northumbria Healthcare Trust, UK
| | - Ríona Mc Ardle
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle Upon Tyne, UK; Newcastle Upon Tyne Hospital NHS Foundation Trust, UK.
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