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Knopman DS, Pike JR, Gottesman RF, Sharrett AR, Windham BG, Mosley TH, Sullivan K, Albert MS, Walker KA, Yasar S, Burgard S, Li D, Gross AL. Patterns of cognitive domain abnormalities enhance discrimination of dementia risk prediction: The ARIC study. Alzheimers Dement 2024. [PMID: 38877664 DOI: 10.1002/alz.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION The contribution of neuropsychological assessments to risk assessment for incident dementia is underappreciated. METHODS We analyzed neuropsychological testing results in dementia-free participants in the Atherosclerosis Risk in Communities (ARIC) study. We examined associations of index domain-specific neuropsychological test performance with incident dementia using cumulative incidence curves and Cox proportional hazards models. RESULTS Among 5296 initially dementia-free participants (mean [standard deviation] age of 75.8 [5.1] years; 60.1% women, 22.2% Black) over a median follow-up of 7.9 years, the covariate-adjusted hazard ratio varied substantially depending on the pattern of domain-specific performance and age, in an orderly manner from single domain language abnormalities (lowest risk) to single domain executive or memory abnormalities, to multidomain abnormalities including memory (highest risk). DISCUSSION By identifying normatively defined cognitive abnormalities by domains based on neuropsychological test performance, there is a conceptually orderly and age-sensitive spectrum of risk for incident dementia that provides valuable information about the likelihood of progression. HIGHLIGHTS Domain-specific cognitive profiles carry enhanced prognostic value compared to mild cognitive impairment. Single-domain non-amnestic cognitive abnormalities have the most favorable prognosis. Multidomain amnestic abnormalities have the greatest risk for incident dementia. Patterns of domain-specific risks are similar by sex and race.
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Affiliation(s)
- David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kevin Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland, USA
| | - Sevil Yasar
- Departments of Medicine and Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sheila Burgard
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Edmonds EC, Thomas KR, Rapcsak SZ, Lindemer SL, Delano‐Wood L, Salmon DP, Bondi MW. Data-driven classification of cognitively normal and mild cognitive impairment subtypes predicts progression in the NACC dataset. Alzheimers Dement 2024; 20:3442-3454. [PMID: 38574399 PMCID: PMC11095435 DOI: 10.1002/alz.13793] [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: 06/14/2023] [Revised: 10/20/2023] [Accepted: 02/23/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Data-driven neuropsychological methods can identify mild cognitive impairment (MCI) subtypes with stronger associations to dementia risk factors than conventional diagnostic methods. METHODS Cluster analysis used neuropsychological data from participants without dementia (mean age = 71.6 years) in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (n = 26,255) and the "normal cognition" subsample (n = 16,005). Survival analyses examined MCI or dementia progression. RESULTS Five clusters were identified: "Optimal" cognitively normal (oCN; 13.2%), "Typical" CN (tCN; 28.0%), Amnestic MCI (aMCI; 25.3%), Mixed MCI-Mild (mMCI-Mild; 20.4%), and Mixed MCI-Severe (mMCI-Severe; 13.0%). Progression to dementia differed across clusters (oCN < tCN < aMCI < mMCI-Mild < mMCI-Severe). Cluster analysis identified more MCI cases than consensus diagnosis. In the "normal cognition" subsample, five clusters emerged: High-All Domains (High-All; 16.7%), Low-Attention/Working Memory (Low-WM; 22.1%), Low-Memory (36.3%), Amnestic MCI (16.7%), and Non-amnestic MCI (naMCI; 8.3%), with differing progression rates (High-All < Low-WM = Low-Memory < aMCI < naMCI). DISCUSSION Our data-driven methods outperformed consensus diagnosis by providing more precise information about progression risk and revealing heterogeneity in cognition and progression risk within the NACC "normal cognition" group.
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Affiliation(s)
- Emily C. Edmonds
- Banner Alzheimer's InstituteTucsonArizonaUSA
- Departments of Neurology and PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Kelsey R. Thomas
- Research Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Steven Z. Rapcsak
- Banner Alzheimer's InstituteTucsonArizonaUSA
- Departments of Neurology and PsychologyUniversity of ArizonaTucsonArizonaUSA
- Department of Speech, Language, & Hearing SciencesUniversity of ArizonaTucsonArizonaUSA
| | | | - Lisa Delano‐Wood
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - David P. Salmon
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology Service, Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
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Graves LV, Tarraf W, Gonzalez K, Bondi MW, Gallo LC, Isasi CR, Daviglus M, Lamar M, Zeng D, Cai J, González HM. Characterizing cognitive profiles in diverse middle-aged and older Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging (HCHS/SOL). ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12592. [PMID: 38655549 PMCID: PMC11035970 DOI: 10.1002/dad2.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
Introduction We investigated cognitive profiles among diverse, middle-aged and older Hispanic/Latino adults in the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) cohort using a cross-sectional observational study design. Methods Based on weighted descriptive statistics, the average baseline age of the target population was 56.4 years, slightly more than half were women (54.6%), and 38.4% reported less than a high school education. We used latent profile analysis of demographically adjusted z scores on SOL-INCA neurocognitive tests spanning domains of verbal memory, language, processing speed, and executive function. Results Statistical fit assessment indices combined with clinical interpretation suggested five profiles: (1) a Higher Global group performing in the average-to-high-average range across all cognitive and instrumental activity of daily living (IADL) tests (13.8%); (2) a Higher Memory group with relatively high performance on memory tests but average performance across all other cognitive/IADL tests (24.6%); (3) a Lower Memory group with relatively low performance on memory tests but average performance across all other cognitive/IADL tests (32.8%); (4) a Lower Executive Function group with relatively low performance on executive function and processing speed tests but average-to-low-average performance across all other cognitive/IADL tests (16.6%); and (5) a Lower Global group performing low-average-to-mildly impaired across all cognitive/IADL tests (12.1%). Discussion Our results provide evidence of heterogeneity in the cognitive profiles of a representative, community-dwelling sample of diverse Hispanic/Latino adults. Our analyses yielded cognitive profiles that may assist efforts to better understand the early cognitive changes that may portend Alzheimer's disease and related dementias among diverse Hispanics/Latinos. Highlights The present study characterized cognitive profiles among diverse middle-aged and older Hispanic/Latino adults.Latent profile analysis of neurocognitive test scores was the primary analysis conducted.The target population consists of middle-aged and older Hispanic/Latino adults enrolled in the Hispanic Community Health Study/Study of Latinos and ancillary Study of Latinos - Investigation of Neurocognitive Aging.
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Affiliation(s)
- Lisa V. Graves
- Department of PsychologyCalifornia State University San MarcosSan MarcosCaliforniaUSA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare SciencesWayne State UniversityDetroitMichiganUSA
| | - Kevin Gonzalez
- Department of NeurosciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California San DiegoSchool of MedicineLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Linda C. Gallo
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Carmen R. Isasi
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineJack and Pearl Resnick CampusBronxNew YorkUSA
| | - Martha Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
| | - Melissa Lamar
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Donglin Zeng
- Department of BiostatisticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jianwen Cai
- Department of BiostatisticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Hector M. González
- Department of NeurosciencesUniversity of California San DiegoLa JollaCaliforniaUSA
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Evans SA, Paitel ER, Bhasin R, Nielson KA. Genetic Risk for Alzheimer's Disease Alters Perceived Executive Dysfunction in Cognitively Healthy Middle-Aged and Older Adults. J Alzheimers Dis Rep 2024; 8:267-279. [PMID: 38405345 PMCID: PMC10894609 DOI: 10.3233/adr-230166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Background Subjective cognitive complaints (SCC) may be an early indicator of future cognitive decline. However, findings comparing SCC and objective cognitive performance have varied, particularly in the memory domain. Even less well established is the relationship between subjective and objective complaints in non-amnestic domains, such as in executive functioning, despite evidence indicating very early changes in these domains. Moreover, particularly early changes in both amnestic and non-amnestic domains are apparent in those carrying the Apolipoprotein-E ɛ4 allele, a primary genetic risk for Alzheimer's disease (AD). Objective This study investigated the role of the ɛ4 allele in the consistency between subjective and objective executive functioning in 54 healthy, cognitively intact, middle-aged and older adults. Methods Participants (Mage = 64.07, SD = 9.27, range = 48-84; ɛ4+ = 18) completed the Frontal Systems Behavior Scale (FrSBe) Executive Dysfunction Scale (EXECDYS) to measure subjective executive functioning (SEF) and multiple executive functioning tasks, which were condensed into a single factor. Results After accounting for age, depression, and anxiety, objective executive functioning performance significantly predicted SEF. Importantly, ɛ4 moderated this effect. Specifically, those carrying the ɛ4 allele had significantly less accurate self-awareness of their executive functioning compared to ɛ4 non-carriers. Conclusions Utilizing an approach that integrates self-evaluation of executive functioning with objective neurocognitive assessment may help identify the earliest signs of impending cognitive decline, particularly in those with genetic risk for AD. Such an approach could sensitively determine those most prone to future cognitive decline prior to symptom onset, when interventions could be most effective.
