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Jimenez MP, Gause EL, Sims KD, Hayes‐Larson E, Morris EP, Fletcher E, Manly J, Gilsanz P, Soh Y, Corrada M, Whitmer RA, Glymour MM. Racial and ethnic differences in the association between depressive symptoms and cognitive outcomes in older adults: Findings from KHANDLE and STAR. Alzheimers Dement 2024; 20:3147-3156. [PMID: 38477489 PMCID: PMC11095484 DOI: 10.1002/alz.13768] [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: 10/18/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Depressive symptoms are associated with higher risk of dementia, but how they impact cognition in diverse populations is unclear. METHODS Asian, Black, Latino, or White participants (n = 2227) in the Kaiser Healthy Aging and Diverse Life Experiences (age 65+) and the Study of Healthy Aging in African Americans (age 50+) underwent up to three waves of cognitive assessments over 4 years. Multilevel models stratified by race/ethnicity were used to examine whether depressive symptoms were associated with cognition or cognitive decline and whether associations differed by race/ethnicity. RESULTS Higher depressive symptoms were associated with lower baseline verbal episodic memory scores (-0.06, 95% CI: -0.12, -0.01; -0.15, 95% CI: -0.25, -0.04), and faster decline annually in semantic memory (-0.04, 95% CI: -0.07, -0.01; -0.10, 95% CI: -0.15, -0.05) for Black and Latino participants. Depressive symptoms were associated with lower baseline but not decline in executive function. DISCUSSION Depressive symptoms were associated with worse cognitive outcomes, with some evidence of heterogeneity across racial/ethnic groups. HIGHLIGHTS We examined whether baseline depressive symptoms were differentially associated with domain-specific cognition or cognitive decline by race/ethnicity. Depressive symptoms were associated with worse cognitive scores for all racial/ethnic groups across different domains examined. Higher depressive symptoms were associated with faster cognitive decline for semantic memory for Black and Latino participants. The results suggest a particularly harmful association between depressive symptoms and cognition in certain racial/ethnic groups.
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Affiliation(s)
- Marcia P. Jimenez
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Emma L. Gause
- Center for Climate and HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Kendra D. Sims
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Eleanor Hayes‐Larson
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Emily P. Morris
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Evan Fletcher
- Department of NeurologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Jennifer Manly
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | - Paola Gilsanz
- Division of ResearchKaiser PermanenteOaklandCaliforniaUSA
| | - Yenee Soh
- Division of ResearchKaiser PermanenteOaklandCaliforniaUSA
| | - Maria Corrada
- Department of EpidemiologyUniversity of California Irvine School of MedicineIrvineCaliforniaUSA
| | - Rachel A. Whitmer
- Department of Public Health Sciences and NeurologyUniversity of California Davis School of MedicineDavisCaliforniaUSA
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Eissman JM, Archer DB, Mukherjee S, Lee ML, Choi S, Scollard P, Trittschuh EH, Mez JB, Bush WS, Kunkle BW, Naj AC, Gifford KA, Cuccaro ML, Cruchaga C, Pericak‐Vance MA, Farrer LA, Wang L, Schellenberg GD, Mayeux RP, Haines JL, Jefferson AL, Kukull WA, Keene CD, Saykin AJ, Thompson PM, Martin ER, Bennett DA, Barnes LL, Schneider JA, Crane PK, Hohman TJ, Dumitrescu L. Sex-specific genetic architecture of late-life memory performance. Alzheimers Dement 2024; 20:1250-1267. [PMID: 37984853 PMCID: PMC10917043 DOI: 10.1002/alz.13507] [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: 04/04/2023] [Revised: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Women demonstrate a memory advantage when cognitively healthy yet lose this advantage to men in Alzheimer's disease. However, the genetic underpinnings of this sex difference in memory performance remain unclear. METHODS We conducted the largest sex-aware genetic study on late-life memory to date (Nmales = 11,942; Nfemales = 15,641). Leveraging harmonized memory composite scores from four cohorts of cognitive aging and AD, we performed sex-stratified and sex-interaction genome-wide association studies in 24,216 non-Hispanic White and 3367 non-Hispanic Black participants. RESULTS We identified three sex-specific loci (rs67099044-CBLN2, rs719070-SCHIP1/IQCJ-SCHIP), including an X-chromosome locus (rs5935633-EGL6/TCEANC/OFD1), that associated with memory. Additionally, we identified heparan sulfate signaling as a sex-specific pathway and found sex-specific genetic correlations between memory and cardiovascular, immune, and education traits. DISCUSSION This study showed memory is highly and comparably heritable across sexes, as well as highlighted novel sex-specific genes, pathways, and genetic correlations that related to late-life memory. HIGHLIGHTS Demonstrated the heritable component of late-life memory is similar across sexes. Identified two genetic loci with a sex-interaction with baseline memory. Identified an X-chromosome locus associated with memory decline in females. Highlighted sex-specific candidate genes and pathways associated with memory. Revealed sex-specific shared genetic architecture between memory and complex traits.
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Reise SP, Wong E, Block J, Widaman KF, Gullett JM, Bauer RM, Drane DL, Loring DW, Umfleet LG, Wahlstrom D, Enriquez K, Whelan F, Shih S, Bilder RM. Computerized adaptive test strategies for the matrix reasoning subtest of the Wechsler Adult Intelligence Scale, 4th Edition (WAIS-IV). J Int Neuropsychol Soc 2024; 30:152-161. [PMID: 37476964 PMCID: PMC10878120 DOI: 10.1017/s1355617723000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Most neuropsychological tests were developed without the benefit of modern psychometric theory. We used item response theory (IRT) methods to determine whether a widely used test - the 26-item Matrix Reasoning subtest of the WAIS-IV - might be used more efficiently if it were administered using computerized adaptive testing (CAT). METHOD Data on the Matrix Reasoning subtest from 2197 participants enrolled in the National Neuropsychology Network (NNN) were analyzed using a two-parameter logistic (2PL) IRT model. Simulated CAT results were generated to examine optimal short forms using fixed-length CATs of 3, 6, and 12 items and scores were compared to the original full subtest score. CAT models further explored how many items were needed to achieve a selected precision of measurement (standard error ≤ .40). RESULTS The fixed-length CATs of 3, 6, and 12 items correlated well with full-length test results (with r = .90, .97 and .99, respectively). To achieve a standard error of .40 (approximate reliability = .84) only 3-7 items had to be administered for a large percentage of individuals. CONCLUSIONS This proof-of-concept investigation suggests that the widely used Matrix Reasoning subtest of the WAIS-IV might be shortened by more than 70% in most examinees while maintaining acceptable measurement precision. If similar savings could be realized in other tests, the accessibility of neuropsychological assessment might be markedly enhanced, and more efficient time use could lead to broader subdomain assessment.
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Affiliation(s)
- Steven P. Reise
- Department of Psychology, College of Letters & Science, UCLA, Los Angeles, CA, USA
| | - Emily Wong
- Department of Psychology, College of Letters & Science, UCLA, Los Angeles, CA, USA
| | - Jared Block
- Department of Psychology, College of Letters & Science, UCLA, Los Angeles, CA, USA
| | | | | | | | - Daniel L. Drane
- Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - David W. Loring
- Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Kristen Enriquez
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, and Jane & Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Fiona Whelan
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, and Jane & Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Stone Shih
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, and Jane & Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Robert M. Bilder
- Department of Psychology, College of Letters & Science, UCLA, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, and Jane & Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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4
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Crane PK, Choi SE, Lee M, Scollard P, Sanders RE, Klinedinst B, Nakano C, Trittschuh EH, Mez J, Saykin AJ, Gibbons LE, Wang C, Mungas D, Zhu R, Foldi NS, Lamar M, Jutten R, Sikkes SA, Grandoit E, Rabin LA, Jones RN, Tommet D. Measurement precision across cognitive domains in the Alzheimer's Disease Neuroimaging Initiative (ADNI) data set. Neuropsychology 2023; 37:373-382. [PMID: 37276134 PMCID: PMC10247161 DOI: 10.1037/neu0000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To demonstrate measurement precision of cognitive domains in the Alzheimer's Disease Neuroimaging Initiative (ADNI) data set. METHOD Participants with normal cognition (NC), mild cognitive impairment (MCI), and Alzheimer's disease (AD) were included from all ADNI waves. We used data from each person's last study visit to calibrate scores for memory, executive function, language, and visuospatial functioning. We extracted item information functions for each domain and used these to calculate standard errors of measurement. We derived scores for each domain for each diagnostic group and plotted standard errors of measurement for the observed range of scores. RESULTS Across all waves, there were 961 people with NC, 825 people with MCI, and 694 people with AD at their most recent study visit (data pulled February 25, 2019). Across ADNI's battery there were 34 memory items, 18 executive function items, 20 language items, and seven visuospatial items. Scores for each domain were highest on average for people with NC, intermediate for people with MCI, and lowest for people with AD, with most scores across all groups in the range of -1 to +1. Standard error of measurement in the range from -1 to +1 was highest for memory, intermediate for language and executive functioning, and lowest for visuospatial. CONCLUSION Modern psychometric approaches provide tools to help understand measurement precision of the scales used in studies. In ADNI, there are important differences in measurement precision across cognitive domains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Seo-Eun Choi
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael Lee
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Phoebe Scollard
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Connie Nakano
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Emily H. Trittschuh
- Department of Psychiatry and Behavioral Sciences, University of Washington, and VA Puget Sound Health Care System, Geriatrics Research, Education, and Clinical Core (GRECC), both in Seattle, WA, USA
| | - Jesse Mez
- Department of Neurology, Boston University, Boston, MA, USA
| | | | - Laura E. Gibbons
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Chun Wang
- College of Education, University of Washington, Seattle, WA, USA
| | - Dan Mungas
- Department of Neurology, University of California at Davis, Sacramento, CA, USA
| | - Ruoyi Zhu
- College of Education, University of Washington, Seattle, WA, USA
| | - Nancy S. Foldi
- Department of Psychology, Queens College and The Graduate Center, City University of New York & Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, NY
| | - Melissa Lamar
- Rush University Alzheimer’s Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Roos Jutten
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sietske A.M. Sikkes
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location, VUmc & Amsterdam Neuroscience, Neurodegeneration & Department of Clinical, Neuro, and Developmental Psychology, Vrije Universitiet Amsterdam, Amsterdam, NL
| | - Evan Grandoit
- Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Laura A. Rabin
- Department of Psychology, Brooklyn College and the Graduate Center, City University of New York, Brooklyn, NY, USA
| | | | - Doug Tommet
- Department of Psychiatry, Brown University, Providence, RI, USA
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5
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Hampton OL, Mukherjee S, Properzi MJ, Schultz AP, Crane PK, Gibbons LE, Hohman TJ, Maruff P, Lim YY, Amariglio RE, Papp KV, Johnson KA, Rentz DM, Sperling RA, Buckley RF. Harmonizing the preclinical Alzheimer cognitive composite for multicohort studies. Neuropsychology 2023; 37:436-449. [PMID: 35862098 PMCID: PMC9859944 DOI: 10.1037/neu0000833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Studies are increasingly examining research questions across multiple cohorts using data from the preclinical Alzheimer cognitive composite (PACC). Our objective was to use modern psychometric approaches to develop a harmonized PACC. METHOD We used longitudinal data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), Harvard Aging Brain Study (HABS), and Australian Imaging, Biomarker and Lifestyle Study of Ageing (AIBL) cohorts (n = 2,712). We further demonstrated our method with the Anti-Amyloid Treatment of Asymptomatic Alzheimer's Disease (A4) Study prerandomized data (n = 4,492). For the harmonization method, we used confirmatory factor analysis (CFA) on the final visit of the longitudinal cohorts to determine parameters to generate latent PACC (lPACC) scores. Overlapping tests across studies were set as "anchors" that tied cohorts together, while parameters from unique tests were freely estimated. We performed validation analyses to assess the performance of lPACC versus the common standardized PACC (zPACC). RESULTS Baseline (BL) scores for the zPACC were centered on zero, by definition. The harmonized lPACC did not define a common mean of zero and demonstrated differences in baseline ability levels across the cohorts. Baseline lPACC slightly outperformed zPACC in the prediction of progression to dementia. Longitudinal change in the lPACC was more constrained and less variable relative to the zPACC. In combined-cohort analyses, longitudinal lPACC slightly outperformed longitudinal zPACC in its association with baseline β-amyloid status. CONCLUSIONS This study proposes procedures for harmonizing the PACC that make fewer strong assumptions than the zPACC, facilitating robust multicohort analyses. This implementation of item response theory lends itself to adapting across future cohorts with similar composites. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Olivia L. Hampton
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Shubhabrata Mukherjee
- Department of Medicine, Division of General Internal Medicine, University of Washington
| | - Michael J. Properzi
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Aaron P. Schultz
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Paul K. Crane
- Department of Medicine, Division of General Internal Medicine, University of Washington
| | - Laura E. Gibbons
- Department of Medicine, Division of General Internal Medicine, University of Washington
| | - Timothy J. Hohman
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Paul Maruff
- Cogstate Ltd., Melbourne, Victoria, Australia
| | - Yen Ying Lim
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Rebecca E. Amariglio
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Kathryn V. Papp
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Keith A. Johnson
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Dorene M. Rentz
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Reisa A. Sperling
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Rachel F. Buckley
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
- Melbourne School of Psychological Science, University of Melbourne
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6
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Mukherjee S, Choi SE, Lee ML, Scollard P, Trittschuh EH, Mez J, Saykin AJ, Gibbons LE, Sanders RE, Zaman AF, Teylan MA, Kukull WA, Barnes LL, Bennett DA, Lacroix AZ, Larson EB, Cuccaro M, Mercado S, Dumitrescu L, Hohman TJ, Crane PK. Cognitive domain harmonization and cocalibration in studies of older adults. Neuropsychology 2023; 37:409-423. [PMID: 35925737 PMCID: PMC9898463 DOI: 10.1037/neu0000835] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Studies use different instruments to measure cognitirating cognitive tests permit direct comparisons of individuals across studies and pooling data for joint analyses. METHOD We began our legacy item bank with data from the Adult Changes in Thought study (n = 5,546), the Alzheimer's Disease Neuroimaging Initiative (n = 3,016), the Rush Memory and Aging Project (n = 2,163), and the Religious on such as the Mini-Mental State Examination, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the Wechsler Memory Scale, and the Boston Naming Test. CocalibOrders Study (n = 1,456). Our workflow begins with categorizing items administered in each study as indicators of memory, executive functioning, language, visuospatial functioning, or none of these domains. We use confirmatory factor analysis models with data from the most recent visit on the pooled sample across these four studies for cocalibration and derive item parameters for all items. Using these item parameters, we then estimate factor scores along with corresponding standard errors for each domain for each study. We added additional studies to our pipeline as available and focused on thorough consideration of candidate anchor items with identical content and administration methods across studies. RESULTS Prestatistical harmonization steps such qualitative and quantitative assessment of granular cognitive items and evaluating factor structure are important steps when trying to cocalibrate cognitive scores across studies. We have cocalibrated cognitive data and derived scores for four domains for 76,723 individuals across 10 studies. CONCLUSIONS We have implemented a large-scale effort to harmonize and cocalibrate cognitive domain scores across multiple studies of cognitive aging. Scores on the same metric facilitate meta-analyses of cognitive outcomes across studies or the joint analysis of individual data across studies. Our systematic approach allows for cocalibration of additional studies as they become available and our growing item bank enables robust investigation of cognition in the context of aging and dementia. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Seo-Eun Choi