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Affiliation(s)
- Sarah A. Evans
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | | | - Riya Bhasin
- Department of Psychology, Marquette University, Milwaukee, WI, USA
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Du L, Hermann BP, Jonaitis EM, Cody KA, Rivera-Rivera L, Rowley H, Field A, Eisenmenger L, Christian BT, Betthauser TJ, Larget B, Chappell R, Janelidze S, Hansson O, Johnson SC, Langhough R. Harnessing cognitive trajectory clusterings to examine subclinical decline risk factors. Brain Commun 2023; 5:fcad333. [PMID: 38107504 PMCID: PMC10724051 DOI: 10.1093/braincomms/fcad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Cognitive decline in Alzheimer's disease and other dementias typically begins long before clinical impairment. Identifying people experiencing subclinical decline may facilitate earlier intervention. This study developed cognitive trajectory clusters using longitudinally based random slope and change point parameter estimates from a Preclinical Alzheimer's disease Cognitive Composite and examined how baseline and most recently available clinical/health-related characteristics, cognitive statuses and biomarkers for Alzheimer's disease and vascular disease varied across these cognitive clusters. Data were drawn from the Wisconsin Registry for Alzheimer's Prevention, a longitudinal cohort study of adults from late midlife, enriched for a parental history of Alzheimer's disease and without dementia at baseline. Participants who were cognitively unimpaired at the baseline visit with ≥3 cognitive visits were included in trajectory modelling (n = 1068). The following biomarker data were available for subsets: positron emission tomography amyloid (amyloid: n = 367; [11C]Pittsburgh compound B (PiB): global PiB distribution volume ratio); positron emission tomography tau (tau: n = 321; [18F]MK-6240: primary regions of interest meta-temporal composite); MRI neurodegeneration (neurodegeneration: n = 581; hippocampal volume and global brain atrophy); T2 fluid-attenuated inversion recovery MRI white matter ischaemic lesion volumes (vascular: white matter hyperintensities; n = 419); and plasma pTau217 (n = 165). Posterior median estimate person-level change points, slopes' pre- and post-change point and estimated outcome (intercepts) at change point for cognitive composite were extracted from Bayesian Bent-Line Regression modelling and used to characterize cognitive trajectory groups (K-means clustering). A common method was used to identify amyloid/tau/neurodegeneration/vascular biomarker thresholds. We compared demographics, last visit cognitive status, health-related factors and amyloid/tau/neurodegeneration/vascular biomarkers across the cognitive groups using ANOVA, Kruskal-Wallis, χ2, and Fisher's exact tests. Mean (standard deviation) baseline and last cognitive assessment ages were 58.4 (6.4) and 66.6 (6.6) years, respectively. Cluster analysis identified three cognitive trajectory groups representing steep, n = 77 (7.2%); intermediate, n = 446 (41.8%); and minimal, n = 545 (51.0%) cognitive decline. The steep decline group was older, had more females, APOE e4 carriers and mild cognitive impairment/dementia at last visit; it also showed worse self-reported general health-related and vascular risk factors and higher amyloid, tau, neurodegeneration and white matter hyperintensity positive proportions at last visit. Subtle cognitive decline was consistently evident in the steep decline group and was associated with generally worse health. In addition, cognitive trajectory groups differed on aetiology-informative biomarkers and risk factors, suggesting an intimate link between preclinical cognitive patterns and amyloid/tau/neurodegeneration/vascular biomarker differences in late middle-aged adults. The result explains some of the heterogeneity in cognitive performance within cognitively unimpaired late middle-aged adults.
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Affiliation(s)
- Lianlian Du
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bruce P Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Karly Alex Cody
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Leonardo Rivera-Rivera
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
| | - Howard Rowley
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Aaron Field
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bradley T Christian
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bret Larget
- Department of Statistics, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Rick Chappell
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53726, USA
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund 205 02, Sweden
| | - Sterling C Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Rebecca Langhough
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
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Fu Z, Zhao M, Li Y, He Y, Wang X, Zhou Z, Han Y, Li S. Heterogeneity in subjective cognitive decline in the Sino Longitudinal Study on Cognitive Decline(SILCODE): Empirically derived subtypes, structural and functional verification. CNS Neurosci Ther 2023; 29:4032-4042. [PMID: 37475187 PMCID: PMC10651943 DOI: 10.1111/cns.14327] [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: 01/15/2023] [Revised: 03/01/2023] [Accepted: 06/17/2023] [Indexed: 07/22/2023] Open
Abstract
AIMS We evaluated whether Subjective Cognitive Decline (SCD) subtypes could be empirically derived within the Sino Longitudinal Study on Cognitive Decline (SILCODE) SCD cohort and examined associated neuroimaging markers, biomarkers, and clinical outcomes. METHODS A cluster analysis was performed on eight neuropsychological test scores from 124 SCD SILCODE participants and 57 normal control (NC) subjects. Structural and functional neuroimaging indices were used to evaluate the SCD subgroups. RESULTS Four subtypes emerged: (1) dysexecutive/mixed SCD (n = 23), (2) neuropsychiatric SCD (n = 24), (3) amnestic SCD (n = 22), and (4) cluster-derived normal (n = 55) who exhibited normal performance in neuropsychological tests. Compared with the NC group, each subgroup showed distinct patterns in gray matter (GM) volume and the amplitude of low-frequency fluctuations (ALFF). Lower fractional anisotropy (FA) values were only found in the neuropsychiatric SCD group relative to NC. CONCLUSION The identification of empirically derived SCD subtypes demonstrates the presence of heterogeneity in SCD neuropsychological profiles. The cluster-derived normal group may represent the majority of SCD individuals who do not show progressive cognitive decline; the dysexecutive/mixed SCD and amnestic SCD might represent high-risk groups with progressing cognitive decline; and finally, the neuropsychiatric SCD may represent a new topic in SCD research.
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Affiliation(s)
- Zhenrong Fu
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU)Ministry of EducationWuhanChina
- School of Psychology, Key Laboratory of Human Development and Mental Health of Hubei ProvinceCentral China Normal UniversityWuhanChina
| | - Mingyan Zhao
- Department of PsychologyTangshan Gongren HospitalTangshanChina
| | - Yuxia Li
- Department of NeurologyTangshan Central HospitalTangshanChina
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Yirong He
- State Key Laboratory of Cognitive Neuroscience and LearningBeijing Normal UniversityBeijingChina
| | - Xuetong Wang
- State Key Laboratory of Cognitive Neuroscience and LearningBeijing Normal UniversityBeijingChina
| | - Zongkui Zhou
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU)Ministry of EducationWuhanChina
- School of Psychology, Key Laboratory of Human Development and Mental Health of Hubei ProvinceCentral China Normal UniversityWuhanChina
| | - Ying Han
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical EngineeringHainan UniversityHaikouChina
- Center of Alzheimer's DiseaseBeijing Institute for Brain DisordersBeijingChina
- National Clinical Research Center for Geriatric DisordersBeijingChina
- Institute of Biomedical EngineeringShenzhen Bay LaboratoryShenzhenChina
| | - Shuyu Li
- State Key Laboratory of Cognitive Neuroscience and LearningBeijing Normal UniversityBeijingChina
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Dörr F, Schäfer S, Öhman F, Linz N, Bodin TH, Skoog J, Zettergren A, Kern S, Skoog I, Tröger J. Dissociating memory and executive function impairment through temporal features in a word list verbal learning task. Neuropsychologia 2023; 189:108679. [PMID: 37683887 DOI: 10.1016/j.neuropsychologia.2023.108679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
The Rey Auditory Verbal Learning Test (RAVLT) is an established verbal learning test commonly used to quantify memory impairments due to Alzheimer's Disease (AD) both at a clinical dementia stage or prodromal stage of mild cognitive impairment (MCI). Focal memory impairment-as quantified e.g. by the RAVLT-at an MCI stage is referred to as amnestic MCI (aMCI) and is often regarded as the cognitive phenotype of prodromal AD. However, recent findings suggest that not only learning and memory but also other cognitive domains, especially executive functions (EF) and processing speed (PS), influence verbal learning performance. This research investigates whether additional temporal features extracted from audio recordings from a participant's RAVLT response can better dissociate memory and EF in such tasks and eventually help to better describe MCI subtypes. 675 age-matched participants from the H70 Swedish birth cohort were included in this analysis; 68 participants were classified as MCI (33 aMCI and 35 due to executive impairment). RAVLT performances were recorded and temporal features extracted. Novel temporal features were correlated with established neuropsychological tests measuring EF and PS. Lastly, the downstream diagnostic potential of temporal features was estimated using group differences and a machine learning (ML) classification scenario. Temporal features correlated moderately with measures of EF and PS. Performance of an ML classifier could be improved by adding temporal features to traditional counts. We conclude that RAVLT temporal features are in general related to EF and that they might be capable of dissociating memory and EF in a word list learning task.
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Affiliation(s)
| | | | - Fredrik Öhman
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Timothy Hadarsson Bodin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Zettergren
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Silke Kern
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pommy J, Conant L, Butts AM, Nencka A, Wang Y, Franczak M, Glass-Umfleet L. A graph theoretic approach to neurodegeneration: five data-driven neuropsychological subtypes in mild cognitive impairment. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:903-922. [PMID: 36648118 DOI: 10.1080/13825585.2022.2163973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023]
Abstract
Mild cognitive Impairment (MCI) is notoriously heterogenous in terms of clinical presentation, neuroimaging correlates, and subsequent progression. Predicting who will progress to dementia, which type of dementia, and over what timeframe is challenging. Previous work has attempted to identify MCI subtypes using neuropsychological measures in an effort to address this challenge; however, there is no consensus on approach, which may account for some of the variability. Using a hierarchical community detection approach, we examined cognitive subtypes within an MCI sample (from the Alzheimer's Disease Neuroimaging Initiative [ADNI] study). We then examined whether these subtypes were related to biomarkers (e.g., cortical volumes, fluorodeoxyglucose (FDG)-positron emission tomography (PET) hypometabolism) or clinical progression. We identified five communities (i.e., cognitive subtypes) within the MCI sample: 1) predominantly memory impairment, 2) predominantly language impairment, 3) cognitively normal, 4) multidomain, with notable executive dysfunction, 5) multidomain, with notable processing speed impairment. Community membership was significantly associated with 1) cortical volume in the hippocampus, entorhinal cortex, and fusiform cortex; 2) FDG PET hypometabolism in the posterior cingulate, angular gyrus, and inferior/middle temporal gyrus; and 3) conversion to dementia at follow up. Overall, community detection as an approach appears a viable method for identifying unique cognitive subtypes in a neurodegenerative sample that were linked to several meaningful biomarkers and modestly with progression at one year follow up.
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Affiliation(s)
- Jessica Pommy
- Department of Neurology, Medical College of Wisconsin, Milwaukee, United States
| | - L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, United States
| | - A M Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, United States
| | - A Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, United States
| | - Y Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, United States
| | - M Franczak
- Department of Neurology, Medical College of Wisconsin, Milwaukee, United States
| | - L Glass-Umfleet
- Department of Neurology, Medical College of Wisconsin, Milwaukee, United States
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Chiari-Correia RD, Tumas V, Santos AC, Salmon CEG. Structural and functional differences in the brains of patients with MCI with and without depressive symptoms and their relations with Alzheimer's disease: an MRI study. PSYCHORADIOLOGY 2023; 3:kkad008. [PMID: 38666129 PMCID: PMC10917365 DOI: 10.1093/psyrad/kkad008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 04/28/2024]
Abstract
Background The mild cognitive impairment (MCI) stage among elderly individuals is very complex, and the level of diagnostic accuracy is far from ideal. Some studies have tried to improve the 'MCI due to Alzheimer's disease (AD)' classification by further stratifying these patients into subgroups. Depression-related symptoms may play an important role in helping to better define the MCI stage in elderly individuals. Objective In this work, we explored functional and structural differences in the brains of patients with nondepressed MCI (nDMCI) and patients with MCI with depressive symptoms (DMCI), and we examined how these groups relate to AD atrophy patterns and cognitive functioning. Methods Sixty-five participants underwent MRI exams and were divided into four groups: cognitively normal, nDMCI, DMCI, and AD. We compared the regional brain volumes, cortical thickness, and white matter microstructure measures using diffusion tensor imaging among groups. Additionally, we evaluated changes in functional connectivity using fMRI data. Results In comparison to the nDMCI group, the DMCI patients had more pronounced atrophy in the hippocampus and amygdala. Additionally, DMCI patients had asymmetric damage in the limbic-frontal white matter connection. Furthermore, two medial posterior regions, the isthmus of cingulate gyrus and especially the lingual gyrus, had high importance in the structural and functional differentiation between the two groups. Conclusion It is possible to differentiate nDMCI from DMCI patients using MRI techniques, which may contribute to a better characterization of subtypes of the MCI stage.
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Affiliation(s)
- Rodolfo Dias Chiari-Correia
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, 3900 Bandeirantes Avenue, Ribeirao Preto SP, 14040-900, Brazil
| | - Vitor Tumas
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, 3900 Bandeirantes Avenue, Ribeirao Preto SP, 14040-900, Brazil
| | - Antônio Carlos Santos
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, 3900 Bandeirantes Avenue, Ribeirao Preto SP, 14040-900, Brazil
| | - Carlos Ernesto G Salmon
- Department of Physics, Faculty of Philosophy, Sciences and Letters, University of Sao Paulo, 3900 Bandeirantes Avenue, Ribeirao Preto SP, 14040-900, Brazil
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10
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Rennie A, Ekman U, Wallert J, Muehlboeck JS, Eriksdotter M, Wahlund LO, Ferreira D, Westman E. Comparing three neuropsychological subgrouping approaches in subjective and mild cognitive impairment from a naturalistic multicenter study. Neurobiol Aging 2023; 129:41-49. [PMID: 37269645 DOI: 10.1016/j.neurobiolaging.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 06/05/2023]
Abstract
Subjective cognitive impairment (SCI) and mild cognitive impairment (MCI) are two clinical groups with an increased risk to develop dementia, but they are highly heterogeneous. This study compared three different approaches to subgroup SCI and MCI patients and investigated their capacity to disentangle cognitive and biomarker heterogeneity. We included 792 patients from the MemClin-cohort (142 SCI and 650 MCI). Biomarkers included cerebrospinal fluid measures of beta-amyloid-42 and phosphorylated tau, as well as visual ratings of medial temporal lobe atrophy and white matter hyperintensities on magnetic resonance imaging. We found that a more inclusive approach identified individuals with a positive beta-amyloid-42 biomarker; a less inclusive approach captured individuals with higher medial temporal lobe atrophy; and a data-driven approach captured individuals with high white matter hyperintensities burden. The three approaches also captured some neuropsychological differences. We conclude that choice of approach may differ depending on the purpose. This study helps to advance our current understanding of the clinical and biological heterogeneity within SCI and MCI, particularly in the unselected memory clinic setting.
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Affiliation(s)
- Anna Rennie
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Urban Ekman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Medical Unit, Medical Psychology, Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Stockholm, Sweden
| | - John Wallert
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - J-Sebastian Muehlboeck
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience: King's College London, London, UK.
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11
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Wang X, Ye T, Zhou W, Zhang J. Uncovering heterogeneous cognitive trajectories in mild cognitive impairment: a data-driven approach. Alzheimers Res Ther 2023; 15:57. [PMID: 36941651 PMCID: PMC10026406 DOI: 10.1186/s13195-023-01205-w] [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: 12/06/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Given the complex and progressive nature of mild cognitive impairment (MCI), the ability to delineate and understand the heterogeneous cognitive trajectories is crucial for developing personalized medicine and informing trial design. The primary goals of this study were to examine whether different cognitive trajectories can be identified within subjects with MCI and, if present, to characterize each trajectory in relation to changes in all major Alzheimer's disease (AD) biomarkers over time. METHODS Individuals with a diagnosis of MCI at the first visit and ≥ 1 follow-up cognitive assessment were selected from the Alzheimer's Disease Neuroimaging Initiative database (n = 936; age 73 ± 8; 40% female; 16 ± 3 years of education; 50% APOE4 carriers). Based on the Alzheimer's Disease Assessment Scale-Cognitive Subscale-13 (ADAS-Cog-13) total scores from baseline up to 5 years follow-up, a non-parametric k-means longitudinal clustering method was performed to obtain clusters of individuals with similar patterns of cognitive decline. We further conducted a series of linear mixed-effects models to study the associations of cluster membership with longitudinal changes in other cognitive measures, neurodegeneration, and in vivo AD pathologies. RESULTS Four distinct cognitive trajectories emerged. Cluster 1 consisted of 255 individuals (27%) with a nearly non-existent rate of change in the ADAS-Cog-13 over 5 years of follow-up and a healthy-looking biomarker profile. Individuals in the cluster 2 (n = 336, 35%) and 3 (n = 240, 26%) groups showed relatively mild and moderate cognitive decline trajectories, respectively. Cluster 4, comprising about 11% of our study sample (n = 105), exhibited an aggressive cognitive decline trajectory and was characterized by a pronouncedly abnormal biomarker profile. CONCLUSIONS Individuals with MCI show substantial heterogeneity in cognitive decline. Our findings may potentially contribute to improved trial design and patient stratification.
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Affiliation(s)
- Xiwu Wang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Teng Ye
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenjun Zhou
- Research and Development, Hangzhou Shansier Medical Technologies Co., Ltd., Hangzhou, China.
| | - Jie Zhang
- Department of Data Science, Hangzhou Shansier Medical Technologies Co., Ltd., Hangzhou, China.
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12
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Anda-Duran ID, Kolachalama VB, Carmichael OT, Hwang PH, Fernandez C, Au R, Bazzano LA, Libon DJ. Midlife Neuropsychological Profiles and Associated Vascular Risk: The Bogalusa Heart Study. J Alzheimers Dis 2023; 94:101-113. [PMID: 37212094 PMCID: PMC10443183 DOI: 10.3233/jad-220931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Individuals with Alzheimer's disease (AD) often present with coexisting vascular pathology that is expressed to different degrees and can lead to clinical heterogeneity. OBJECTIVE To examine the utility of unsupervised statistical clustering approaches in identifying neuropsychological (NP) test performance subtypes that closely correlate with carotid intima-media thickness (cIMT) in midlife. METHODS A hierarchical agglomerative and k-means clustering analysis based on NP scores (standardized for age, sex, and race) was conducted among 1,203 participants (age 48±5.3 years) from the Bogalusa Heart Study. Regression models assessed the association between cIMT ≥50th percentile and NP profiles, and global cognitive score (GCS) tertiles for sensitivity analysis. RESULTS Three NP profiles were identified: Mixed-low performance [16%, n = 192], scores ≥1 SD below the mean on immediate, delayed free recall, recognition verbal memory, and information processing; Average [59%, n = 704]; and Optimal [26%, n = 307] NP performance. Participants with greater cIMT were more likely to have a Mixed-low profile [OR = 3.10, 95% CI (2.13, 4.53), p < 0.001] compared to Optimal. After adjusting for education and cardiovascular (CV) risks, results remained. The association with GCS tertiles was more attenuated [lowest (34%, n = 407) versus highest (33%, n = 403) tertile: adjusted OR = 1.66, 95% CI (1.07, 2.60), p = 0.024]. CONCLUSION As early as midlife, individuals with higher subclinical atherosclerosis were more likely to be in the Mixed-low profile, underscoring the potential malignancy of CV risk as related to NP test performance, suggesting that classification approaches may aid in identifying those at risk for AD/vascular dementia spectrum illness.
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Affiliation(s)
- Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Owen T. Carmichael
- Louisiana State University’s Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Phillip H. Hwang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer’s Disease Center, Boston, MA, USA
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David J. Libon
- Department of Psychology, Rowan University, Glassboro, NJ, USA
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
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13
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Umfleet LG, Bilder RM, Loring DW, Thames A, Hampstead BM, Bauer RM, Drane DL, Cavanagh L. The Future of Cognitive Screening in Neurodegenerative Diseases. J Alzheimers Dis 2023; 93:47-59. [PMID: 36970899 DOI: 10.3233/jad-221077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Cognitive screening instruments (CSI) have variable sensitivity and specificity to the cognitive changes associated with dementia syndromes, and the most recent systematic review found insufficient evidence to support the benefit of cognitive screening tools in older adults residing within the community. Consequently, there is a critical need to improve CSI methods, which have not yet incorporated advances in psychometrics, neuroscience, and technology. The primary goal of this article is to provide a framework for transitioning from legacy CSIs to advanced dementia screening measurement. In line with ongoing efforts in neuropsychology and the call for next-generation digital assessment for early detection of AD, we propose a psychometrically advanced (including application of item response theory methods), automated selective assessment model that provides a framework to help propel an assessment revolution. Further, we present a three-phase model for modernizing CSIs and discuss critical diversity and inclusion issues, current challenges in differentiating normal from pathological aging, and ethical considerations.