- Department of Medicine, The University of Washington
| | | | | | - Emily H. Trittschuh
- Department of Psychiatry and Behavioral Sciences, The University of Washington
- VA Puget Sound Health Care System, Seattle, Washington, United States
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine
| | - Andrew J. Saykin
- Department of Radiology and Imaging Services, Indiana Alzheimer’s Disease Research Center, Indiana University
| | | | | | - Andrew F. Zaman
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine
| | - Merilee A. Teylan
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington
| | - Walter A. Kukull
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington
- Department of Epidemiology, The University of Washington
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States
| | | | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Michael Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine
| | - Shannon Mercado
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Logan Dumitrescu
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Timothy J. Hohman
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Paul K. Crane
- Department of Medicine, The University of Washington
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7
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Gavett BE, Ilango SD, Koscik R, Ma Y, Helfand B, Eng CW, Gross A, Trittschuh EH, Jones RN, Mungas D. Harmonization of cognitive screening tools for dementia across diverse samples: A simulation study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12438. [PMID: 37342610 PMCID: PMC10277671 DOI: 10.1002/dad2.12438] [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: 11/16/2022] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 06/23/2023]
Abstract
Introduction Research focusing on cognitive aging and dementia is a global endeavor. However, cross-national differences in cognition are embedded in other sociocultural differences, precluding direct comparisons of test scores. Such comparisons can be facilitated by co-calibration using item response theory (IRT). The goal of this study was to explore, using simulation, the necessary conditions for accurate harmonization of cognitive data. Method Neuropsychological test scores from the US Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) were subjected to IRT analysis to estimate item parameters and sample means and standard deviations. These estimates were used to generate simulated item response patterns under 10 scenarios that adjusted the quality and quantity of linking items used in harmonization. IRT-derived factor scores were compared to the known population values to assess bias, efficiency, accuracy, and reliability of the harmonized data. Results The current configuration of HRS and MHAS data was not suitable for harmonization, as poor linking item quality led to large bias in both cohorts. Scenarios with more numerous and higher quality linking items led to less biased and more accurate harmonization. Discussion Linking items must possess low measurement error across the range of latent ability for co-calibration to be successful. HIGHLIGHTS We developed a statistical simulation platform to evaluate the degree to which cross-sample harmonization accuracy varies as a function of the quality and quantity of linking items.Two large studies of aging-one in Mexico and one in the United States-use three common items to measure cognition.These three common items have weak correspondence with the ability being measured and are all low in difficulty.Harmonized scores derived from the three common linking items will provide biased and inaccurate estimates of cognitive ability.Harmonization accuracy is greatest when linking items vary in difficulty and are strongly related to the ability being measured.
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Affiliation(s)
- Brandon E. Gavett
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Sindana D. Ilango
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWashingtonUSA
| | - Rebecca Koscik
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Yue Ma
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Division of Geriatrics and GerontologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Benjamin Helfand
- Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
- Departments of Psychiatry and Human Behavior and NeurologyWarren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Chloe W. Eng
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Alden Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School Public HealthBaltimoreMarylandUSA
| | - Emily H. Trittschuh
- VA Puget Sound Health Care SystemGeriatric Research Education and Clinical CareSeattleWashingtonUSA
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Richard N. Jones
- Departments of Psychiatry and Human Behavior and NeurologyWarren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
- Department of NeurologyBrown University Warren Alpert Medical SchoolProvidenceRhode IslandUSA
| | - Dan Mungas
- Department of NeurologyUniversity of CaliforniaSacramentoCaliforniaUSA
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8
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Wu Y, Rosenberg DE, Greenwood-Hickman MA, McCurry SM, Proust-Lima C, Nelson JC, Crane PK, LaCroix AZ, Larson EB, Shaw PA. Analysis of the 24-h activity cycle: An illustration examining the association with cognitive function in the Adult Changes in Thought study. Front Psychol 2023; 14:1083344. [PMID: 37057157 PMCID: PMC10087899 DOI: 10.3389/fpsyg.2023.1083344] [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: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 03/30/2023] Open
Abstract
The 24-h activity cycle (24HAC) is a new paradigm for studying activity behaviors in relation to health outcomes. This approach inherently captures the interrelatedness of the daily time spent in physical activity (PA), sedentary behavior (SB), and sleep. We describe three popular approaches for modeling outcome associations with the 24HAC exposure. We apply these approaches to assess an association with a cognitive outcome in a cohort of older adults, discuss statistical challenges, and provide guidance on interpretation and selecting an appropriate approach. We compare the use of the isotemporal substitution model (ISM), compositional data analysis (CoDA), and latent profile analysis (LPA) to analyze 24HAC. We illustrate each method by exploring cross-sectional associations with cognition in 1,034 older adults (Mean age = 77; Age range = 65-100; 55.8% female; 90% White) who were part of the Adult Changes in Thought (ACT) Activity Monitoring (ACT-AM) sub-study. PA and SB were assessed with thigh-worn activPAL accelerometers for 7-days. For each method, we fit a multivariable regression model to examine the cross-sectional association between the 24HAC and Cognitive Abilities Screening Instrument item response theory (CASI-IRT) score, adjusting for baseline characteristics. We highlight differences in assumptions and the scientific questions addressable by each approach. ISM is easiest to apply and interpret; however, the typical ISM assumes a linear association. CoDA uses an isometric log-ratio transformation to directly model the compositional exposure but can be more challenging to apply and interpret. LPA can serve as an exploratory analysis tool to classify individuals into groups with similar time-use patterns. Inference on associations of latent profiles with health outcomes need to account for the uncertainty of the LPA classifications, which is often ignored. Analyses using the three methods did not suggest that less time spent on SB and more in PA was associated with better cognitive function. The three standard analytical approaches for 24HAC each have advantages and limitations, and selection of the most appropriate method should be guided by the scientific questions of interest and applicability of each model's assumptions. Further research is needed into the health implications of the distinct 24HAC patterns identified in this cohort.
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Affiliation(s)
- Yinxiang Wu
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Dori E. Rosenberg
- Investigative Sciences Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Susan M. McCurry
- School of Nursing, University of Washington, Seattle, WA, United States
| | | | - Jennifer C. Nelson
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Eric B. Larson
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Pamela A. Shaw
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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9
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Scaduto P, Lauterborn JC, Cox CD, Fracassi A, Zeppillo T, Gutierrez BA, Keene CD, Crane PK, Mukherjee S, Russell WK, Taglialatela G, Limon A. Functional excitatory to inhibitory synaptic imbalance and loss of cognitive performance in people with Alzheimer's disease neuropathologic change. Acta Neuropathol 2023; 145:303-324. [PMID: 36538112 PMCID: PMC9925531 DOI: 10.1007/s00401-022-02526-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/12/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
Individuals at distinct stages of Alzheimer's disease (AD) show abnormal electroencephalographic activity, which has been linked to network hyperexcitability and cognitive decline. However, whether pro-excitatory changes at the synaptic level are observed in brain areas affected early in AD, and if they are emergent in MCI, is not clearly known. Equally important, it is not known whether global synaptic E/I imbalances correlate with the severity of cognitive impairment in the continuum of AD. Measuring the amplitude of ion currents of human excitatory and inhibitory synaptic receptors microtransplanted from the hippocampus and temporal cortex of cognitively normal, mildly cognitively impaired and AD individuals into surrogate cells, we found regional differences in pro-excitatory shifts of the excitatory to inhibitory (E/I) current ratio that correlates positively with toxic proteins and degree of pathology, and impinges negatively on cognitive performance scores. Using these data with electrophysiologically anchored analysis of the synapto-proteome in the same individuals, we identified a group of proteins sustaining synaptic function and those related to synaptic toxicity. We also found an uncoupling between the function and expression of proteins for GABAergic signaling in the temporal cortex underlying larger E/I and worse cognitive performance. Further analysis of transcriptomic and in situ hybridization datasets from an independent cohort across the continuum of AD confirm regional differences in pro-excitatory shifts of the E/I balance that correlate negatively with the most recent calibrated composite scores for memory, executive function, language and visuospatial abilities, as well as overall cognitive performance. These findings indicate that early shifts of E/I balance may contribute to loss of cognitive capabilities in the continuum of AD clinical syndrome.
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Affiliation(s)
- Pietro Scaduto
- Department of Neurology, Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Julie C Lauterborn
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, CA, USA
| | - Conor D Cox
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, CA, USA
| | - Anna Fracassi
- Department of Neurology, Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Tommaso Zeppillo
- Department of Neurology, Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Berenice A Gutierrez
- Department of Neurology, Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - William K Russell
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Giulio Taglialatela
- Department of Neurology, Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Agenor Limon
- Department of Neurology, Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
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10
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Feng L, Wang Y, Zeng D, Wang M, Duan X. Predictors of cognitive decline in older individuals without dementia: An updated meta-analysis. Ann Clin Transl Neurol 2023; 10:497-506. [PMID: 36705073 PMCID: PMC10109353 DOI: 10.1002/acn3.51740] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the effect of overall peripheral inflammatory levels on cognitive function, we explored the relationship between established biomarkers of peripheral inflammation (circulating C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]) and cognitive decline by performing a review of observational studies and creating an updated summary. METHODS We included literatures exploring the relationship between peripheral levels of CRP, IL-6, and TNF-α and subsequent cognitive decline, published until July 2022, by searching the following databases: PubMed, Embase, Web of Science, the Cochrane Library, ClinicalTrials, CNKI, and VIP databases. We used random-effects models to pool the odds ratios (ORs) for the risks of subsequent cognitive decline in older adults with high levels of peripheral inflammation. We initially screened out 501 literatures, of which only 17 were ultimately eligible. Overall, there were 19,516 older individuals included in our meta-analysis, and 2134 of them experienced subsequent cognitive change. RESULTS Individuals with high levels of peripheral inflammation may have 14% more chance to develop subsequent cognitive decline than those with low levels (OR = 1.14, 95% CI: 1.03-1.27; p < 0.00001). In the subgroup analysis, the incidence of cognitive decline was higher in individuals with high levels of IL-6. This study further demonstrates the link between systemic inflammation and cognitive status. INTERPRETATION Detecting CRP, IL-6, and TNF-α in peripheral blood is necessary, as they may become effective indicators for forthcoming cognitive performance.
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Affiliation(s)
- Lan Feng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Yuhao Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Daojun Zeng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Maohua Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Xiaoxia Duan
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
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11
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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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12
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Kawilapat S, Maneeton B, Maneeton N, Prasitwattanaseree S, Kongsuk T, Arunpongpaisal S, Leejongpermpoon J, Sukhawaha S, Traisathit P. Comparison of unweighted and item response theory-based weighted sum scoring for the Nine-Questions Depression-Rating Scale in the Northern Thai Dialect. BMC Med Res Methodol 2022; 22:268. [PMID: 36224520 PMCID: PMC9555165 DOI: 10.1186/s12874-022-01744-0] [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: 12/11/2021] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Nine-Questions Depression-Rating Scale (9Q) has been developed as an alternative assessment tool for assessing the severity of depressive symptoms in Thai adults. The traditional unweighted sum scoring approach does not account for differences in the loadings of the items on the actual severity. Therefore, we developed an Item Response Theory (IRT)-based weighted sum scoring approach to provide a scoring method that is more precise than the unweighted sum score. Methods Secondary data from a study on the criterion-related validity of the 9Q in the northern Thai dialect was used in this study. All participants were interviewed to obtain demographic data and screened/evaluated for major depressive disorder and the severity of the associated depressive symptoms, followed by diagnosis by a psychiatrist for major depressive disorder. IRT models were used to estimate the discrimination and threshold parameters. Differential item functioning (DIF) of responses to each item between males and females was compared using likelihood-ratio tests. The IRT-based weighed sum scores of the individual items are defined as the linear combination of individual response weighted with the discrimination and threshold parameters divided by the plausible maximum score based on the graded-response model (GRM) for the 9Q score (9Q-GRM) or the nominal-response model (NRM) for categorical combinations of the intensity and frequency of symptoms from the 9Q responses (9QSF-NRM). The performances of the two scoring procedures were compared using relative precision. Results Of the 1,355 participants, 1,000 and 355 participants were randomly selected for the developmental and validation group for the IRT-based weighted scoring, respectively. the gender-related DIF were presented for items 2 and 5 for the 9Q-GRM, while most items (except for items 3 and 6) for the 9QSF-NRM, which could be used to separately estimate the parameters between genders. The 9Q-GRM model accounting for DIF had a higher precision (16.7%) than the unweighted sum-score approach. Discussion Our findings suggest that weighted sum scoring with the IRT parameters can improve the scoring when using 9Q to measure the severity of the depressive symptoms in Thai adults. Accounting for DIF between the genders resulted in higher precision for IRT-based weighted scoring. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01744-0.