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Affiliation(s)
| | - Robert M Bilder
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Benjamin M Hampstead
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucia Cavanagh
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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14
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Beba A, Peterson SM, Brennan PC, O’Byrne J, Machulda MM, Jannetto PI, Vemuri P, Lewallen DG, Kremers HM, Vassilaki M. Correlation of Blood Metal Concentrations with Cognitive Scores and Neuroimaging Findings in Patients with Total Joint Arthroplasty. J Alzheimers Dis 2023; 94:1335-1342. [PMID: 37393495 PMCID: PMC10481381 DOI: 10.3233/jad-221182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
Total joint arthroplasty (TJA) implants are composed of metals, ceramics, and/or polyethylene. Studies suggest that the debris released from metal implants may possess neurotoxic properties with reports of neuropsychiatric symptoms and memory deficits, which could be relevant to Alzheimer's disease and related dementias. This exploratory study examined the cross-sectional correlation of blood metal concentrations with cognitive performance and neuroimaging findings in a convenience sample of 113 TJA patients with history of elevated blood metal concentrations of either titanium, cobalt and/or chromium. Associations with neuroimaging measures were observed but not with cognitive scores. Larger studies with longitudinal follow-up are warranted.
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Affiliation(s)
- Alican Beba
- George Washington University, Columbian College of Arts and Sciences, Washington, DC, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Peter C. Brennan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jamie O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Paul I. Jannetto
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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15
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Krinsky‐McHale SJ, Hartley S, Hom C, Pulsifer M, Clare IC, Handen BL, Lott IT, Schupf N, Silverman W. A modified Cued Recall Test for detecting prodromal AD in adults with Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12361. [PMID: 36212742 PMCID: PMC9527593 DOI: 10.1002/dad2.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 01/07/2023]
Abstract
Introduction The development of valid methods to diagnose prodromal Alzheimer's disease (AD) in adults with Down syndrome (DS) is one of the many goals of the Alzheimer's Biomarkers Consortium-Down Syndrome (ABC-DS). Methods The diagnostic utility of a modified Cued Recall Test (mCRT) was evaluated in 332 adults with DS ranging from 25 to 81 years of age. Total recall was selected a priori, as the primary indicator of performance. Multiple regression and receiver-operating characteristic (ROC) analyses were used to compare diagnostic groups. Results Performance on the mCRT, as indicated by the total recall score, was highly sensitive to differences between diagnostic groups. ROC areas under the curve (AUCs) ranging from 0.843 to 0.955, were observed. Discussion The mCRT has strong empirical support for its use in clinical settings, as a valuable tool in studies targeting biomarkers of AD, and as a potential outcome measure in clinical trials targeting AD in this high-risk population.
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Affiliation(s)
- Sharon J. Krinsky‐McHale
- Department of PsychologyNew York State Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Sigan Hartley
- Department of Human Development and Family StudiesWaisman CenterUniversity of WisconsinMadisonUSA
| | - Christy Hom
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvine School of MedicineIrvineCaliforniaUSA
| | - Margaret Pulsifer
- Department of PsychiatryMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Benjamin L. Handen
- Department of PsychiatryPediatrics and PsychologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Ira T. Lott
- Department of PediatricsUniversity of CaliforniaIrvineCaliforniaUSA
| | - Nicole Schupf
- Department of NeurologyCollege of Physicians and Surgeons and Department of EpidemiologySchool of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Wayne Silverman
- Department of PediatricsUniversity of CaliforniaIrvineCaliforniaUSA
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16
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Kikuchi M, Kobayashi K, Itoh S, Kasuga K, Miyashita A, Ikeuchi T, Yumoto E, Kosaka Y, Fushimi Y, Takeda T, Manabe S, Hattori S, Disease Neuroimaging Initiative A, Nakaya A, Kamijo K, Matsumura Y. Identification of mild cognitive impairment subtypes predicting conversion to Alzheimer’s disease using multimodal data. Comput Struct Biotechnol J 2022; 20:5296-5308. [PMID: 36212530 PMCID: PMC9513733 DOI: 10.1016/j.csbj.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022] Open
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17
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Romero K, Ladyka-Wojcik N, Heir A, Bellana B, Leach L, Proulx GB. The Influence of Cerebrovascular Pathology on Cluster Analysis of Neuropsychological Scores in Patients With Mild Cognitive Impairment. Arch Clin Neuropsychol 2022; 37:1480-1492. [PMID: 35772970 DOI: 10.1093/arclin/acac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The diagnostic entity of mild cognitive impairment (MCI) is heterogeneous, highlighting the need for data-driven classification approaches to identify patient subgroups. However, these approaches can be strongly determined by sample characteristics and selected measures. Here, we applied a cluster analysis to an MCI patient database from a neuropsychology clinic to determine whether the inclusion of patients with MCI with vascular pathology would result in a different classification of subgroups. METHODS Participants diagnosed with MCI (n = 166), vascular cognitive impairment-no dementia (n = 26), and a group of older adults with subjective cognitive concerns but no objective impairment (n = 144) were assessed using a full neuropsychological battery and other clinical measures. Cognitive measures were analyzed using a hierarchical cluster analysis and then a k-means approach, with resulting clusters compared on a range of demographic and clinical variables. RESULTS We found a 4-factor solution: a cognitively intact cluster, a globally impaired cluster, an amnestic/visuospatial impairment cluster, and a mild, mixed-domain cluster. Interestingly, group differences in self-reported multilingualism emerged in the derived clusters that were not observed when comparing diagnostic groups. CONCLUSIONS Our results were generally consistent with previous studies using cluster analysis in MCI. Including patients with primarily cerebrovascular disease resulted in subtle differences in the derived clusters and revealed new insights into shared cognitive profiles of patients beyond diagnostic categories. These profiles should be further explored to develop individualized assessment and treatment approaches.
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Affiliation(s)
| | | | - Arjan Heir
- Department of Psychology, York University Glendon Campus
| | | | - Larry Leach
- Department of Psychology, York University Glendon Campus
| | - Guy B Proulx
- Department of Psychology, York University Glendon Campus
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18
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Thomas KR, Bangen KJ, Weigand AJ, Ortiz G, Walker KS, Salmon DP, Bondi MW, Edmonds EC. Cognitive Heterogeneity and Risk of Progression in Data-Driven Subtle Cognitive Decline Phenotypes. J Alzheimers Dis 2022; 90:323-331. [PMID: 36120785 PMCID: PMC9661321 DOI: 10.3233/jad-220684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is increasing recognition of cognitive and pathological heterogeneity in early-stage Alzheimer's disease and other dementias. Data-driven approaches have demonstrated cognitive heterogeneity in those with mild cognitive impairment (MCI), but few studies have examined this heterogeneity and its association with progression to MCI/dementia in cognitively unimpaired (CU) older adults. OBJECTIVE We identified cluster-derived subgroups of CU participants based on comprehensive neuropsychological data and compared baseline characteristics and rates of progression to MCI/dementia or a Dementia Rating Scale (DRS) of ≤129 across subgroups. METHODS Hierarchical cluster analysis was conducted on individual baseline neuropsychological test scores from 365 CU participants in the UCSD Shiley-Marcos Alzheimer's Disease Research Center longitudinal cohort. Cox regressions examined the risk of progression to consensus diagnosis of MCI or dementia, or to DRS score ≤129, by cluster group. RESULTS Cluster analysis identified 5 groups: All-Average (n = 139), Low-Visuospatial (n = 46), Low-Executive (n = 51), Low-Memory/Language (n = 83), and Low-All Domains (n = 46). Subgroups had unique demographic and clinical characteristics. Rates of progression to MCI/dementia or to DRS ≤129 were faster for all subgroups (Low-All Domains progressed the fastest > Low Memory/Language≥Low-Visuospatial and Low-Executive) relative to the All-Average subgroup. CONCLUSION Faster progression in the Low-Visuospatial, Low-Executive, and Low-Memory/Language groups compared to the All-Average group suggests that there are multiple pathways and/or unique subtle cognitive decline profiles that ultimately lead to a diagnosis of MCI/dementia. Use of comprehensive neuropsychological test batteries that assess several domains may be a key first step toward an individualized approach to early detection and fewer missed opportunities for early intervention.
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Affiliation(s)
- Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Gema Ortiz
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kayla S. Walker
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - David P. Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute, Tucson, AZ, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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19
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Machulda MM, Lundt ES, Mester CT, Albertson SM, Raghavan S, Reid RI, Schwarz CG, Graff‐Radford J, Jack CR, Knopman DS, Mielke MM, Kremers WK, Petersen RC, Bondi MW, Vemuri P. White matter changes in empirically derived incident MCI subtypes in the Mayo Clinic Study of Aging. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12269. [PMID: 35005199 PMCID: PMC8719426 DOI: 10.1002/dad2.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to examine white matter hyperintensities (WMH) and fractional anisotropy (FA) in empirically derived incident mild cognitive impairment (MCI) subtypes. METHODS We evaluated 188 participants with incident MCI in the Mayo Clinic Study of Aging (MCSA) identified as having one of four cluster-derived subtypes: subtle cognitive impairment, amnestic, dysnomic, and dysexecutive. We used linear regression models to evaluate whole brain and regional WMH volumes. We examined fractional anisotropy (FA) on a subset of 63 participants with diffusion tensor imaging. RESULTS Amnestic and dysexecutive subtypes had higher WMH volumes in differing patterns than cognitively unimpaired; the dysexecutive subtype had higher WMH than subtle cognitive impairment. There was widespread WM degeneration in long association and commissural fibers in the amnestic, dysnomic, and dysexecutive subtypes, and corpus callosum FA accounted for significant variability in global cognition. DISCUSSION White matter changes likely contribute to cognitive symptoms in incident MCI.
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Affiliation(s)
- Mary M. Machulda
- Division of Neurocognitive DisordersDepartment of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Emily S. Lundt
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | - Carly T. Mester
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | - Sabrina M. Albertson
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - Robert I. Reid
- Department of Information TechnologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Michelle M. Mielke
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Walter K. Kremers
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - Mark W. Bondi
- Department of PsychiatryUniversity of California San DiegoSchool of MedicineLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
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20
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Kwak K, Giovanello KS, Bozoki A, Styner M, Dayan E. Subtyping of mild cognitive impairment using a deep learning model based on brain atrophy patterns. Cell Rep Med 2021; 2:100467. [PMID: 35028609 PMCID: PMC8714856 DOI: 10.1016/j.xcrm.2021.100467] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/08/2021] [Accepted: 11/13/2021] [Indexed: 12/28/2022]
Abstract
Trajectories of cognitive decline vary considerably among individuals with mild cognitive impairment (MCI). To address this heterogeneity, subtyping approaches have been developed, with the objective of identifying more homogeneous subgroups. To date, subtyping of MCI has been based primarily on cognitive measures, often resulting in indistinct boundaries between subgroups and limited validity. Here, we introduce a subtyping method for MCI based solely upon brain atrophy. We train a deep learning model to differentiate between Alzheimer's disease (AD) and cognitively normal (CN) subjects based on whole-brain MRI features. We then deploy the trained model to classify MCI subjects based on whole-brain gray matter resemblance to AD-like or CN-like patterns. We subsequently validate the subtyping approach using cognitive, clinical, fluid biomarker, and molecular imaging data. Overall, the results suggest that atrophy patterns in MCI are sufficiently heterogeneous and can thus be used to subtype individuals into biologically and clinically meaningful subgroups.