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Affiliation(s)
- Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, 239 Huaykaew Road, Suthep, Muang, 50200, Chiang Mai, Thailand.,Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sukon Prasitwattanaseree
- Department of Statistics, Faculty of Science, Chiang Mai University, 239 Huaykaew Road, Suthep, Muang, 50200, Chiang Mai, Thailand
| | - Thoranin Kongsuk
- Prasrimahabhodi Psychiatric Hospital, Ubon Ratchathani, Thailand.,Somdet Chaopraya Institute of Psychiatry, Bangkok, Thailand
| | - Suwanna Arunpongpaisal
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, 239 Huaykaew Road, Suthep, Muang, 50200, Chiang Mai, Thailand. .,Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Department of Statistics, Faculty of Science, Data Science Research Center, Chiang Mai University, Chiang Mai, Thailand.
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13
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Penfold RB, Carrell DS, Cronkite DJ, Pabiniak C, Dodd T, Glass AM, Johnson E, Thompson E, Arrighi HM, Stang PE. Development of a machine learning model to predict mild cognitive impairment using natural language processing in the absence of screening. BMC Med Inform Decis Mak 2022; 22:129. [PMID: 35549702 PMCID: PMC9097352 DOI: 10.1186/s12911-022-01864-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients and their loved ones often report symptoms or complaints of cognitive decline that clinicians note in free clinical text, but no structured screening or diagnostic data are recorded. These symptoms/complaints may be signals that predict who will go on to be diagnosed with mild cognitive impairment (MCI) and ultimately develop Alzheimer's Disease or related dementias. Our objective was to develop a natural language processing system and prediction model for identification of MCI from clinical text in the absence of screening or other structured diagnostic information. METHODS There were two populations of patients: 1794 participants in the Adult Changes in Thought (ACT) study and 2391 patients in the general population of Kaiser Permanente Washington. All individuals had standardized cognitive assessment scores. We excluded patients with a diagnosis of Alzheimer's Disease, Dementia or use of donepezil. We manually annotated 10,391 clinic notes to train the NLP model. Standard Python code was used to extract phrases from notes and map each phrase to a cognitive functioning concept. Concepts derived from the NLP system were used to predict future MCI. The prediction model was trained on the ACT cohort and 60% of the general population cohort with 40% withheld for validation. We used a least absolute shrinkage and selection operator logistic regression approach (LASSO) to fit a prediction model with MCI as the prediction target. Using the predicted case status from the LASSO model and known MCI from standardized scores, we constructed receiver operating curves to measure model performance. RESULTS Chart abstraction identified 42 MCI concepts. Prediction model performance in the validation data set was modest with an area under the curve of 0.67. Setting the cutoff for correct classification at 0.60, the classifier yielded sensitivity of 1.7%, specificity of 99.7%, PPV of 70% and NPV of 70.5% in the validation cohort. DISCUSSION AND CONCLUSION Although the sensitivity of the machine learning model was poor, negative predictive value was high, an important characteristic of models used for population-based screening. While an AUC of 0.67 is generally considered moderate performance, it is also comparable to several tests that are widely used in clinical practice.
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Affiliation(s)
- Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA.
| | - David S Carrell
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - David J Cronkite
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Chester Pabiniak
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Tammy Dodd
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Ashley Mh Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Ella Thompson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | | | - Paul E Stang
- Janssen Research and Development, LLC, Raritan, USA
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14
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Ashford JW, Schmitt FA, Bergeron MF, Bayley PJ, Clifford JO, Xu Q, Liu X, Zhou X, Kumar V, Buschke H, Dean M, Finkel SI, Hyer L, Perry G. Now is the Time to Improve Cognitive Screening and Assessment for Clinical and Research Advancement. J Alzheimers Dis 2022; 87:305-315. [DOI: 10.3233/jad-220211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Alzheimer’s disease (AD) is the only cause of death ranked in the top ten globally without precise early diagnosis or effective means of prevention or treatment. Further, AD was identified as a pandemic [1] well before COVID-19 was dubbed a 21st century pandemic [2]. And now, with the realization of the prominent secondary impacts of pandemics, there is a growing, widespread recognition of the tremendous magnitude of the impending burden from AD in an aging world population in the coming decades [3]. This appreciation has amplified the growing and pressing need for a new, efficacious, and practical platform to detect and track cognitive decline, beginning in the preliminary (prodromal) phases of the disease, sensitively, accurately, effectively, reliably, efficiently, and remotely [4–7]. Moreover, the parallel necessity of clarifying and understanding risk factors, developing successful prevention strategies [8–17], and discovering and monitoring viable and effective treatments could all benefit from accurate and efficient screening and assessment platforms. Modern recognition of AD [18] as a common affliction of the elderly began in 1968 with a paper by Blessed, Tomlinson, & Roth [19] in which two tests, one a brief assessment of cognitive function and the other a measure of daily function, demonstrated impairment which was associated with the postmortem counts of neurofibrillary tangles, composed mainly of microtubule-associated protein-tau (tau), in the brain, though not to senile plaques, composed mainly of amyloid-β (Aβ). Even in more recent analyses, the tangles correspond with the severity of dementia more than the plaques [20, 21]. Since 1960, a plethora of cognitive tests, paper and pencil [22, 23], simple screening models [24], and computerized [25–27], have been developed to assess the dysfunction associated with AD. However, there has been limited application of Modern Test Theory, which includes Item Characteristic Curve Analysis, used in the technological development of such tools [28–31], along with widespread failure to understand the underlying AD pathological process to guide test development [32, 33]. The lack of such development has likely been a major contributor to the failure of the field to develop timely screening approaches for AD [34, 35], inaccurate assessment of the progression of AD [36], and even now, failure to find an effective approach to stopping AD.
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Affiliation(s)
- J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
| | - Frederick A. Schmitt
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
- Departments of Neurology, Psychiatry, Neurosurgery, Psychology, Behavioral Science; Sanders-Brown Center on Aging, Spinal Cord & Brain Injury Research Center, University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
| | | | - Peter J. Bayley
- War Related Illness and Injury Study Center, VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
| | | | - Qun Xu
- Health Management Center, Department of Neurology, Renji Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolei Liu
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Provincial Clinical Research Center for Neurological Diseases, Yunnan, China
| | - Xianbo Zhou
- Center for Alzheimer’s Research, Washington Institute of Clinical Research, Vienna, VA, USA
- Zhongze Therapeutics, Shanghai, China
| | | | - Herman Buschke
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
- The Saul R. Korey Department of Neurology and Dominick P. Purpura Department of Neuroscience, Lena and Joseph Gluck Distinguished Scholar in Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Margaret Dean
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
- Geriatric Division, Internal Medicine, Texas Tech Health Sciences Center, Amarillo, TX, USA
| | - Sanford I. Finkel
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
- University of Chicago Medical School, Chicago, IL, USA
| | - Lee Hyer
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
- Gateway Behavioral Health, Mercer University, School of Medicine, Savannah, GA, USA
| | - George Perry
- Medical, Scientific, Memory Screening Advisory Board, Alzheimer’s Foundation of American (AFA), New York, USA
- Brain Health Consortium, Department Biology and Chemistry, University of Texas at San Antonio, San Antonio, TX, USA
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15
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Kobayashi LC, Gross AL, Gibbons LE, Tommet D, Sanders RE, Choi SE, Mukherjee S, Glymour M, Manly JJ, Berkman LF, Crane PK, Mungas DM, Jones RN. You Say Tomato, I Say Radish: Can Brief Cognitive Assessments in the U.S. Health Retirement Study Be Harmonized With Its International Partner Studies? J Gerontol B Psychol Sci Soc Sci 2021; 76:1767-1776. [PMID: 33249448 DOI: 10.1093/geronb/gbaa205] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To characterize the extent to which brief cognitive assessments administered in the population-representative U.S. Health and Retirement Study (HRS) and its International Partner Studies can be considered to be measuring a single, unidimensional latent cognitive function construct. METHODS Cognitive function assessments were administered in face-to-face interviews in 12 studies in 26 countries (N = 155,690), including the U.S. HRS and selected International Partner Studies. We used the time point of the first cognitive assessment for each study to minimize differential practice effects across studies and documented cognitive test item coverage across studies. Using confirmatory factor analysis models, we estimated single-factor general cognitive function models and bifactor models representing memory-specific and nonmemory-specific cognitive domains for each study. We evaluated model fits and factor loadings across studies. RESULTS Despite relatively sparse and inconsistent cognitive item coverage across studies, all studies had some cognitive test items in common with other studies. In all studies, the bifactor models with a memory-specific domain fit better than single-factor general cognitive function models. The data fit the models at reasonable thresholds for single-factor models in 6 of the 12 studies and for the bifactor models in all 12 of the 12 studies. DISCUSSION The cognitive assessments in the U.S. HRS and its International Partner Studies reflect comparable underlying cognitive constructs. We discuss the assumptions underlying our methods, present alternatives, and future directions for cross-national harmonization of cognitive aging data.
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Affiliation(s)
- Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.,Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University Center on Aging and Health, Baltimore, Maryland
| | - Laura E Gibbons
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Doug Tommet
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | - R Elizabeth Sanders
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Seo-Eun Choi
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | | | - Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jennifer J Manly
- Department of Neurology and the Taubman Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York
| | - Lisa F Berkman
- Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts
| | - Paul K Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Dan M Mungas
- Department of Neurology, University of California, Davis, Sacramento
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
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16
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Power MC, Murphy AE, Gianattasio KZ, Zhang YI, Walker RL, Crane PK, Larson EB, Gibbons LE, Kumar RG, Dams-O'Connor K. Association of Military Employment With Late-Life Cognitive Decline and Dementia: A Population-Based Prospective Cohort Study. Mil Med 2021; 188:e1132-e1139. [PMID: 34626181 PMCID: PMC10390078 DOI: 10.1093/milmed/usab413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/06/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown. Whether military employment is associated with increased risk of cognitive decline and dementia remains unclear. MATERIALS AND METHODS We used data from 4,370 participants of the longitudinal Adult Changes in Thought (ACT) cohort study, enrolled at age 65 or older, to examine whether military employment was associated with greater cognitive decline or higher risk of incident dementia in late life. We classified persons as having military employment if their first or second-longest occupation was with the military. Cognitive status was assessed at each biennial Adult Changes in Thought study visit using the Cognitive Abilities Screening Instrument, scored using item response theory (CASI-IRT). Participants meeting screening criteria were referred for dementia ascertainment involving clinical examination and additional cognitive testing. Primary analyses were adjusted for sociodemographic characteristics and APOE genotype. Secondary analyses additionally adjusted for indicators of early-life socioeconomic status and considered effect modification by age, gender, and prior traumatic brain injury with loss of consciousness TBI with LOC. RESULTS Overall, 6% of participants had military employment; of these, 76% were males. Military employment was not significantly associated with cognitive change (difference in modeled 10-year cognitive change in CASI-IRT scores in SD units (95% confidence interval [CI]): -0.042 (-0.19, 0.11), risk of dementia (hazard ratio [HR] [95% CI]: 0.92 [0.71, 1.18]), or risk of Alzheimer's disease dementia (HR [95% CI]: 0.93 [0.70, 1.23]). These results were robust to additional adjustment and sensitivity analyses. There was no evidence of effect modification by age, gender, or traumatic brain injury with loss of consciousness. CONCLUSIONS Among members of the Adult Changes in Thought cohort, military employment was not associated with increased risk of cognitive decline or dementia. Nevertheless, military veterans face the same high risks for cognitive decline and dementia as other aging adults.