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Affiliation(s)
- Kichang Kwak
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kelly S. Giovanello
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Andrea Bozoki
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Martin Styner
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Eran Dayan
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - for the Alzheimer’s Disease Neuroimaging Initiative
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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21
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Ibrahim OA, Fu S, Vassilaki M, Petersen RC, Mielke MM, St Sauver J, Sohn S. Early Alert of Elderly Cognitive Impairment using Temporal Streaming Clustering. PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICINE 2021; 2021:905-912. [PMID: 35237461 PMCID: PMC8883577 DOI: 10.1109/bibm52615.2021.9669672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
more than 44 million people have been diagnosed with dementia worldwide, and this number is estimated to triple by next three decades. Given this increasing trend of older adults with cognitive impairment (CI; dementia and mild cognitive impairment) and its significant underdiagnosis, early identification of CI and understanding its progression is a critical step towards a better quality of life for the aging population. Early alert of individual health changes could facilitate better ways for clinicians to diagnose CI in its early stages and come up with more effective treatment plans. However, there is a lack of approaches to characterize patient health conditions accounting for temporal information in an unsupervised manner. Limited CI cases and its costly ascertainment in clinical settings also make unsupervised learning more promising in CI research. In this paper, a streaming clustering model was used to determine distinct patterns of older adults' health changes from their clinical visits in Mayo Clinic Study of Aging. The streaming clustering was also examined to study its ability to generate early alerts for potential incidents of CI. Our analysis demonstrated that temporal characteristics incorporated in a streaming clustering model has a promising potential to increase power in predicting CI.
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Affiliation(s)
- Omar A. Ibrahim
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunyang Fu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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22
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Devlin KN, Brennan L, Saad L, Giovannetti T, Hamilton RH, Wolk DA, Xie SX, Mechanic-Hamilton D. Diagnosing Mild Cognitive Impairment Among Racially Diverse Older Adults: Comparison of Consensus, Actuarial, and Statistical Methods. J Alzheimers Dis 2021; 85:627-644. [PMID: 34864658 DOI: 10.3233/jad-210455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Actuarial and statistical methods have been proposed as alternatives to conventional methods of diagnosing mild cognitive impairment (MCI), with the aim of enhancing diagnostic and prognostic validity, but have not been compared in racially diverse samples. OBJECTIVE We compared the agreement of consensus, actuarial, and statistical MCI diagnostic methods, and their relationship to race and prognostic indicators among diverse older adults. METHODS Participants (N = 354; M age = 71; 68% White, 29% Black) were diagnosed with MCI or normal cognition (NC) according to clinical consensus, actuarial neuropsychological criteria (Jak/Bondi), and latent class analysis (LCA). We examined associations with race/ethnicity, longitudinal cognitive and functional change, and incident dementia. RESULTS MCI rates by consensus, actuarial criteria, and LCA were 44%, 53%, and 41%, respectively. LCA identified three MCI subtypes (memory; memory/language; memory/executive) and two NC classes (low normal; high normal). Diagnostic agreement was substantial, but agreement of the actuarial method with consensus and LCA was weaker than the agreement between consensus and LCA. Among cases classified as MCI by actuarial criteria only, Black participants were over-represented, and outcomes were generally similar to those of NC participants. Consensus diagnoses best predicted longitudinal outcomes overall, whereas actuarial diagnoses best predicted longitudinal functional change among Black participants. CONCLUSION Consensus diagnoses optimize specificity in predicting dementia, but among Black older adults, actuarial diagnoses may be more sensitive to early signs of decline. Results highlight the need for cross-cultural validity in MCI diagnosis and should be explored in community- and population-based samples.
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Affiliation(s)
- Kathryn N Devlin
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Laura Brennan
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Laura Saad
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | | | - Roy H Hamilton
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Wolk
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon X Xie
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Dawn Mechanic-Hamilton
- Alzheimer's Disease Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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23
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Edmonds EC, Smirnov DS, Thomas KR, Graves LV, Bangen KJ, Delano-Wood L, Galasko DR, Salmon DP, Bondi MW. Data-Driven vs Consensus Diagnosis of MCI: Enhanced Sensitivity for Detection of Clinical, Biomarker, and Neuropathologic Outcomes. Neurology 2021; 97:e1288-e1299. [PMID: 34376506 PMCID: PMC8480404 DOI: 10.1212/wnl.0000000000012600] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Given prior work demonstrating that mild cognitive impairment (MCI) can be empirically differentiated into meaningful cognitive subtypes, we applied actuarial methods to comprehensive neuropsychological data from the University of California San Diego Alzheimer's Disease Research Center (ADRC) in order to identify cognitive subgroups within ADRC participants without dementia and to examine cognitive, biomarker, and neuropathologic trajectories. METHODS Cluster analysis was performed on baseline neuropsychological data (n = 738; mean age 71.8). Survival analysis examined progression to dementia (mean follow-up 5.9 years). CSF Alzheimer disease (AD) biomarker status and neuropathologic findings at follow-up were examined in a subset with available data. RESULTS Five clusters were identified: optimal cognitively normal (CN; n = 130) with above-average cognition, typical CN (n = 204) with average cognition, nonamnestic MCI (naMCI; n = 104), amnestic MCI (aMCI; n = 216), and mixed MCI (mMCI; n = 84). Progression to dementia differed across MCI subtypes (mMCI > aMCI > naMCI), with the mMCI group demonstrating the highest rate of CSF biomarker positivity and AD pathology at autopsy. Actuarial methods classified 29.5% more of the sample with MCI and outperformed consensus diagnoses in capturing those who had abnormal biomarkers, progressed to dementia, or had AD pathology at autopsy. DISCUSSION We identified subtypes of MCI and CN with differing cognitive profiles, clinical outcomes, CSF AD biomarkers, and neuropathologic findings over more than 10 years of follow-up. Results demonstrate that actuarial methods produce reliable cognitive phenotypes, with data from a subset suggesting unique biological and neuropathologic signatures. Findings indicate that data-driven algorithms enhance diagnostic sensitivity relative to consensus diagnosis for identifying older adults at risk for cognitive decline.
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Affiliation(s)
- Emily C Edmonds
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla.
| | - Denis S Smirnov
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Kelsey R Thomas
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Lisa V Graves
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Katherine J Bangen
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Lisa Delano-Wood
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Douglas R Galasko
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - David P Salmon
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
| | - Mark W Bondi
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., D.R.G., M.W.B.); and Departments of Psychiatry (E.C.E., K.R.T., L.V.G., K.J.B., L.D.-W., M.W.B.) and Neurosciences (D.S.S., D.R.G., D.P.S.), University of California San Diego, La Jolla
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24
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Petersen RC. MCI Criteria in ADNI: Meeting Biological Expectations. Neurology 2021; 97:597-599. [PMID: 34341151 PMCID: PMC8480480 DOI: 10.1212/wnl.0000000000012588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
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25
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Lamar M, Drabick D, Boots EA, Agarwal P, Emrani S, Delano-Wood L, Bondi MW, Barnes LL, Libon DJ. Latent Profile Analysis of Cognition in a Non-Demented Diverse Cohort: A Focus on Modifiable Cardiovascular and Lifestyle Factors. J Alzheimers Dis 2021; 82:1833-1846. [PMID: 34219713 DOI: 10.3233/jad-210110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitively-defined subgroups are well-documented within neurodegeneration. OBJECTIVE We examined such profiles in diverse non-demented older adults and considered how resulting subgroups relate to modifiable factors associated with neurodegeneration. METHODS 121 non-demented (MMSE = 28.62) diverse (46%non-Latino Black, 40%non-Latino White, 15%Latino) community-dwelling adults (age = 67.7 years) completed cognitive, cardiovascular, physical activity, and diet evaluations. Latent profile analyses (LPA) employed six cognitive scores (letter fluency, letter-number sequencing, confrontational naming, 'animal' fluency, list-learning delayed recall, and recognition discriminability) to characterize cognitively-defined subgroups. Differences between resulting subgroups on cardiovascular (composite scores of overall health; specific health components including fasting blood levels) and lifestyle (sedentary behavior; moderate-to-vigorous physical activity; Mediterranean diet consumption) factors were examined using ANCOVAs adjusting for relevant confounders. RESULTS Based on sample means across cognitive scores, LPA resulted in the following cognitive subgroups: 1) high-average cognition, 55%non-Latino White and 64%female participants; 2) average cognition, 58%non-Latino Black and 68%male participants; 3) lower memory, 58%non-Latino Black participants; and 4) lower executive functioning, 70%Latinos. The high-average subgroup reported significantly higher Mediterranean diet consumption than the average subgroup (p = 0.001). The lower executive functioning group had higher fasting glucose and hemoglobin A1c than all other subgroups (p-values<0.001). CONCLUSION LPA revealed two average subgroups reflecting level differences in cognition previously reported between non-Latino White and Black adults, and two lower cognition subgroups in domains similar to those documented in neurodegeneration. These subgroups, and their differences, suggest the importance of considering social determinants of health in cognitive aging and modifiable risk.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Deborah Drabick
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Elizabeth A Boots
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Puja Agarwal
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sheina Emrani
- Department of Psychology, Rowan University, Glassboro, NJ, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Mark W Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David J Libon
- Rowan University School of Osteopathic Medicine, New Jersey Institute for Successful Aging Departments of Geriatrics and Gerontology and Psychology, Stratford, NJ, USA
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26
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Pudumjee SB, Lundt ES, Albertson SM, Machulda MM, Kremers WK, Jack CR, Knopman DS, Petersen RC, Mielke MM, Stricker NH. A Comparison of Cross-Sectional and Longitudinal Methods of Defining Objective Subtle Cognitive Decline in Preclinical Alzheimer's Disease Based on Cogstate One Card Learning Accuracy Performance. J Alzheimers Dis 2021; 83:861-877. [PMID: 34366338 DOI: 10.3233/jad-210251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Longitudinal, but not cross-sectional, cognitive testing is one option proposed to define transitional cognitive decline for individuals on the Alzheimer's disease continuum. OBJECTIVE Compare diagnostic accuracy of cross-sectional subtle objective cognitive impairment (sOBJ) and longitudinal objective decline (ΔOBJ) over 30 months for identifying 1) cognitively unimpaired participants with preclinical Alzheimer's disease defined by elevated brain amyloid and tau (A+T+) and 2) incident mild cognitive impairment (MCI) based on Cogstate One Card Learning (OCL) accuracy performance. METHODS Mayo Clinic Study of Aging cognitively unimpaired participants aged 50 + with amyloid and tau PET scans (n = 311) comprised the biomarker-defined sample. A case-control sample of participants aged 65 + remaining cognitively unimpaired for at least 30 months included 64 who subsequently developed MCI (incident MCI cases) and 184 controls, risk-set matched by age, sex, education, and visit number. sOBJ was assessed by OCL z-scores. ΔOBJ was assessed using within subjects' standard deviation and annualized change from linear regression or linear mixed effects (LME) models. Concordance measures Area Under the ROC Curve (AUC) or C-statistic and odds ratios (OR) from conditional logistic regression models were derived. sOBJ and ΔOBJ were modeled jointly to compare methods. RESULTS sOBJ and ΔOBJ-LME methods differentiated A+T+ from A-T- (AUC = 0.64, 0.69) and controls from incident MCI (C-statistic = 0.59, 0.69) better than chance; other ΔOBJ methods did not. ΔOBJ-LME improved prediction of future MCI over baseline sOBJ (p = 0.003) but not over 30-month sOBJ (p = 0.09). CONCLUSION Longitudinal decline did not offer substantial benefit over cross-sectional assessment in detecting preclinical Alzheimer's disease or incident MCI.
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Affiliation(s)
- Shehroo B Pudumjee
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Emily S Lundt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sabrina M Albertson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald C Petersen
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Nikki H Stricker
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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27
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Petersen RC, Wiste HJ, Weigand SD, Fields JA, Geda YE, Graff‐Radford J, Knopman DS, Kremers WK, Lowe V, Machulda MM, Mielke MM, Stricker NH, Therneau TM, Vemuri P, Jack CR. NIA-AA Alzheimer's Disease Framework: Clinical Characterization of Stages. Ann Neurol 2021; 89:1145-1156. [PMID: 33772866 PMCID: PMC8131266 DOI: 10.1002/ana.26071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND To operationalize the National Institute on Aging - Alzheimer's Association (NIA-AA) Research Framework for Alzheimer's Disease 6-stage continuum of clinical progression for persons with abnormal amyloid. METHODS The Mayo Clinic Study of Aging is a population-based longitudinal study of aging and cognitive impairment in Olmsted County, Minnesota. We evaluated persons without dementia having 3 consecutive clinical visits. Measures for cross-sectional categories included objective cognitive impairment (OBJ) and function (FXN). Measures for change included subjective cognitive impairment (SCD), objective cognitive change (ΔOBJ), and new onset of neurobehavioral symptoms (ΔNBS). We calculated frequencies of the stages using different cutoff points and assessed stability of the stages over 15 months. RESULTS Among 243 abnormal amyloid participants, the frequencies of the stages varied with age: 66 to 90% were classified as stage 1 at age 50 but at age 80, 24 to 36% were stage 1, 32 to 47% were stage 2, 18 to 27% were stage 3, 1 to 3% were stage 4 to 6, and 3 to 9% were indeterminate. Most stage 2 participants were classified as stage 2 because of abnormal ΔOBJ only (44-59%), whereas 11 to 21% had SCD only, and 9 to 13% had ΔNBS only. Short-term stability varied by stage and OBJ cutoff points but the most notable changes were seen in stage 2 with 38 to 63% remaining stable, 4 to 13% worsening, and 24 to 41% improving (moving to stage 1). INTERPRETATION The frequency of the stages varied by age and the precise membership fluctuated by the parameters used to define the stages. The staging framework may require revisions before it can be adopted for clinical trials. ANN NEUROL 2021;89:1145-1156.
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Affiliation(s)
| | | | | | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMN
| | - Yonas E. Geda
- Department of NeurologyBarrow Neurological InstitutePhoenixAZ
| | | | | | | | - Val Lowe
- Department of RadiologyMayo ClinicRochesterMN
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28
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Stricker NH, Lundt ES, Albertson SM, Machulda MM, Pudumjee SB, Kremers WK, Jack CR, Knopman DS, Petersen RC, Mielke MM. Diagnostic and Prognostic Accuracy of the Cogstate Brief Battery and Auditory Verbal Learning Test in Preclinical Alzheimer's Disease and Incident Mild Cognitive Impairment: Implications for Defining Subtle Objective Cognitive Impairment. J Alzheimers Dis 2021; 76:261-274. [PMID: 32538841 DOI: 10.3233/jad-200087] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND There are detectable cognitive differences in cognitively unimpaired (CU) individuals with preclinical Alzheimer's disease (AD). OBJECTIVE To determine whether cross-sectional performance on the Cogstate Brief Battery (CBB) and Auditory Verbal Learning Test (AVLT) could identify 1) CU participants with preclinical AD defined by neuroimaging biomarkers of amyloid and tau, and 2) incident mild cognitive impairment (MCI)/dementia. METHOD CU participants age 50+ were eligible if they had 1) amyloid (A) and tau (T) imaging within two years of their baseline CBB or 2) at least one follow-up visit. AUROC analyses assessed the ability of measures to differentiate groups. We explored the frequency of cross-sectional subtle objective cognitive impairment (sOBJ) defined as performance ≤-1 SD on CBB Learning/Working Memory Composite (Lrn/WM) or AVLT delayed recall using age-corrected normative data. RESULTS A+T+ (n = 33, mean age 79.5) and A+T- (n = 61, mean age 77.8) participants were older than A-T- participants (n = 146, mean age 66.3), and comparable on sex and education. Lrn/WM did not differentiate A + T+or A+T- from A-T- participants. AVLT differentiated both A+T+ and A+T- from A-T- participants; 45% of A+T+ and 25% of A+T- participants met sOBJ criteria. The follow-up cohort included 150 CU individuals who converted to MCI/dementia and 450 age, sex, and education matched controls. Lrn/WM and AVLT differentiated between stable and converter CU participants. CONCLUSION Among CU participants, AVLT helped differentiate A+T+ and A+T- from A-T- participants. The CBB did not differentiate biomarker subgroups, but showed potential for predicting incident MCI/dementia. Results inform future definitions of sOBJ.
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Affiliation(s)
- Nikki H Stricker
- Department of Psychiatry and Psychology, Division of Neurocognitive Disorders, Mayo Clinic, Rochester, MN, USA
| | - Emily S Lundt
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Sabrina M Albertson
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Division of Neurocognitive Disorders, Mayo Clinic, Rochester, MN, USA
| | - Shehroo B Pudumjee
- Department of Psychiatry and Psychology, Division of Neurocognitive Disorders, Mayo Clinic, Rochester, MN, USA
| | - Walter K Kremers
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
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29
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Silverman W, Krinsky-McHale SJ, Lai F, Rosas HD, Hom C, Doran E, Pulsifer M, Lott I, Schupf N. Evaluation of the National Task Group-Early Detection Screen for Dementia: Sensitivity to 'mild cognitive impairment' in adults with Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:905-915. [PMID: 33314467 PMCID: PMC8356176 DOI: 10.1111/jar.12849] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/09/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The accuracy of the National Task Group-Early Detection Screen for Dementia (NTG-EDSD) was evaluated in a sample of 185 adults with Down syndrome (DS), emphasizing 'mild cognitive impairment (MCI-DS)'. METHOD Knowledgeable informants were interviewed with the NTG-EDSD, and findings were compared to an independent dementia status rating based on consensus review of detailed assessments of cognition, functional abilities and health status (including physician examination). RESULTS Results indicated that sections of the NTG-EDSD were sensitive to MCI-DS, with one or more concerns within the 'Memory' or 'Language and Communication' domains being most informative. CONCLUSIONS The NTG-EDSD is a useful tool for evaluating dementia status, including MCI-DS. However, estimates of sensitivity and specificity, even for detecting frank dementia, indicated that NTG-EDSD findings need to be supplemented by additional sources of relevant information to achieve an acceptable level of diagnostic/screening accuracy.
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Affiliation(s)
- Wayne Silverman
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Sharon J. Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA,Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
| | - Florence Lai
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - H. Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Christy Hom
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Margaret Pulsifer
- Department of Psychiatry, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Ira Lott
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Nicole Schupf
- Sergievsky Center, Taub Institute, New York, CA, USA,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, CA, USA,Department of Epidemiology, School of Public Health, Columbia University, New York, CA, USA
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Cognitive Phenotypes of Older Adults with Subjective Cognitive Decline and Amnestic Mild Cognitive Impairment: The Czech Brain Aging Study. J Int Neuropsychol Soc 2021; 27:329-342. [PMID: 33138890 DOI: 10.1017/s1355617720001046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare cognitive phenotypes of participants with subjective cognitive decline (SCD) and amnestic mild cognitive impairment (aMCI), estimate progression to MCI/dementia by phenotype and assess classification error with machine learning. METHOD Dataset consisted of 163 participants with SCD and 282 participants with aMCI from the Czech Brain Aging Study. Cognitive assessment included the Uniform Data Set battery and additional tests to ascertain executive function, language, immediate and delayed memory, visuospatial skills, and processing speed. Latent profile analyses were used to develop cognitive profiles, and Cox proportional hazards models were used to estimate risk of progression. Random forest machine learning algorithms reported cognitive phenotype classification error. RESULTS Latent profile analysis identified three phenotypes for SCD, with one phenotype performing worse across all domains but not progressing more quickly to MCI/dementia after controlling for age, sex, and education. Three aMCI phenotypes were characterized by mild deficits, memory and language impairment (dysnomic aMCI), and severe multi-domain aMCI (i.e., deficits across all domains). A dose-response relationship between baseline level of impairment and subsequent risk of progression to dementia was evident for aMCI profiles after controlling for age, sex, and education. Machine learning more easily classified participants with aMCI in comparison to SCD (8% vs. 21% misclassified). CONCLUSIONS Cognitive performance follows distinct patterns, especially within aMCI. The patterns map onto risk of progression to dementia.