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Affiliation(s)
- Melinda C Power
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC 20052, USA
| | - Alia E Murphy
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC 20052, USA
| | - Kan Z Gianattasio
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC 20052, USA
| | - Y I Zhang
- Department of Statistics, George Washington University Columbian College of Arts and Sciences, Washington, DC 20052, USA
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA 98195-6420, USA
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA 98195-6420, USA
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA 98195-6420, USA
| | - Raj G Kumar
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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17
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Han Y, Xue J, Pei W, Fang Y. Hierarchical structure in the activities of daily living and trajectories of disability prior to death in elderly Chinese individuals. BMC Geriatr 2021; 21:522. [PMID: 34600493 PMCID: PMC8487510 DOI: 10.1186/s12877-021-02460-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background The global burden of disability continues to increase. Understanding the hierarchical structure of activities of daily living (ADL) and the trajectories of disability of elderly individuals is pivotal to developing early interventions. Purpose To determine the hierarchical structure of the ability of Chinese elderly individuals to perform ADL and further describe the trajectories of disability prior to death. Methods Longitudinal item response theory model (LIRT) was constructed for 28,345 elderly participants in the Chinese Longitudinal Healthy Longevity Survey, in which ADL were measured using the Katz scale from 1998 to 2018, until the participants’ death. Two difficulty parameters (κ−partial and κ−total) were used in the LIRT defining the thresholds for hierarchical structure in ADL (κ−partial: no limitation to partial limitation, κ−total: partial limitation to totally limited). Disability values estimated from the LIRT were fitted to a mixed-effects model to examine the manner in which the trajectories of disability varied with different subject characteristics. Results The findings confirmed the earliest loss in the capability to perform ADL (bathing(κ-partial = − 1.396), toileting(κ-partial = − 0.904)) at the level of partial limitation, with an overlap of partial and totally limited (total bathing, partial dressing, partial transferring, total dressing, partial feeding, partial continence), and finally a total loss of capability for toileting, feeding, transferring, and continence (κ-total = 3.647). Disability trajectories varied with sex (β = 0.041, SE = 0.001), place of residence (β = 0.010, SE = 0.001), and marital status (β = 0.144, SE = 0.001). Females, individuals living in urban areas, and those who lived without a spouse had a poorer disability status. Conclusion The loss in the ability to perform ADL has a hierarchical structure. Subject characteristics affect trajectories of disability in the elderly Chinese population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02460-y.
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Affiliation(s)
- Yaofeng Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China.,Center for Aging and Health Research School of Public Health, Xiamen University, Xiamen, China
| | - Jihui Xue
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China
| | - Wei Pei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China.
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18
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Shaffer RM, Blanco MN, Li G, Adar SD, Carone M, Szpiro AA, Kaufman JD, Larson TV, Larson EB, Crane PK, Sheppard L. Fine Particulate Matter and Dementia Incidence in the Adult Changes in Thought Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:87001. [PMID: 34347531 PMCID: PMC8336685 DOI: 10.1289/ehp9018] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Air pollution may be associated with elevated dementia risk. Prior research has limitations that may affect reliability, and no studies have evaluated this question in a population-based cohort of men and women in the United States. OBJECTIVES We evaluated the association between time-varying, 10-y average fine particulate matter (PM2.5) exposure and hazard of all-cause dementia. An additional goal was to understand how to adequately control for age and calendar-time-related confounding through choice of the time axis and covariate adjustment. METHODS Using the Adult Changes in Thought (ACT) population-based prospective cohort study in Seattle, we linked spatiotemporal model-based PM2.5 exposures to participant addresses from 1978 to 2018. Dementia diagnoses were made using high-quality, standardized, consensus-based protocols at biennial follow-ups. We conducted multivariable Cox proportional hazards regression to evaluate the association between time-varying, 10-y average PM2.5 exposure and time to event in a model with age as the time axis, stratified by apolipoprotein E (APOE) genotype, and adjusted for sex, education, race, neighborhood median household income, and calendar time. Alternative models used calendar time as the time axis. RESULTS We report 1,136 cases of incident dementia among 4,166 individuals with nonmissing APOE status. Mean [mean ± standard deviation (SD)] 10-y average PM2.5 was 10.1 (±2.9) μg/m3. Each 1-μg/m3 increase in the moving average of 10-y PM2.5 was associated with a 16% greater hazard of all-cause dementia [1.16 (95% confidence interval: 1.03, 1.31)]. Results using calendar time as the time axis were similar. DISCUSSION In this prospective cohort study with extensive exposure data and consensus-based outcome ascertainment, elevated long-term exposure to PM2.5 was associated with increased hazard of all-cause dementia. We found that optimal control of age and time confounding could be achieved through use of either age or calendar time as the time axis in our study. Our results strengthen evidence on the neurodegenerative effects of PM2.5. https://doi.org/10.1289/EHP9018.
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Affiliation(s)
- Rachel M. Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Magali N. Blanco
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Ge Li
- VA Northwest Network Mental Illness Research, Education, and Clinical Center, Virginia Puget Sound Health Care System, Seattle, Washington, USA
- Geriatric Research, Education, and Clinical Center, Virginia Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
- Departments of Medicine and Epidemiology, University of Washington Seattle School of Public Health, Seattle, Washington, USA
| | - Timothy V. Larson
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
- Department of Civil & Environmental Engineering, University of Washington, Seattle, Washington, USA
| | - Eric B. Larson
- School of Medicine, University of Washington, Seattle, Washington, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Paul K. Crane
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA
- Department of Biostatistics, University of Washington Seattle School of Public Health, Seattle, Washington, USA
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19
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Effects of Apolipoprotein Ε ε4 allele on early postoperative cognitive dysfunction after anesthesia. Anaesthesist 2021; 70:60-67. [PMID: 34143234 DOI: 10.1007/s00101-021-00972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is one of the main causes of morbidity after noncardiac surgery; however, the pathogenic mechanisms of POCD have remained unclear until now. In this study, we performed a pilot study to investigate the association between apolipoprotein E (ApoE) ε4 and POCD in older patients undergoing intravenous anesthesia (IVA) and inhalation anesthesia (IAA). METHODS In total, 180 patients from Shenzhen People's Hospital were recruited and randomly divided into an IVA group and an IAA group. The IVA group and IAA group received propofol and sevoflurane treatment, respectively. Within 7 days after surgery, the mini-mental state examination (MMSE) was used daily to assess the cognitive function of both groups of patients. The genotypes of the ApoE gene were detected using the restriction fragment length polymorphism technique. In addition, the serum levels of (soluble protein-100β) S‑100β and (Interleukin- 6) L‑6 were also analyzed. RESULTS Compared to the preoperative and IVA groups, the MMSE score in the IAA group significantly decreased at 3 days after surgery. Furthermore, the IAA group had a higher percentage of patients who scored less than 25 points than the IVA group at 3 days after surgery. The decrease in the MMSE score was closely related to the ApoE ε4 allele in the IAA group, but this correlation was not observed in the IVA group. The levels of S‑100β and IL‑6 were increased sharply in patients with the ε4/ε4 genotype who received IAA compared with IVA at 1 day after surgery. CONCLUSION The results of the study indicated that the ApoΕ ε4/ε4 genotype was a risk factor for early POCD in older patients undergoing sevoflurane anesthesia.
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20
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Ip EH, Pierce J, Chen S, Lovato J, Hughes TM, Hayden KM, Hugenschmidt CE, Craft S, Kitzman D, Rapp S. Conversion between the Modified Mini-Mental State Examination (3MSE) and the Mini-Mental State Examination (MMSE). ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12161. [PMID: 33816754 PMCID: PMC8010479 DOI: 10.1002/dad2.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Modified Mini-Mental State Examination (3MSE) and the Mini-Mental State Examination (MMSE) are two commonly used instruments for assessing cognitive function. Although conversion between 3MSE and MMSE is useful in applications such as integrative data analysis, there are limited published reports on the topic. Our objective is to provide a dual tool: (1) an item-level conversion tool to score responses for deriving both 3MSE and MMSE measures, and (2) cross-walk tables to facilitate quick conversion between 3MSE and MMSE. METHODS An SAS program tool allows scoring of 3MSE item-level responses into MMSE score. Using integrated data sets (n = 8346), actual 3MSE and MMSE scores obtained from the same individuals were linked to form cross-walk tables. RESULTS An SAS conversion program was made available. Cross-walk tables were derived. Validation sample shows bias is -0.11 (standard deviation = 1.02) in 3MSE→MMSE; the converse had substantially large bias. DISCUSSION The 3MSE→MMSE conversion table can be used in clinical practice and legacy system data.
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Affiliation(s)
- Edward H. Ip
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - June Pierce
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Shyh‐Huei Chen
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - James Lovato
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Timothy M. Hughes
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Christina E. Hugenschmidt
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Suzanne Craft
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Dalane Kitzman
- Department of Internal MedicineSection on Gerontology and GeriatricsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Internal MedicineSection on Cardiovascular MedicineWinston‐SalemNorth CarolinaUSA
| | - Steve Rapp
- Department of Psychiatry & Behavioral MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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21
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Ramanan VK, Lesnick TG, Przybelski SA, Heckman MG, Knopman DS, Graff-Radford J, Lowe VJ, Machulda MM, Mielke MM, Jack CR, Petersen RC, Ross OA, Vemuri P. Coping with brain amyloid: genetic heterogeneity and cognitive resilience to Alzheimer's pathophysiology. Acta Neuropathol Commun 2021; 9:48. [PMID: 33757599 PMCID: PMC7986461 DOI: 10.1186/s40478-021-01154-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Although abnormal accumulation of amyloid in the brain is an early biomarker of Alzheimer's disease (AD), wide variation in cognitive trajectories during life can be seen in the setting of brain amyloidosis, ranging from maintenance of normal function to progression to dementia. It is widely presumed that cognitive resilience (i.e., coping) to amyloidosis may be influenced by environmental, lifestyle, and inherited factors, but relatively little in specifics is known about this architecture. Here, we leveraged multimodal longitudinal data from a large, population-based sample of older adults to discover genetic factors associated with differential cognitive resilience to brain amyloidosis determined by positron emission tomography (PET). Among amyloid-PET positive older adults, the AD risk allele APOE ɛ4 was associated with worse longitudinal memory trajectories as expected, and was thus covaried in the main analyses. Through a genome-wide association study (GWAS), we uncovered a novel association with cognitive resilience on chromosome 8 at the MTMR7/CNOT7/ZDHHC2/VPS37A locus (p = 4.66 × 10-8, β = 0.23), and demonstrated replication in an independent cohort. Post-hoc analyses confirmed this association as specific to the setting of elevated amyloid burden and not explained by differences in tau deposition or cerebrovascular disease. Complementary gene-based analyses and publically available functional data suggested that the causative variant at this locus may tag CNOT7 (CCR4-NOT Transcription Complex Subunit 7), a gene linked to synaptic plasticity and hippocampal-dependent learning and memory. Pathways related to cell adhesion and immune system activation displayed enrichment of association in the GWAS. Our findings, resulting from a unique study design, support the hypothesis that genetic heterogeneity is one of the factors that explains differential cognitive resilience to brain amyloidosis. Further characterization of the underlying biological mechanisms influencing cognitive resilience may facilitate improved prognostic counseling, therapeutic application, and trial enrollment in AD.
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Affiliation(s)
- Vijay K Ramanan
- Department of Neurology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic-Minnesota, Rochester, MN, 55905, USA
| | - Scott A Przybelski
- Department of Health Sciences Research, Mayo Clinic-Minnesota, Rochester, MN, 55905, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic-Florida, Jacksonville, FL, 32224, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jonathan Graff-Radford
- Department of Neurology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic-Minnesota, Rochester, MN, 55905, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Health Sciences Research, Mayo Clinic-Minnesota, Rochester, MN, 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Health Sciences Research, Mayo Clinic-Minnesota, Rochester, MN, 55905, USA
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic-Florida, Jacksonville, FL, 32224, USA
- Department of Clinical Genomics, Mayo Clinic-Florida, Jacksonville, FL, 32224, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic-Minnesota, 200 First Street SW, Rochester, MN, 55905, USA.
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22
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Makkar SR, Lipnicki DM, Crawford JD, Kochan NA, Castro-Costa E, Lima-Costa MF, Diniz BS, Brayne C, Stephan B, Matthews F, Llibre-Rodriguez JJ, Llibre-Guerra JJ, Valhuerdi-Cepero AJ, Lipton RB, Katz MJ, Wang C, Ritchie K, Carles S, Carriere I, Scarmeas N, Yannakoulia M, Kosmidis M, Lam L, Chan WC, Fung A, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Suh SW, Riedel-Heller SG, Roehr S, Pabst A, Ganguli M, Hughes TF, Snitz B, Anstey KJ, Cherbuin N, Easteal S, Haan MN, Aiello AE, Dang K, Pin Ng T, Gao Q, Zin Nyunt MS, Brodaty H, Trollor JN, Leung Y, Lo JW, Sachdev P. APOE ε4 and the Influence of Sex, Age, Vascular Risk Factors, and Ethnicity on Cognitive Decline. J Gerontol A Biol Sci Med Sci 2021; 75:1863-1873. [PMID: 32396611 DOI: 10.1093/gerona/glaa116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Indexed: 01/08/2023] Open
Abstract
We aimed to examine the relationship between Apolipoprotein E ε4 (APOE*4) carriage on cognitive decline, and whether these associations were moderated by sex, baseline age, ethnicity, and vascular risk factors. Participants were 19,225 individuals aged 54-103 years from 15 longitudinal cohort studies with a mean follow-up duration ranging between 1.2 and 10.7 years. Two-step individual participant data meta-analysis was used to pool results of study-wise analyses predicting memory and general cognitive decline from carriage of one or two APOE*4 alleles, and moderation of these associations by age, sex, vascular risk factors, and ethnicity. Separate pooled estimates were calculated in both men and women who were younger (ie, 62 years) and older (ie, 80 years) at baseline. Results showed that APOE*4 carriage was related to faster general cognitive decline in women, and faster memory decline in men. A stronger dose-dependent effect was observed in older men, with faster general cognitive and memory decline in those carrying two versus one APOE*4 allele. Vascular risk factors were related to an increased effect of APOE*4 on memory decline in younger women, but a weaker effect of APOE*4 on general cognitive decline in older men. The relationship between APOE*4 carriage and memory decline was larger in older-aged Asians than Whites. In sum, APOE*4 is related to cognitive decline in men and women, although these effects are enhanced by age and carriage of two APOE*4 alleles in men, a higher numbers of vascular risk factors during the early stages of late adulthood in women, and Asian ethnicity.