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Yao W, Chen H, Luo C, Sheng X, Zhao H, Xu Y, Bai F. Hyperconnectivity of Self-Referential Network as a Predictive Biomarker of the Progression of Alzheimer's Disease. J Alzheimers Dis 2021; 80:577-590. [PMID: 33579849 DOI: 10.3233/jad-201376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Self-referential processing is associated with the progression of Alzheimer's disease (AD), and cerebrospinal fluid (CSF) proteins have become accepted biomarkers of AD. OBJECTIVE Our objective in this study was to focus on the relationships between the self-referential network (SRN) and CSF pathology in AD-spectrum patients. METHODS A total of 80 participants, including 20 cognitively normal, 20 early mild cognitive impairment (EMCI), 20 late MCI (LMCI), and 20 AD, were recruited for this study. Independent component analysis was used to explore the topological SRN patterns, and the abnormalities of this network were identified at different stages of AD. Finally, CSF pathological characteristics (i.e., CSF Aβ, t-tau, and p-tau) that affected the abnormalities of the SRN were further determined during the progression of AD. RESULTS Compared to cognitively normal subjects, AD-spectrum patients (i.e., EMCI, LMCI, and AD) showed a reversing trend toward an association between CSF pathological markers and the abnormal SRN occurring during the progression of AD. However, a certain disease state (i.e., the present LMCI) with a low concentration of CSF tau could evoke more hyperconnectivity of the SRN than other patients with progressively increasing concentrations of CSF tau (i.e., EMCI and AD), and this fluctuation of CSF tau was more sensitive to the hyperconnectivity of the SRN than the dynamic changes of CSF Aβ. CONCLUSION The integrity of the SRN was closely associated with CSF pathological characteristics, and these findings support the view that the hyperconnectivity of the SRN will play an important role in monitoring the progression of the pre-dementia state to AD.
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Affiliation(s)
- Weina Yao
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Haifeng Chen
- Department of Neurology, Nanjing Drum Tower Hospital of The Affiliated Hospital of Nanjing University Medical School, and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Caimei Luo
- Department of Neurology, Nanjing Drum Tower Hospital of The Affiliated Hospital of Nanjing University Medical School, and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
| | - Xiaoning Sheng
- Department of Neurology, Nanjing Drum Tower Hospital of The Affiliated Hospital of Nanjing University Medical School, and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
| | - Hui Zhao
- Department of Neurology, Nanjing Drum Tower Hospital of The Affiliated Hospital of Nanjing University Medical School, and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital of The Affiliated Hospital of Nanjing University Medical School, and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Feng Bai
- Department of Neurology, Nanjing Drum Tower Hospital of The Affiliated Hospital of Nanjing University Medical School, and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
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Petkus AJ, Younan D, Wang X, Beavers DP, Espeland MA, Gatz M, Gruenewald T, Kaufman JD, Chui HC, Millstein J, Rapp SR, Manson JE, Resnick SM, Wellenius GA, Whitsel EA, Widaman K, Chen JC. Associations Between Air Pollution Exposure and Empirically Derived Profiles of Cognitive Performance in Older Women. J Alzheimers Dis 2021; 84:1691-1707. [PMID: 34744078 PMCID: PMC9057084 DOI: 10.3233/jad-210518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Elucidating associations between exposures to ambient air pollutants and profiles of cognitive performance may provide insight into neurotoxic effects on the aging brain. OBJECTIVE We examined associations between empirically derived profiles of cognitive performance and residential concentrations of particulate matter of aerodynamic diameter < 2.5 (PM2.5) and nitrogen dioxide (NO2) in older women. METHOD Women (N = 2,142) from the Women's Health Initiative Study of Cognitive Aging completed a neuropsychological assessment measuring attention, visuospatial, language, and episodic memory abilities. Average yearly concentrations of PM2.5 and NO2 were estimated at the participant's addresses for the 3 years prior to the assessment. Latent profile structural equation models identified subgroups of women exhibiting similar profiles across tests. Multinomial regressions examined associations between exposures and latent profile classification, controlling for covariates. RESULT Five latent profiles were identified: low performance across multiple domains (poor multi-domain; n = 282;13%), relatively poor verbal episodic memory (poor memory; n = 216; 10%), average performance across all domains (average multi-domain; n = 974; 45%), superior memory (n = 381; 18%), and superior attention (n = 332; 15%). Using women with average cognitive ability as the referent, higher PM2.5 (per interquartile range [IQR] = 3.64μg/m3) was associated with greater odds of being classified in the poor memory (OR = 1.29; 95% Confidence Interval [CI] = 1.10-1.52) or superior attention (OR = 1.30; 95% CI = 1.10-1.53) profiles. NO2 (per IQR = 9.86 ppb) was associated with higher odds of being classified in the poor memory (OR = 1.38; 95% CI = 1.17-1.63) and lower odds of being classified with superior memory (OR = 0.81; 95% CI = 0.67-0.97). CONCLUSION Exposure to PM2.5 and NO2 are associated with patterns of cognitive performance characterized by worse verbal episodic memory relative to performance in other domains.
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Affiliation(s)
- Andrew J. Petkus
- University of Southern California, Department of Neurology, Los Angeles, CA, USA
| | - Diana Younan
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Xinhui Wang
- University of Southern California, Department of Neurology, Los Angeles, CA, USA
| | - Daniel P. Beavers
- Wake Forest School of Medicine, Department of Biostatistics, Winston-Salem, NC, USA
| | - Mark A. Espeland
- Wake Forest School of Medicine, Department of Biostatistics, Winston-Salem, NC, USA
| | - Margaret Gatz
- University of Southern California, Center for Economic and Social Research, Los Angeles, CA, USA
| | - Tara Gruenewald
- Chapman University, Department of Psychology, Orange, CA, USA
| | - Joel D. Kaufman
- University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, WA, USA
| | - Helena C. Chui
- University of Southern California, Department of Neurology, Los Angeles, CA, USA
| | - Joshua Millstein
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Stephen R. Rapp
- Wake Forest School of Medicine, Department of Psychiatry and Behavioral Medicine, Winston-Salem, NC, USA
| | - JoAnn E. Manson
- Harvard Medical School, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Susan M. Resnick
- National Institute on Aging, Laboratory of Behavioral Neuroscience, Baltimore, MD, USA
| | | | - Eric A. Whitsel
- University of North Carolina, Departments of Epidemiology and Medicine, Chapel Hill, NC, USA
| | - Keith Widaman
- University of California, Riverside, Graduate School of Education, Riverside, CA, USA
| | - Jiu-Chiuan Chen
- University of Southern California, Department of Neurology, Los Angeles, CA, USA
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
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Bermejo-Pareja F, Contador I, Del Ser T, Olazarán J, Llamas-Velasco S, Vega S, Benito-León J. Predementia constructs: Mild cognitive impairment or mild neurocognitive disorder? A narrative review. Int J Geriatr Psychiatry 2020. [PMID: 33340379 DOI: 10.1002/gps.5474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Predementia is a heuristic umbrella concept to classify older adults with cognitive impairment who do not suffer dementia. Many diagnostic entities have been proposed to address this concept, but most of them have not had widespread acceptance. AIMS To review clinical definitions, epidemiologic data (prevalence, incidence) and rate of conversion to dementia of the main predementia constructs, with special interest in the two most frequently used: mild cognitive impairment (MCI) and minor neurocognitive disorder (miNCD). METHODS We have selected in three databases (MEDLINE, Web of Science and Google scholar) the references from inception to 31 December 2019 of relevant reviews, population and community-based surveys, and clinical series with >500 participants and >3 years follow-up as the best source of evidence. MAIN RESULTS The history of predementia constructs shows that MCI is the most referred entity. It is widely recognized as a clinical syndrome harbinger of dementia of several etiologies, mainly MCI due to Alzheimer's disease. The operational definition of MCI has shortcomings: vagueness of its requirement of "preserved independence in functional abilities" and others. The recent miNCD construct presents analogous difficulties. Current data indicate that it is a stricter predementia condition, with lower prevalence than MCI, less sensitivity to cognitive decline and, possibly, higher conversion rate to dementia. CONCLUSIONS MCI is a widely employed research and clinical entity. Preliminary data indicate that the clinical use of miNCD instead of MCI requires more scientific evidence. Both approaches have common limitations that need to be addressed.
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Affiliation(s)
- Félix Bermejo-Pareja
- Research Institute (Imas12), University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science, University of Salamanca, Salamanca, Spain
| | - Teodoro Del Ser
- Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation Alzheimer Research, Madrid, Spain
| | - Javier Olazarán
- Department of Neurology, University Hospital "Gregorio Marañón", Madrid, Spain
| | - Sara Llamas-Velasco
- Research Institute (Imas12), University Hospital "12 de Octubre", Madrid, Spain
| | | | - Julián Benito-León
- Research Institute (Imas12), University Hospital "12 de Octubre", Madrid, Spain
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Mohanty R, Mårtensson G, Poulakis K, Muehlboeck JS, Rodriguez-Vieitez E, Chiotis K, Grothe MJ, Nordberg A, Ferreira D, Westman E. Comparison of subtyping methods for neuroimaging studies in Alzheimer's disease: a call for harmonization. Brain Commun 2020; 2:fcaa192. [PMID: 33305264 PMCID: PMC7713995 DOI: 10.1093/braincomms/fcaa192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023] Open
Abstract
Biological subtypes in Alzheimer's disease, originally identified on neuropathological data, have been translated to in vivo biomarkers such as structural magnetic resonance imaging and positron emission tomography, to disentangle the heterogeneity within Alzheimer's disease. Although there is methodological variability across studies, comparable characteristics of subtypes are reported at the group level. In this study, we investigated whether group-level similarities translate to individual-level agreement across subtyping methods, in a head-to-head context. We compared five previously published subtyping methods. Firstly, we validated the subtyping methods in 89 amyloid-beta positive Alzheimer's disease dementia patients (reference group: 70 amyloid-beta negative healthy individuals) using structural magnetic resonance imaging. Secondly, we extended and applied the subtyping methods to 53 amyloid-beta positive prodromal Alzheimer's disease and 30 amyloid-beta positive Alzheimer's disease dementia patients (reference group: 200 amyloid-beta negative healthy individuals) using structural magnetic resonance imaging and tau positron emission tomography. Subtyping methods were implemented as outlined in each original study. Group-level and individual-level comparisons across methods were performed. Each individual subtyping method was replicated, and the proof-of-concept was established. At the group level, all methods captured subtypes with similar patterns of demographic and clinical characteristics, and with similar cortical thinning and tau positron emission tomography uptake patterns. However, at the individual level, large disagreements were found in subtype assignments. Although characteristics of subtypes are comparable at the group level, there is a large disagreement at the individual level across subtyping methods. Therefore, there is an urgent need for consensus and harmonization across subtyping methods. We call for the establishment of an open benchmarking framework to overcome this problem.