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Affiliation(s)
- Steve R Makkar
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | | | | | - Breno Satler Diniz
- Department of Psychiatry, Faculty of Medicine University Toronto, Ontario, Canada.,Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, UK
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jorge J Llibre-Guerra
- Institute of Neurology and Neurosurgery, Havana, Cuba.,Memory and Aging Center, UCSF, San Francisco, California
| | | | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Cuiling Wang
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Karen Ritchie
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France.,Université de Montpellier, Montpellier, France
| | - Sophie Carles
- Inserm, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France.,Paris Descartes University, Paris, France
| | - Isabelle Carriere
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France.,Université de Montpellier, Montpellier, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's disease and the Aging Brain, Gertrude H Sergievsky Center, Department of Neurology, Columbia University, New York city, New York
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics (M.Y.), Harokopio University, Athens, Greece
| | - Mary Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Linda Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The Chinese University of Hong Kong
| | - Ada Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University
| | | | | | | | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, Australia.,Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Simon Easteal
- John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mary N Haan
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, California
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina.,Carolina Population Center, Chapel Hill, North Carolina
| | - Kristina Dang
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, California
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Australia
| | - Yvonne Leung
- School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, University of New South Wales Sydney, Sydney, Australia
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23
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Röhr S, Pabst A, Riedel-Heller SG, Jessen F, Turana Y, Handajani YS, Brayne C, Matthews FE, Stephan BCM, Lipton RB, Katz MJ, Wang C, Guerchet M, Preux PM, Mbelesso P, Ritchie K, Ancelin ML, Carrière I, Guaita A, Davin A, Vaccaro R, Kim KW, Han JW, Suh SW, Shahar S, Din NC, Vanoh D, van Boxtel M, Köhler S, Ganguli M, Jacobsen EP, Snitz BE, Anstey KJ, Cherbuin N, Kumagai S, Chen S, Narazaki K, Ng TP, Gao Q, Gwee X, Brodaty H, Kochan NA, Trollor J, Lobo A, López-Antón R, Santabárbara J, Crawford JD, Lipnicki DM, Sachdev PS. Estimating prevalence of subjective cognitive decline in and across international cohort studies of aging: a COSMIC study. ALZHEIMERS RESEARCH & THERAPY 2020; 12:167. [PMID: 33339532 PMCID: PMC7749505 DOI: 10.1186/s13195-020-00734-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
Abstract
Background Subjective cognitive decline (SCD) is recognized as a risk stage for Alzheimer’s disease (AD) and other dementias, but its prevalence is not well known. We aimed to use uniform criteria to better estimate SCD prevalence across international cohorts. Methods We combined individual participant data for 16 cohorts from 15 countries (members of the COSMIC consortium) and used qualitative and quantitative (Item Response Theory/IRT) harmonization techniques to estimate SCD prevalence. Results The sample comprised 39,387 cognitively unimpaired individuals above age 60. The prevalence of SCD across studies was around one quarter with both qualitative harmonization/QH (23.8%, 95%CI = 23.3–24.4%) and IRT (25.6%, 95%CI = 25.1–26.1%); however, prevalence estimates varied largely between studies (QH 6.1%, 95%CI = 5.1–7.0%, to 52.7%, 95%CI = 47.4–58.0%; IRT: 7.8%, 95%CI = 6.8–8.9%, to 52.7%, 95%CI = 47.4–58.0%). Across studies, SCD prevalence was higher in men than women, in lower levels of education, in Asian and Black African people compared to White people, in lower- and middle-income countries compared to high-income countries, and in studies conducted in later decades. Conclusions SCD is frequent in old age. Having a quarter of older individuals with SCD warrants further investigation of its significance, as a risk stage for AD and other dementias, and of ways to help individuals with SCD who seek medical advice. Moreover, a standardized instrument to measure SCD is needed to overcome the measurement variability currently dominant in the field.
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Affiliation(s)
- Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany. .,Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland.
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Yuda Turana
- Department of Neurology, School of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Yvonne S Handajani
- Center for Health Research, School of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Carol Brayne
- Cambridge Public Health, Cambridge University, Cambridge, UK
| | - Fiona E Matthews
- MRC Biostatistics Unit, Institute of Public Health, Cambridge University, Cambridge, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom C M Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA.,Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
| | - Maëlenn Guerchet
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,CHU, Department of Medical Information & Evaluation, Clinical Research and Biostatistic Unit, Limoges, France
| | - Pascal Mbelesso
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | - Karen Ritchie
- INSERM U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, Université de Montpellier, Montpellier, France.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marie-Laure Ancelin
- INSERM U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, Université de Montpellier, Montpellier, France
| | - Isabelle Carrière
- INSERM U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, Université de Montpellier, Montpellier, France
| | - Antonio Guaita
- Golgi Cenci Foundation, Corso San Martino 10, 20081, Abbiategrasso, Italy
| | - Annalisa Davin
- Golgi Cenci Foundation, Corso San Martino 10, 20081, Abbiategrasso, Italy
| | - Roberta Vaccaro
- Golgi Cenci Foundation, Corso San Martino 10, 20081, Abbiategrasso, Italy
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Wan Suh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suzana Shahar
- Centre of Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Normah C Din
- Centre for Rehabilitation Science and Special Needs, Faculty of Health Science, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Divya Vanoh
- School of Health Science, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Erin P Jacobsen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Beth E Snitz
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia.,Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Shuzo Kumagai
- Center for Health Science and Counseling, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan
| | - Sanmei Chen
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenji Narazaki
- Faculty of Socio-Environmental Studies, Department of Socio-Environmental Studies, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka, 811-0295, Japan
| | - Tze Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qi Gao
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xinyi Gwee
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia.,Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Julian Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia.,Department of Developmental Disability Neuropsychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza and Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Raúl López-Antón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Santabárbara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia.,Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
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Matchanova A, Babicz M, Medina LD, Fazeli PL, Vance DE, Woods SP. Latent structure of health literacy and its association with health-related management and decision-making in HIV. Psychol Health 2020; 36:985-1002. [PMID: 32897101 DOI: 10.1080/08870446.2020.1817453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Determine the latent structure of health literacy in persons living with HIV (PLWH) and its association with health management and decision-making. Method: Participants included 220 PLWH and 123 seronegative participants from Southern California and Alabama who completed a battery of well-validated health literacy measures, along with assessments of health management self-efficacy, health-related decision-making, depression, and basic clinical laboratory measures. Results: Exploratory factor analysis in HIV - participants showed that the shared variance between a battery of health literacy measures, including health word reading, verbal comprehension, numeracy, and self-reported problems was best explained by a single factor. Similarly, a confirmatory factor analysis in PLWH also supported a single factor structure, but for a re-specified four-test solution based on the core performance-based measures of health literacy. In analyses adjusting for demographics, PLWH demonstrated significantly lower health literacy composite scores as compared to their HIV - counterparts. Among PLWH, lower health literacy was independently associated with lower self-efficacy for health management and poorer health-related decision-making. Conclusions: Findings suggest that numeracy, word recognition, and verbal comprehension and reasoning comprise a unitary construct of health literacy that is lower in PLWH as compared to seronegatives and is independently associated with important downstream aspects of health management and decision-making.
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Affiliation(s)
| | - Michelle Babicz
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, Texas, USA
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Zaslavsky O, Walker RL, Crane PK, Gray SL, Larson EB. Glucose control and cognitive and physical function in adults 80+ years of age with diabetes. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12058. [PMID: 32802933 PMCID: PMC7424264 DOI: 10.1002/trc2.12058] [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: 02/12/2020] [Revised: 06/17/2020] [Accepted: 07/09/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We modeled associations between glycated hemoglobin (HbA1c) levels (<7%, 7% to 8%, and >8%) and cognitive and physical function among adults 80+ years of age with diabetes and determined whether associations differ by frailty, multimorbidity, and disability. METHODS A total of 316, adults with diabetes, 80+ years of age, were from the Adult Changes in Thought Study. The Cognitive Abilities Screening Instrument Item Response Theory (CASI-IRT) measured cognition. Short performance-based physical function (sPPF) and gait speed measured physical function. Glycosylated hemoglobin (HbA1c) levels were from clinical measurements. Analyses estimated associations between average HbA1c levels (<7%, 7% to 8%, and >8%) and functional outcomes using linear regressions estimated with generalized estimating equations. RESULTS sPPF scores did not differ significantly by HbA1c levels. Gait speed did, but only for non-frail individuals; those with HbA1c >8% were slower (-0.10 m/s [95% CI, -0.16 to -0.04]) compared to those with HbA1c 7% to 8%. The association between HbA1c and CASI-IRT varied with age (interaction P = 0.04). At age 80, for example, relative to people with HbA1c levels of 7% to 8%, CASI-IRT scores were, on average, 0.18 points lower (95% CI, -0.35 to -0.02) for people with HbA1c <7% and 0.22 points lower (95% CI, -0.40 to -0.05) for people with HbA1c >8%. At older ages, these estimated differences were attenuated. Estimated associations were not modified by multimorbidity or disability. DISCUSSION Moderate HbA1c levels of 7% to 8% were associated with better cognition in early but not late octogenarians with diabetes. Furthermore, HbA1c >8% was associated with slower gait speed among those without frailty. These results add to an evidence base for determining glucose targets for very old adults with diabetes.
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Affiliation(s)
- Oleg Zaslavsky
- Department of Biobehavioral Nursing and Health InformaticsUniversity of WashingtonSeattleUSA
| | - Rod L. Walker
- Kaiser Permanente Washington Health Research InstituteSeattleUSA
| | - Paul K. Crane
- Department of MedicineUniversity of WashingtonSeattleUSA
| | | | - Eric B. Larson
- Kaiser Permanente Washington Health Research InstituteSeattleUSA
- Department of MedicineUniversity of WashingtonSeattleUSA
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26
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Suemoto CK, Gibbons LE, Thacker EL, Jackson JD, Satizabal CL, Bettcher BM, Launer L, Phillips C, White LR, Power MC. Incident prolonged QT interval in midlife and late-life cognitive performance. PLoS One 2020; 15:e0229519. [PMID: 32097438 PMCID: PMC7041789 DOI: 10.1371/journal.pone.0229519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measures of cardiac ventricular electrophysiology have been associated with cognitive performance in cross-sectional studies. We sought to evaluate the association of worsening ventricular repolarization in midlife, as measured by incident prolonged QT interval, with cognitive decline in late life. METHODS Midlife QT interval was assessed by electrocardiography during three study visits from 1965/68 to 1971/74 in a cohort of Japanese American men aged 46-68 at Exam 1 from the Honolulu Heart Study. We defined incident prolonged QT as the QT interval in the upper quartile at Exam 2 or 3 after QT interval in lower three quartiles at Exam 1. Cognitive performance was assessed at least once using the Cognitive Abilities Screening Instrument (CASI), scored using item response theory (CASI-IRT), during four subsequent visits from 1991/93 to 1999/2000 among 2,511 of the 4,737 men in the Honolulu-Asia Aging Study otherwise eligible for inclusion in analyses. We used marginal structural modeling to determine the association of incident prolonged QT with cognitive decline, using weighting to account for confounding and attrition. RESULTS Incident prolonged QT interval in midlife was not associated with late-life CASI-IRT at cognitive baseline (estimated difference in CASI-IRT: 0.04; 95% CI: -0.28, 0.35; p = 0.81), or change in CASI-IRT over time (estimated difference in annual change in CASI-IRT: -0.002; 95%CI: -0.013, 0.010; p = 0.79). Findings were consistent across sensitivity analyses. CONCLUSIONS Although many midlife cardiovascular risk factors and cardiac structure and function measures are associated with late-life cognitive decline, incident prolonged QT interval in midlife was not associated with late-life cognitive performance or cognitive decline.
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Affiliation(s)
- Claudia K. Suemoto
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Laura E. Gibbons
- Harborview Medical Center, University of Washington, Seattle, Washington, United States of America
| | - Evan L. Thacker
- Department of Public Health, Brigham Young University, Provo, Utah, United States of America
| | - Jonathan D. Jackson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Claudia L. Satizabal
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- UT Health San Antonio, San Antonio, Texas, United States of America
| | - Brianne M. Bettcher
- Departments of Neurosurgery and Neurology, Rocky Mountain Alzheimer’s Disease Center, University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States of America
| | - Lenore Launer
- National Institute on Aging, Bethesda, Maryland, United States of America
| | - Caroline Phillips
- National Institute on Aging, Bethesda, Maryland, United States of America
| | - Lon R. White
- Departments of Medicine and Geriatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, DC, United States of America
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Glymour MM, Gibbons LE, Gilsanz P, Gross AL, Mez J, Brewster PW, Marden J, Zahodne LB, Nho K, Hamilton J, Li G, Larson EB, Crane PK. Initiation of antidepressant medication and risk of incident stroke: using the Adult Changes in Thought cohort to address time-varying confounding. Ann Epidemiol 2019; 35:42-47.e1. [PMID: 31200987 PMCID: PMC8074509 DOI: 10.1016/j.annepidem.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Depression strongly predicts stroke incidence, suggesting that treating depression may reduce stroke risk. Antidepressant medications, however, may increase stroke risk via direct pathways. Previous evidence on antidepressant medication and stroke incidence is mixed. We evaluated associations between antidepressant use and incident stroke. METHODS For 2302 Adult Changes in Thought cohort participants with no stroke at study entry, we characterized antidepressant use from pharmacy records, biennial depressive symptoms with a 10-item Centers for Epidemiologic Study-Depression scale, and incident strokes from ICD codes. We used discrete-time survival models with inverse probability weighting to compare stroke risk associated with filling antidepressant prescriptions and by medication category: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors, or other. RESULTS Over an average 8.4-year follow-up, 441 incident strokes occurred. Filling antidepressant medications 3+ times versus 0-2 times predicted 35% increased odds of stroke (OR = 1.35; 95% CI: 0.98, 1.66). Use of TCAs was associated with stroke onset (OR per 10 fills = 1.28; CI: 1.04, 1.57), but use of selective serotonin reuptake inhibitors (OR = 0.98; CI: 0.80, 1.20) or other antidepressants (OR = 0.99; CI: 0.67, 1.45) was not. CONCLUSIONS Although patients who received antidepressant medication were at higher risk of stroke, this association appeared specific to TCA prescriptions.