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Affiliation(s)
- Rosaleena Mohanty
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Mårtensson
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - J-Sebastian Muehlboeck
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Elena Rodriguez-Vieitez
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Konstantinos Chiotis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Clinical Dementia Research Section, German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Graves LV, Edmonds EC, Thomas KR, Weigand AJ, Cooper S, Bondi MW. Evidence for the Utility of Actuarial Neuropsychological Criteria Across the Continuum of Normal Aging, Mild Cognitive Impairment, and Dementia. J Alzheimers Dis 2020; 78:371-386. [PMID: 32986674 PMCID: PMC7683095 DOI: 10.3233/jad-200778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Research suggests that actuarial neuropsychological criteria improve the accuracy of mild cognitive impairment (MCI) diagnoses relative to conventional diagnostic methods. Objective: We sought to examine the utility of actuarial criteria relative to consensus diagnostic methods used in the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS), and more broadly across the continuum of normal aging, MCI, and dementia. Methods: We compared rates of cognitively normal (CN), MCI, and dementia diagnoses at baseline using actuarial versus consensus diagnostic methods in 1524 individuals from the NACC UDS. Results: Approximately one-third (33.59%) of individuals diagnosed as CN and more than one-fifth (22.03%) diagnosed with dementia based on consensus methods, met actuarial criteria for MCI. Many participants diagnosed with MCI via consensus methods also appeared to represent possible diagnostic errors. Notably, the CNa/CNc group (i.e., participants diagnosed as CN based on both actuarial [a] and consensus [c] criteria) had a lower proportion of apolipoprotein E ɛ4 carriers than the MCIa/MCIc group, which in turn had a lower proportion of ɛ4 carriers than the dementia (Dem)a/Demc group. Proportions of ɛ4 carriers were comparable between the CNa/CNc and CNa/MCIc, MCIa/MCIc and MCIa/CNc, MCIa/MCIc and MCIa/Demc, and Dema/Demc and Dema/MCIc groups. These results were largely consistent with diagnostic agreement/discrepancy group comparisons on neuropsychological performance. Conclusion: The present results extend previous findings and suggest that actuarial neuropsychological criteria may enhance diagnostic accuracy relative to consensus methods, and across the wider continuum of normal aging, MCI, and dementia. Findings have implications for both clinical practice and research.
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Affiliation(s)
- Lisa V Graves
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Emily C Edmonds
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Shanna Cooper
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Krinsky‐McHale SJ, Zigman WB, Lee JH, Schupf N, Pang D, Listwan T, Kovacs C, Silverman W. Promising outcome measures of early Alzheimer's dementia in adults with Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12044. [PMID: 32647741 PMCID: PMC7335903 DOI: 10.1002/dad2.12044] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Adults with Down syndrome (DS) are at high risk for developing Alzheimer's disease (AD) and its associated dementia, warranting the development of strategies to improve early detection when prevention is possible. METHODS Using a broad battery of neuropsychological assessments, informant interviews, and clinical record review, we evaluated the psychometrics of measures in a large sample of 561 adults with DS. We tracked longitudinal stability or decline in functioning in a subsample of 269 participants over a period of 3 years, all initially without indications of clinically significant aging-related decline. RESULTS Results identified an array of objective measures that demonstrated sensitivity in distinguishing individuals with incident "mild cognitive impairment" (MCI-DS) as well as subsequent declines occurring with incident dementia. DISCUSSION Several instruments showed clear promise for use as outcome measures for future clinical trials and for informing diagnosis of individuals suspected of experiencing early signs and symptoms of a progressive dementia process.
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Affiliation(s)
- Sharon J Krinsky‐McHale
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Warren B. Zigman
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Joseph H. Lee
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversitySergievsky Center/Taub InstituteNew YorkNew YorkUSA
- Department of EpidemiologySchool of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Nicole Schupf
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversitySergievsky Center/Taub InstituteNew YorkNew YorkUSA
- Department of EpidemiologySchool of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Deborah Pang
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Tracy Listwan
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Cynthia Kovacs
- New YorkState Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Wayne Silverman
- Department of EpidemiologySchool of Public HealthColumbia UniversityNew YorkNew YorkUSA
- University of CaliforniaIrvineCaliforniaUSA
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Machulda MM, Lundt ES, Albertson SM, Spychalla AJ, Schwarz CG, Mielke MM, Jack CR, Kremers WK, Vemuri P, Knopman DS, Jones DT, Bondi MW, Petersen RC. Cortical atrophy patterns of incident MCI subtypes in the Mayo Clinic Study of Aging. Alzheimers Dement 2020; 16:1013-1022. [PMID: 32418367 PMCID: PMC7383989 DOI: 10.1002/alz.12108] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION We examined differences in cortical thickness in empirically derived mild cognitive impairment (MCI) subtypes in the Mayo Clinic Study of Aging. METHODS We compared cortical thickness of four incident MCI subtypes (n = 192) to 1257 cognitive unimpaired individuals. RESULTS The subtle cognitive impairment cluster had atrophy in the entorhinal and parahippocampal cortex. The amnestic, dysnomic, and dysexecutive clusters also demonstrated entorhinal cortex atrophy as well as thinning in temporal, parietal, and frontal isocortex in somewhat different patterns. DISCUSSION We found patterns of atrophy in each of the incident MCI clusters that corresponded to their patterns of cognitive impairment. The identification of MCI subtypes based on cognitive and structural features may allow for more efficient trial and study designs. Given individuals in the subtle cognitive impairment cluster have less structural changes and cognitive decline and may represent the earliest group, this could be a unique group to target with early interventions.
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Affiliation(s)
- Mary M Machulda
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily S Lundt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Sabrina M Albertson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Michelle M Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Edmonds EC, Weigand AJ, Hatton SN, Marshall AJ, Thomas KR, Ayala DA, Bondi MW, McDonald CR. Patterns of longitudinal cortical atrophy over 3 years in empirically derived MCI subtypes. Neurology 2020; 94:e2532-e2544. [PMID: 32393648 DOI: 10.1212/wnl.0000000000009462] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We previously identified 4 empirically derived mild cognitive impairment (MCI) subtypes via cluster analysis within the Alzheimer's Disease Neuroimaging Initiative (ADNI) and demonstrated high correspondence between patterns of cortical thinning at baseline and each cognitive subtype. We aimed to determine whether our MCI subtypes demonstrate unique longitudinal atrophy patterns. METHODS ADNI participants (295 with MCI and 134 cognitively normal [CN]) underwent annual structural MRI and neuropsychological assessments. General linear modeling compared vertex-wise differences in cortical atrophy rates between each MCI subtype and the CN group. Linear mixed models examined trajectories of cortical atrophy over 3 years within lobar regions of interest. RESULTS Compared to the CN group, those with amnestic MCI (memory deficit) initially demonstrated greater atrophy rates within medial temporal lobe regions that became more widespread over time. Those with dysnomic/amnestic MCI (naming/memory deficits) showed greater atrophy rates largely localized to temporal lobe regions. The mixed MCI (impairment in all cognitive domains) group showed greater atrophy rates in widespread regions at all time points. The cluster-derived normal group, who had intact neuropsychological performance and normal cortical thickness at baseline despite their MCI diagnosis via conventional diagnostic criteria, continued to show normal cognition and minimal cortical atrophy over 3 years. CONCLUSIONS ADNI's purported amnestic MCI sample produced more refined cognitive subtypes with unique longitudinal cortical atrophy rates. These novel MCI subtypes reliably reflect underlying atrophy, reduce false-positive diagnostic errors, and improve prediction of clinical course. Such improvements have implications for the selection of participants for clinical trials and for providing more precise risk assessment for individuals diagnosed with MCI.
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Affiliation(s)
- Emily C Edmonds
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA.
| | - Alexandra J Weigand
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Sean N Hatton
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Anisa J Marshall
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Kelsey R Thomas
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Daniela A Ayala
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Mark W Bondi
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Carrie R McDonald
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
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Blanken AE, Jang JY, Ho JK, Edmonds EC, Han SD, Bangen KJ, Nation DA. Distilling Heterogeneity of Mild Cognitive Impairment in the National Alzheimer Coordinating Center Database Using Latent Profile Analysis. JAMA Netw Open 2020; 3:e200413. [PMID: 32142126 PMCID: PMC7060488 DOI: 10.1001/jamanetworkopen.2020.0413] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/13/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Anna E. Blanken
- Department of Psychology, University of Southern California, Los Angeles
| | - Jung Yun Jang
- Department of Psychology, University of Southern California, Los Angeles
| | - Jean K. Ho
- Department of Psychology, University of Southern California, Los Angeles
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego
| | - S. Duke Han
- Department of Psychology, University of Southern California, Los Angeles
- Department of Family Medicine, University of Southern California, Los Angeles
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego
| | - Daniel A. Nation
- Department of Psychological Science, University of California, Irvine
- Institute for Memory Disorders and Neurological Impairments, University of California, Irvine
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