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Affiliation(s)
- M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University Center on Aging and Health, Baltimore, MD
| | - Jesse Mez
- Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA
| | - Paul W Brewster
- Institute on Aging & Lifelong Health and Department of Psychology, University of Victoria, Victoria BC
| | | | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Kwangsik Nho
- Center for Neuroimaging, Center for Computational Biology and Bioinformatics, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Jamie Hamilton
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY
| | - Gail Li
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA; Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA
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Bilder RM, Reise SP. Neuropsychological tests of the future: How do we get there from here? Clin Neuropsychol 2019; 33:220-245. [PMID: 30422045 PMCID: PMC6422683 DOI: 10.1080/13854046.2018.1521993] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This article reviews current approaches to neuropsychological assessment, identifies opportunities for development of new methods using modern psychometric theory and advances in technology, and suggests a transition path that promotes application of novel methods without sacrificing validity. METHODS Theoretical/state-of-the-art review. CONCLUSIONS Clinical neuropsychological assessment today does not reflect advances in neuroscience, modern psychometrics, or technology. Major opportunities for improving practice include both psychometric and technological strategies. Modern psychometric approaches including item response theory (IRT) enable linking procedures that can place different measures on common scales; adaptive testing algorithms that can dramatically increase efficiency of assessment; examination of differential item functioning (DIF) to detect measures that behave differently in different groups; and person fit statistics to detect aberrant patterns of responding of high value for performance validity testing. Opportunities to introduce novel technologies include computerized adaptive testing, Web-based assessment, healthcare- and bio-informatics strategies, mobile platforms, wearables, and the 'internet-of-things'. To overcome inertia in current practices, new methods must satisfy requirements for back-compatibility with legacy instrumentation, enabling us to leverage the wealth of validity data already accrued for classic procedures. A path to achieve these goals involves creation of a global network to aggregate item-level data into a shared repository that will enable modern psychometric analyses to refine existing methods, and serve as a platform to evolve novel assessment strategies, which over time can revolutionize neuropsychological assessment practices world-wide.
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Affiliation(s)
- Robert M Bilder
- a Departments of Psychiatry & Biobehavioral Science, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , California , USA
- b Department of Psychiatry & Biobehavioral Science , Los Angeles , California , USA
| | - Steven P Reise
- b Department of Psychiatry & Biobehavioral Science , Los Angeles , California , USA
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Fraade-Blanar LA, Ebel BE, Larson EB, Sears JM, Thompson HJ, Chan KCG, Crane PK. Cognitive Decline and Older Driver Crash Risk. J Am Geriatr Soc 2018; 66:1075-1081. [PMID: 29667168 DOI: 10.1111/jgs.15378] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine automobile crash risk associated with cognition in older drivers without dementia. DESIGN Retrospective secondary analysis of longitudinal cohort study. SETTING Our study used data from the Adult Changes in Thought (ACT) Study merged with Washington State crash reports and licensure records. Data were available from 2002 to 2015. PARTICIPANTS Group Health enrollees from Washington State aged 65 and older with active driver's licenses (N=2,615). MEASUREMENTS Cognitive function was assessed using the Cognitive Abilities Screening Instrument scored using item response theory (CASI-IRT). The study outcome was police-reported motor vehicle crash. We used a negative binomial mixed-effects model with robust standard errors clustered on the individual and considered associations between crash risk, level of cognition, and amount of decline since the previous study visit. Covariates included age, sex, education, alcohol, depression, medical comorbidities, eyesight, hearing, and physical function. Individuals were censored at dementia diagnosis, death, or failure to renew their license. RESULTS Over an average of 7 years of follow-up, 350 (13%) people had at least one crash. A 1-unit lower CASI-IRT score was associated with a higher adjusted incidence rate ratio of crash of 1.26 (95% confidence interval=1.08-1.51). Beyond level of cognition, amount of cognitive decline between study visits was not associated with crash risk. CONCLUSION This study suggests that, in older drivers, poorer performance on the CASI-IRT may be a risk factor for motor vehicle crashes, even in individuals without diagnosed dementia. Further research is needed to understand driving behavior and inform driving decisions for older adults with poor cognitive function.
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Affiliation(s)
- Laura A Fraade-Blanar
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Beth E Ebel
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jeanne M Sears
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington.,Institute for Work and Health, Seattle, Washington
| | - Hilaire J Thompson
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
| | - Kwun Chuen G Chan
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Department of Biostatistics, University of Washington, Seattle, Washington
| | - Paul K Crane
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Department of Medicine, University of Washington, Seattle, Washington
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Adroher ND, Prodinger B, Fellinghauer CS, Tennant A. All metrics are equal, but some metrics are more equal than others: A systematic search and review on the use of the term 'metric'. PLoS One 2018; 13:e0193861. [PMID: 29509813 PMCID: PMC5839589 DOI: 10.1371/journal.pone.0193861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 02/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the use of the term 'metric' in health and social sciences' literature, focusing on the interval scale implication of the term in Modern Test Theory (MTT). MATERIALS AND METHODS A systematic search and review on MTT studies including 'metric' or 'interval scale' was performed in the health and social sciences literature. The search was restricted to 2001-2005 and 2011-2015. A Text Mining algorithm was employed to operationalize the eligibility criteria and to explore the uses of 'metric'. The paradigm of each included article (Rasch Measurement Theory (RMT), Item Response Theory (IRT) or both), as well as its type (Theoretical, Methodological, Teaching, Application, Miscellaneous) were determined. An inductive thematic analysis on the first three types was performed. RESULTS 70.6% of the 1337 included articles were allocated to RMT, and 68.4% were application papers. Among the number of uses of 'metric', it was predominantly a synonym of 'scale'; as adjective, it referred to measurement or quantification. Three incompatible themes 'only RMT/all MTT/no MTT models can provide interval measures' were identified, but 'interval scale' was considerably more mentioned in RMT than in IRT. CONCLUSION 'Metric' is used in many different ways, and there is no consensus on which MTT metric has interval scale properties. Nevertheless, when using the term 'metric', the authors should specify the level of the metric being used (ordinal, ordered, interval, ratio), and justify why according to them the metric is at that level.
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Affiliation(s)
- Núria Duran Adroher
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Birgit Prodinger
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Faculty of Applied Health and Social Sciences, University of Applied Sciences Rosenheim, Rosenheim, Germany
| | - Carolina Saskia Fellinghauer
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Alan Tennant
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Balsis S, Choudhury TK, Geraci L, Benge JF, Patrick CJ. Alzheimer’s Disease Assessment: A Review and Illustrations Focusing on Item Response Theory Techniques. Assessment 2017; 25:360-373. [DOI: 10.1177/1073191117745125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alzheimer’s disease (AD) affects neurological, cognitive, and behavioral processes. Thus, to accurately assess this disease, researchers and clinicians need to combine and incorporate data across these domains. This presents not only distinct methodological and statistical challenges but also unique opportunities for the development and advancement of psychometric techniques. In this article, we describe relatively recent research using item response theory (IRT) that has been used to make progress in assessing the disease across its various symptomatic and pathological manifestations. We focus on applications of IRT to improve scoring, test development (including cross-validation and adaptation), and linking and calibration. We conclude by describing potential future multidimensional applications of IRT techniques that may improve the precision with which AD is measured.
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Affiliation(s)
| | | | - Lisa Geraci
- Texas A&M University, College Station, TX, USA
| | - Jared F. Benge
- Baylor Scott & White Health, Temple, TX, USA
- Texas A&M Health Science Center, Temple, TX, USA
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Miller JA, Guillozet-Bongaarts A, Gibbons LE, Postupna N, Renz A, Beller AE, Sunkin SM, Ng L, Rose SE, Smith KA, Szafer A, Barber C, Bertagnolli D, Bickley K, Brouner K, Caldejon S, Chapin M, Chua ML, Coleman NM, Cudaback E, Cuhaciyan C, Dalley RA, Dee N, Desta T, Dolbeare TA, Dotson NI, Fisher M, Gaudreault N, Gee G, Gilbert TL, Goldy J, Griffin F, Habel C, Haradon Z, Hejazinia N, Hellstern LL, Horvath S, Howard K, Howard R, Johal J, Jorstad NL, Josephsen SR, Kuan CL, Lai F, Lee E, Lee F, Lemon T, Li X, Marshall DA, Melchor J, Mukherjee S, Nyhus J, Pendergraft J, Potekhina L, Rha EY, Rice S, Rosen D, Sapru A, Schantz A, Shen E, Sherfield E, Shi S, Sodt AJ, Thatra N, Tieu M, Wilson AM, Montine TJ, Larson EB, Bernard A, Crane PK, Ellenbogen RG, Keene CD, Lein E. Neuropathological and transcriptomic characteristics of the aged brain. eLife 2017; 6. [PMID: 29120328 PMCID: PMC5679757 DOI: 10.7554/elife.31126] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/22/2017] [Indexed: 12/11/2022] Open
Abstract
As more people live longer, age-related neurodegenerative diseases are an increasingly important societal health issue. Treatments targeting specific pathologies such as amyloid beta in Alzheimer’s disease (AD) have not led to effective treatments, and there is increasing evidence of a disconnect between traditional pathology and cognitive abilities with advancing age, indicative of individual variation in resilience to pathology. Here, we generated a comprehensive neuropathological, molecular, and transcriptomic characterization of hippocampus and two regions cortex in 107 aged donors (median = 90) from the Adult Changes in Thought (ACT) study as a freely-available resource (http://aging.brain-map.org/). We confirm established associations between AD pathology and dementia, albeit with increased, presumably aging-related variability, and identify sets of co-expressed genes correlated with pathological tau and inflammation markers. Finally, we demonstrate a relationship between dementia and RNA quality, and find common gene signatures, highlighting the importance of properly controlling for RNA quality when studying dementia.
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Affiliation(s)
| | | | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, United States
| | - Nadia Postupna
- Department of Pathology, University of Washington, Seattle, United States
| | - Anne Renz
- Kaiser Permanente Washington Health Research Institute, Seattle, United States
| | - Allison E Beller
- Department of Pathology, University of Washington, Seattle, United States
| | - Susan M Sunkin
- Allen Institute for Brain Science, Seattle, United States
| | - Lydia Ng
- Allen Institute for Brain Science, Seattle, United States
| | - Shannon E Rose
- Department of Pathology, University of Washington, Seattle, United States
| | | | - Aaron Szafer
- Allen Institute for Brain Science, Seattle, United States
| | - Chris Barber
- Allen Institute for Brain Science, Seattle, United States
| | | | | | - Krissy Brouner
- Allen Institute for Brain Science, Seattle, United States
| | | | - Mike Chapin
- Allen Institute for Brain Science, Seattle, United States
| | - Mindy L Chua
- Department of Pathology, University of Washington, Seattle, United States
| | - Natalie M Coleman
- Department of Pathology, University of Washington, Seattle, United States
| | - Eiron Cudaback
- Department of Pathology, University of Washington, Seattle, United States
| | | | | | - Nick Dee
- Allen Institute for Brain Science, Seattle, United States
| | - Tsega Desta
- Allen Institute for Brain Science, Seattle, United States
| | - Tim A Dolbeare
- Allen Institute for Brain Science, Seattle, United States
| | | | - Michael Fisher
- Allen Institute for Brain Science, Seattle, United States
| | | | - Garrett Gee
- Allen Institute for Brain Science, Seattle, United States
| | | | - Jeff Goldy
- Allen Institute for Brain Science, Seattle, United States
| | - Fiona Griffin
- Allen Institute for Brain Science, Seattle, United States
| | - Caroline Habel
- Allen Institute for Brain Science, Seattle, United States
| | - Zeb Haradon
- Allen Institute for Brain Science, Seattle, United States
| | - Nika Hejazinia
- Allen Institute for Brain Science, Seattle, United States
| | - Leanne L Hellstern
- Department of Pathology, University of Washington, Seattle, United States
| | - Steve Horvath
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, United States
| | - Kim Howard
- Department of Pathology, University of Washington, Seattle, United States
| | - Robert Howard
- Allen Institute for Brain Science, Seattle, United States
| | - Justin Johal
- Allen Institute for Brain Science, Seattle, United States
| | - Nikolas L Jorstad
- Department of Pathology, University of Washington, Seattle, United States
| | - Samuel R Josephsen
- Department of Pathology, University of Washington, Seattle, United States
| | | | - Florence Lai
- Allen Institute for Brain Science, Seattle, United States
| | - Eric Lee
- Allen Institute for Brain Science, Seattle, United States
| | - Felix Lee
- Allen Institute for Brain Science, Seattle, United States
| | - Tracy Lemon
- Allen Institute for Brain Science, Seattle, United States
| | - Xianwu Li
- Department of Pathology, University of Washington, Seattle, United States
| | - Desiree A Marshall
- Department of Pathology, University of Washington, Seattle, United States
| | - Jose Melchor
- Allen Institute for Brain Science, Seattle, United States
| | | | - Julie Nyhus
- Allen Institute for Brain Science, Seattle, United States
| | | | | | - Elizabeth Y Rha
- Department of Pathology, University of Washington, Seattle, United States
| | - Samantha Rice
- Department of Pathology, University of Washington, Seattle, United States
| | - David Rosen
- Allen Institute for Brain Science, Seattle, United States
| | - Abharika Sapru
- Department of Pathology, University of Washington, Seattle, United States
| | - Aimee Schantz
- Department of Pathology, University of Washington, Seattle, United States
| | - Elaine Shen
- Allen Institute for Brain Science, Seattle, United States
| | - Emily Sherfield
- Department of Pathology, University of Washington, Seattle, United States
| | - Shu Shi
- Allen Institute for Brain Science, Seattle, United States
| | - Andy J Sodt
- Allen Institute for Brain Science, Seattle, United States
| | | | - Michael Tieu
- Allen Institute for Brain Science, Seattle, United States
| | - Angela M Wilson
- Department of Pathology, University of Washington, Seattle, United States
| | - Thomas J Montine
- Department of Pathology, University of Washington, Seattle, United States
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, United States
| | - Amy Bernard
- Allen Institute for Brain Science, Seattle, United States
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, United States
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, United States
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, United States
| | - Ed Lein
- Allen Institute for Brain Science, Seattle, United States
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Li G, Larson EB, Shofer JB, Crane PK, Gibbons LE, McCormick W, Bowen JD, Thompson ML. Cognitive Trajectory Changes Over 20 Years Before Dementia Diagnosis: A Large Cohort Study. J Am Geriatr Soc 2017; 65:2627-2633. [PMID: 28940184 DOI: 10.1111/jgs.15077] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Longitudinal studies have shown an increase in cognitive decline many years before clinical diagnosis of dementia. We sought to estimate changes, relative to "normal" aging, in the trajectory of scores on a global cognitive function test-the Cognitive Abilities Screening Instrument (CASI). DESIGN A prospective cohort study. SETTING Community-dwelling members of a U.S. health maintenance organization. PARTICIPANTS Individuals aged 65 and older who had no dementia diagnosis at baseline and had at least two visits with valid CASI test score (N = 4,315). MEASUREMENTS Average longitudinal trajectories, including changes in trajectory before clinical diagnosis in those who would be diagnosed with dementia, were estimated for CASI item response theory (IRT) scores. The impact of sex, education level, and APOE genotype on cognitive trajectories was assessed. RESULTS Increased cognitive decline relative to "normal" aging was evident in CASI IRT at least 10 years before clinical diagnosis. Male gender, lower education, and presence of ≥1 APOE ε4 alleles were associated with lower average IRT scores. In those who would be diagnosed with dementia, a trajectory change point was estimated at an average of 3.1 years (95% confidence interval 3.0-3.2) before clinical diagnosis, after which cognitive decline appeared to accelerate. The change point did not differ by sex, education level, or APOE ε4 genotype. There were subtle differences in trajectory slopes by sex and APOE ε4 genotype, but not by education. CONCLUSION Decline in average global cognitive function was evident at least 10 years before clinical diagnosis of dementia. The decline accelerated about 3 years before clinical diagnosis.
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Affiliation(s)
- Ge Li
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Eric B Larson
- Department of General Internal Medicine, University of Washington, Seattle, Washington.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane B Shofer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Paul K Crane
- Department of General Internal Medicine, University of Washington, Seattle, Washington
| | - Laura E Gibbons
- Department of General Internal Medicine, University of Washington, Seattle, Washington
| | - Wayne McCormick
- Department of General Internal Medicine, University of Washington, Seattle, Washington
| | - James D Bowen
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Mary Lou Thompson
- Department of Biostatistics, University of Washington, Seattle, Washington
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Crane HM, Fredericksen RJ, Church A, Harrington A, Ciechanowski P, Magnani J, Nasby K, Brown T, Dhanireddy S, Harrington RD, Lober WB, Simoni J, Safren SA, Edwards TC, Patrick DL, Saag MS, Crane PK, Kitahata MM. A Randomized Controlled Trial Protocol to Evaluate the Effectiveness of an Integrated Care Management Approach to Improve Adherence Among HIV-Infected Patients in Routine Clinical Care: Rationale and Design. JMIR Res Protoc 2016; 5:e156. [PMID: 27707688 PMCID: PMC5071617 DOI: 10.2196/resprot.5492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings. OBJECTIVE We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues. METHODS We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting. RESULTS The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017. DISCUSSION This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to sufficient improvements, and there remains little guidance regarding how adherence interventions should be implemented into clinical care. By focusing on improving adherence within care settings using existing staff, routine assessment of key domains, such as depression, adherence, and substance use, and feasible interventions, we propose to evaluate this innovative way to improve clinical outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT01505660; http://clinicaltrials.gov/ct2/show/NCT01505660 (Archived by WebCite at http://www.webcitation/ 6ktOq6Xj7).
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, United States.
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Application of Latent Variable Methods to the Study of Cognitive Decline When Tests Change over Time. Epidemiology 2016; 26:878-87. [PMID: 26414855 DOI: 10.1097/ede.0000000000000379] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The way a construct is measured can differ across cohort study visits, complicating longitudinal comparisons. We demonstrated the use of factor analysis to link differing cognitive test batteries over visits to common metrics representing general cognitive performance, memory, executive functioning, and language. METHODS We used data from three visits (over 26 years) of the Atherosclerosis Risk in Communities Neurocognitive Study (N = 14,252). We allowed individual tests to contribute information differentially by race, an important factor to consider in cognitive aging. Using generalized estimating equations, we compared associations of diabetes with cognitive change using general and domain-specific factor scores versus averages of equally weighted standardized test scores. RESULTS Factor scores provided stronger associations with diabetes at the expense of greater variability around estimates (e.g., for general cognitive performance, -0.064 standard deviation units/year, standard error = 0.015, vs. -0.041 standard deviation units/year, standard error = 0.014), which is consistent with the notion that factor scores more explicitly address error in measuring assessed traits than averages of standardized tests. CONCLUSIONS Factor analysis facilitates use of all available data when measures change over time, and further, it allows objective evaluation and correction for differential item functioning.
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Silverberg ND, Crane PK, Dams-O'Connor K, Holdnack J, Ivins BJ, Lange RT, Manley GT, McCrea M, Iverson GL. Developing a Cognition Endpoint for Traumatic Brain Injury Clinical Trials. J Neurotrauma 2016; 34:363-371. [PMID: 27188248 DOI: 10.1089/neu.2016.4443] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cognitive impairment is a core clinical feature of traumatic brain injury (TBI). After TBI, cognition is a key determinant of post-injury productivity, outcome, and quality of life. As a final common pathway of diverse molecular and microstructural TBI mechanisms, cognition is an ideal endpoint in clinical trials involving many candidate drugs and nonpharmacological interventions. Cognition can be reliably measured with performance-based neuropsychological tests that have greater granularity than crude rating scales, such as the Glasgow Outcome Scale-Extended, which remain the standard for clinical trials. Remarkably, however, there is no well-defined, widely accepted, and validated cognition endpoint for TBI clinical trials. A single cognition endpoint that has excellent measurement precision across a wide functional range and is sensitive to the detection of small improvements (and declines) in cognitive functioning would enhance the power and precision of TBI clinical trials and accelerate drug development research. We outline methodologies for deriving a cognition composite score and a research program for validation. Finally, we discuss regulatory issues and the limitations of a cognition endpoint.
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Affiliation(s)
- Noah D Silverberg
- 1 Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia , and GF Strong Rehab Centre, Vancouver, British Columbia, Canada, and Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
| | - Paul K Crane
- 2 Department of Medicine, University of Washington , Seattle, Washington
| | - Kristen Dams-O'Connor
- 3 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York City, New York
| | - James Holdnack
- 4 Department of Physical Therapy, University of Delaware , Newark, Delaware
| | - Brian J Ivins
- 5 Defense and Veterans Brain Injury Center (DVBIC) , Silver Spring, Maryland
| | - Rael T Lange
- 6 Defense and Veterans Brain Injury Center (DVBIC) , Walter Reed National Military Medical Center, and National Intrepid Center of Excellence, Bethesda, Maryland
| | - Geoffrey T Manley
- 7 Department of Neurological Surgery, University of California San Francisco , San Francisco, California
| | - Michael McCrea
- 8 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Grant L Iverson
- 9 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, MassGeneral Hospital for Children Sports Concussion Program, and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, and Defense and Veterans Brain Injury Center, National Intrepid Center of Excellence , Bethesda, Maryland
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37
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Standardisation of the Test Your Memory and evaluation of their concordance with the outcome of the psychometric examination. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mez J, Mukherjee S, Thornton T, Fardo DW, Trittschuh E, Sutti S, Sherva R, Kauwe JS, Naj AC, Beecham GW, Gross A, Saykin AJ, Green RC, Crane PK. The executive prominent/memory prominent spectrum in Alzheimer's disease is highly heritable. Neurobiol Aging 2016; 41:115-121. [PMID: 27103524 PMCID: PMC4843522 DOI: 10.1016/j.neurobiolaging.2016.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 02/03/2023]
Abstract
Late-onset Alzheimer's disease (LOAD) can present heterogeneously, with several subtypes recognized, including dysexecutive AD. One way to identify people with dysexecutive AD is to consider the difference between memory and executive functioning, which we refer to as the executive prominent/memory prominent spectrum. We aimed to determine if this spectrum was heritable. We used neuropsychological and genetic data from people with mild LOAD (Clinical Dementia Rating 0.5 or 1.0) from the National Alzheimer's Coordinating Center and the Alzheimer's Disease Neuroimaging Initiative. We cocalibrated the neuropsychological data to obtain executive functioning and memory scores and used their difference as a continuous phenotype to calculate its heritability overall and by chromosome. Narrow-sense heritability of the difference between memory and executive functioning scores was 0.68 (standard error 0.12). Single nucleotide polymorphisms on chromosomes 1, 2, 4, 11, 12, and 18 explained the largest fraction of phenotypic variance, with signals from each chromosome accounting for 5%-7%. The chromosomal pattern of heritability differed substantially from that of LOAD itself.
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Affiliation(s)
- Jesse Mez
- Alzheimer's Disease Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Shubhabrata Mukherjee
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Timothy Thornton
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - David W Fardo
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Emily Trittschuh
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sheila Sutti
- G2P Program, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard Sherva
- Biomedical Genetics, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - John S Kauwe
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Adam C Naj
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary W Beecham
- Miller School of Medicine, Hussman Institute for Human Genomics and Dr. John T. Macdonald Foundation, Department of Human Genetics, University of Miami, Miami, FL, USA
| | - Alden Gross
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew J Saykin
- IU Health Neuroscience Center, Department of Radiology, Indiana University, Indianapolis, IN, USA
| | - Robert C Green
- G2P Program, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul K Crane
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
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Gray SL, Dublin S, Yu O, Walker R, Anderson M, Hubbard RA, Crane PK, Larson EB. Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. BMJ 2016; 352:i90. [PMID: 26837813 PMCID: PMC4737849 DOI: 10.1136/bmj.i90] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline. DESIGN Prospective population based cohort. SETTING Integrated healthcare delivery system, Seattle, Washington. PARTICIPANTS 3434 participants aged ≥ 65 without dementia at study entry. There were two rounds of recruitment (1994-96 and 2000-03) followed by continuous enrollment beginning in 2004. MAIN OUTCOMES MEASURES The cognitive abilities screening instrument (CASI) was administered every two years to screen for dementia and was used to examine cognitive trajectory. Incident dementia and Alzheimer's disease were determined with standard diagnostic criteria. Benzodiazepine exposure was defined from computerized pharmacy data and consisted of the total standardized daily doses (TSDDs) dispensed over a 10 year period (a rolling window that moved forward in time during follow-up). The most recent year was excluded because of possible use for prodromal symptoms. Multivariable Cox proportional hazard models were used to examine time varying use of benzodiazepine and dementia risk. Analyses of cognitive trajectory used linear regression models with generalized estimating equations. RESULTS Over a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia, of whom 637 developed Alzheimer's disease. For dementia, the adjusted hazard ratios associated with cumulative benzodiazepine use compared with non-use were 1.25 (95% confidence interval 1.03 to 1.51) for 1-30 TSDDs; 1.31 (1.00 to 1.71) for 31-120 TSDDs; and 1.07 (0.82 to 1.39) for ≥ 121 TSDDs. Results were similar for Alzheimer's disease. Higher benzodiazepine use was not associated with more rapid cognitive decline. CONCLUSION The risk of dementia is slightly higher in people with minimal exposure to benzodiazepines but not with the highest level of exposure. These results do not support a causal association between benzodiazepine use and dementia.
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Affiliation(s)
- Shelly L Gray
- School of Pharmacy, University of Washington, Seattle, WA 98195-7630, US
| | - Sascha Dublin
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Onchee Yu
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Rod Walker
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Melissa Anderson
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, US
| | - Paul K Crane
- University of Washington Department of Medicine, Division of General Internal Medicine, Seattle, WA, US
| | - Eric B Larson
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, US
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Dowling NM, Bolt DM, Deng S. An approach for estimating item sensitivity to within-person change over time: An illustration using the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog). Psychol Assess 2016; 28:1576-1585. [PMID: 27046272 DOI: 10.1037/pas0000285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
When assessments are primarily used to measure change over time, it is important to evaluate items according to their sensitivity to change, specifically. Items that demonstrate good sensitivity to between-person differences at baseline may not show good sensitivity to change over time, and vice versa. In this study, we applied a longitudinal factor model of change to a widely used cognitive test designed to assess global cognitive status in dementia, and contrasted the relative sensitivity of items to change. Statistically nested models were estimated introducing distinct latent factors related to initial status differences between test-takers and within-person latent change across successive time points of measurement. Models were estimated using all available longitudinal item-level data from the Alzheimer's Disease Assessment Scale-Cognitive subscale, including participants representing the full-spectrum of disease status who were enrolled in the multisite Alzheimer's Disease Neuroimaging Initiative. Five of the 13 Alzheimer's Disease Assessment Scale-Cognitive items demonstrated noticeably higher loadings with respect to sensitivity to change. Attending to performance change on only these 5 items yielded a clearer picture of cognitive decline more consistent with theoretical expectations in comparison to the full 13-item scale. Items that show good psychometric properties in cross-sectional studies are not necessarily the best items at measuring change over time, such as cognitive decline. Applications of the methodological approach described and illustrated in this study can advance our understanding regarding the types of items that best detect fine-grained early pathological changes in cognition. (PsycINFO Database Record
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Affiliation(s)
- N Maritza Dowling
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin-Madison
| | - Sien Deng
- Department of Educational Psychology, University of Wisconsin-Madison
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41
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Lim YY, Snyder PJ, Pietrzak RH, Ukiqi A, Villemagne VL, Ames D, Salvado O, Bourgeat P, Martins RN, Masters CL, Rowe CC, Maruff P. Sensitivity of composite scores to amyloid burden in preclinical Alzheimer's disease: Introducing the Z-scores of Attention, Verbal fluency, and Episodic memory for Nondemented older adults composite score. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2015; 2:19-26. [PMID: 27239532 PMCID: PMC4879646 DOI: 10.1016/j.dadm.2015.11.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Cognitive composite scores developed for preclinical Alzheimer's disease (AD) often consist of multiple cognitive domains as they may provide greater sensitivity to detect β-amyloid (Aβ)–related cognitive decline than episodic memory (EM) composite scores alone. However, this has never been empirically tested. We compared the rate of cognitive decline associated with high Aβ (Aβ+) and very high Aβ (Aβ++) in cognitively normal (CN) older adults on three multidomain cognitive composite scores and one single-domain (EM) composite score. Methods CN older adults (n = 423) underwent Aβ neuroimaging and completed neuropsychological assessments at baseline, and at 18-, 36-, 54-, and 72-month follow-ups. Four cognitive composite scores were computed: the ADCS-PACC (ADCS-Preclinical Alzheimer Cognitive Composite), ADCS-PACC without the inclusion of the mini-mental state examination (MMSE), an EM composite, and the Z-scores of Attention, Verbal fluency, and Episodic memory for Nondemented older adults (ZAVEN) composite. Results Compared with Aβ+ CN older adults, Aβ++ CN older adults showed faster rates of decline across all cognitive composites, with the largest decline observed for ZAVEN composite (d = 1.07). Similarly, compared with Aβ− CN older adults, Aβ+ CN older adults also showed faster rates of cognitive decline, but only for the ADCS-PACC no MMSE (d = 0.43), EM (d = 0.53), and ZAVEN (d = 0.50) composites. Discussion Aβ-related cognitive decline is best detected using validated neuropsychological instruments. Removal of the MMSE from the ADCS-PACC and replacing it with a test of executive function (verbal fluency; i.e., the ZAVEN) rendered this composite more sensitive even in detecting Aβ-related cognitive decline between Aβ+ and Aβ++ CN older adults.
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Affiliation(s)
- Yen Ying Lim
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Snyder
- Department of Neurology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA; Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Albulene Ukiqi
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Victor L Villemagne
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, St. Vincent's Health, The University of Melbourne, Kew, Victoria, Australia; National Ageing Research Institute, Parkville, Victoria, Australia
| | - Olivier Salvado
- Commonwealth Scientific Industrial Research Organization (CSIRO) Preventative Health National Research Flagship, Australian e-Health Research Centre-BioMedIA, Brisbane, Queensland, Australia
| | - Pierrick Bourgeat
- Commonwealth Scientific Industrial Research Organization (CSIRO) Preventative Health National Research Flagship, Australian e-Health Research Centre-BioMedIA, Brisbane, Queensland, Australia
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christopher C Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Paul Maruff
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Cogstate Ltd., Melbourne, Victoria, Australia
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42
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Gross AL, Mungas DM, Crane PK, Gibbons LE, MacKay-Brandt A, Manly JJ, Mukherjee S, Romero H, Sachs B, Thomas M, Potter GG, Jones RN. Effects of education and race on cognitive decline: An integrative study of generalizability versus study-specific results. Psychol Aging 2015; 30:863-880. [PMID: 26523693 DOI: 10.1037/pag0000032] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective of the study was to examine variability across multiple prospective cohort studies in level and rate of cognitive decline by race/ethnicity and years of education. We compare data across studies, we harmonized estimates of common latent factors representing overall or general cognitive performance, memory, and executive function derived from the: (a) Washington Heights, Hamilton Heights, Inwood Columbia Aging Project (N = 4,115), (b) Spanish and English Neuropsychological Assessment Scales (N = 525), (c) Duke Memory, Health, and Aging study (N = 578), and (d) Neurocognitive Outcomes of Depression in the Elderly (N = 585). We modeled cognitive change over age for cognitive outcomes by race, education, and study. We adjusted models for sex, dementia status, and study-specific characteristics. The results found that for baseline levels of overall cognitive performance, memory, and executive function, differences in race and education tended to be larger than between-study differences and consistent across studies. This pattern did not hold for rate of cognitive decline: effects of education and race/ethnicity on cognitive change were not consistently observed across studies, and when present were small, with racial/ethnic minorities and those with lower education declining at faster rates. In this diverse set of datasets, non-Hispanic Whites and those with higher education had substantially higher baseline cognitive test scores. However, differences in the rate of cognitive decline by race/ethnicity and education did not follow this pattern. This study suggests that baseline test scores and longitudinal change have different determinants, and future studies to examine similarities and differences of causes of cognitive decline in racially/ethnically and educationally diverse older groups is needed.
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Affiliation(s)
| | | | | | | | | | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain
| | | | | | | | | | - Guy G Potter
- Department of Psychiatry and Behavioral Sciences
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43
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Saczynski JS, Inouye SK, Guess J, Jones RN, Fong TG, Nemeth E, Hodara A, Ngo L, Marcantonio ER. The Montreal Cognitive Assessment: Creating a Crosswalk with the Mini-Mental State Examination. J Am Geriatr Soc 2015; 63:2370-4. [PMID: 26503296 DOI: 10.1111/jgs.13710] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish Montreal Cognitive Assessment (MoCA) scores that correspond to well-established cut-points on the Mini-Mental State Examination (MMSE). DESIGN Cross-sectional observational study. SETTING General medical service of a large teaching hospital. PARTICIPANTS Individuals aged 75 and older (N = 199; mean age 84, 63% female). MEASUREMENTS The MoCA (range 0-30) and the MMSE (range 0-30) were administered within 2 hours of each other. The Abbreviated MoCA (A-MoCA; range 0-22) was calculated from the full MoCA. Scores from the three tests were analyzed using equipercentile equating, a statistical method for determining comparable scores on different tests of a similar construct by estimating percentile equivalents. RESULTS MoCA scores were lower (mean 19.3 ± 5.8) than MMSE scored (mean 24.1 ± 6.6). Traditional MMSE cut-points of 27 for mild cognitive impairment and 23 for dementia corresponded to MoCA scores of 23 and 17, respectively. CONCLUSION Scores on the full and abbreviated versions of the MoCA can be linked directly to the MMSE. The MoCA may be more sensitive to changes in cognitive performance at higher levels of functioning.
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Affiliation(s)
- Jane S Saczynski
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Sharon K Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jamey Guess
- Harvard Medical School, Boston, Massachusetts.,Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Richard N Jones
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, Rhode Island
| | - Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Emese Nemeth
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ariel Hodara
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Long Ngo
- Harvard Medical School, Boston, Massachusetts.,Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Edward R Marcantonio
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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44
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Hohman TJ, Samuels LR, Liu D, Gifford KA, Mukherjee S, Benson EM, Abel T, Ruberg FL, Jefferson AL. Stroke risk interacts with Alzheimer's disease biomarkers on brain aging outcomes. Neurobiol Aging 2015; 36:2501-8. [PMID: 26119224 PMCID: PMC4523400 DOI: 10.1016/j.neurobiolaging.2015.05.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 12/19/2022]
Abstract
Alzheimer's disease (AD) biomarkers and stroke risk factors independently predict cognitive impairment, likely through independent disease pathways. However, limited work has sought to describe the dynamic interplay between these important risk factors. This article evaluated the interaction between stroke risk and AD biomarkers on hippocampal volume and cognitive performance. We first evaluated the interaction between stroke risk factors and AD biomarkers using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI, n = 1202). We then extended our findings to an independent autopsy data set from the National Alzheimer's Coordinating Center (NACC, n = 1122) using measures of AD pathology. Stroke risk was quantified using the Framingham Stroke Risk Profile. In ADNI, stroke risk interacted with tau and amyloid levels in relation to baseline and longitudinal cognitive performance. Similarly, in NACC, stroke risk interacted with amyloid and tau positivity on cognitive performance. The effect of stroke risk factors on cognition was strongest in the absence of AD biomarkers or neuropathology, providing additional evidence that AD biomarkers and stroke risk factors relate to cognition through independent pathways.
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Affiliation(s)
- Timothy J Hohman
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Lauren R Samuels
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dandan Liu
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Katherine A Gifford
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Elleena M Benson
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ty Abel
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Angela L Jefferson
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University School of Medicine, Nashville, TN, USA
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45
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Tripodis Y, Zirogiannis N. Dynamic Factor Analysis for Multivariate Time Series: An Application to Cognitive Trajectories. INTERNATIONAL JOURNAL OF CLINICAL BIOSTATISTICS AND BIOMETRICS 2015; 1:001. [PMID: 26753177 PMCID: PMC4704801 DOI: 10.23937/2469-5831/1510001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We propose a dynamic factor model appropriate for large epidemiological studies and develop an estimation algorithm which can handle datasets with large number of subjects and short temporal information. The algorithm uses a two cycle iterative approach for parameter estimation in such a large dataset. Each iteration consists of two distinct cycles, both following an EM algorithm approach. This iterative process will continue until convergence is achieved. We utilized a dataset from the National Alzheimer Coordinating Center (NACC) to estimate underlying measures of cognition based on a battery of observed neuropsychological tests. We assess the goodness of fit and the precision of the dynamic factor model estimators and compare it with a non-dynamic version in which temporal information is not used. The dynamic factor model is superior to a non-dynamic version with respect to fit statistics shown in simulation experiments. Moreover, it has increased power to detect differences in the rate of decline for a given sample size.
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46
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Ferrero-Arias J, Turrión-Rojo MA. [Standardization of the Test Your Memory and evaluation of their concordance with the outcome of the psychometric examination]. Neurologia 2015; 31:239-46. [PMID: 26059809 DOI: 10.1016/j.nrl.2015.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/21/2015] [Accepted: 03/24/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the relationship between scores on the Test Your Memory (TYM) battery and findings from a more exhaustive neurocognitive assessment. METHODS The TYM and fourteen psychometric tests were administered to 84 subjects aged 50 or older who attended an outpatient neurology clinic due to cognitive symptoms. Each patient's cognitive state was determined independently from his/her score on the TYM (CDR 0, n=25; CDR 0.5, n=45; CDR 1, n=14). We analysed concurrent validity of TYM scores and results from the psychometric tests, as well as the degree of concordance between the two types of measurement, by contrasting normalised data from each instrument. RESULTS Although the intraclass correlation coefficient was 0.67 (confidence interval 95%, 0.53-0.77), analysis of the Bland-Altman plot and the curve on the survival-agreement plot (Luiz et al. method) demonstrates that the individual distances between the two methods exhibit excessive dispersion from a clinical viewpoint. TYM-based predictions of the mean z-score on psychometric tests differed substantially from real results in 30% of the subjects. Concordance of 95% can only be achieved by accepting absolute inter-instrument differences of up to 0.87 as identical values. Furthermore, the TYM underestimates cognitive performance for low values and overestimates it for high values. CONCLUSIONS The TYM is a cognitive screening test which should not be used to predict results on psychometric tests or to detect cognitive changes in clinical trials.
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47
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Yamada M, Landes RD, Mimori Y, Nagano Y, Sasaki H. Trajectories of cognitive function in dementia-free subjects: Radiation Effects Research Foundation Adult Health Study. J Neurol Sci 2015; 351:115-119. [DOI: 10.1016/j.jns.2015.02.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/05/2015] [Accepted: 02/27/2015] [Indexed: 11/28/2022]
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48
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Gurnani AS, John SE, Gavett BE. Regression-Based Norms for a Bi-factor Model for Scoring the Brief Test of Adult Cognition by Telephone (BTACT). Arch Clin Neuropsychol 2015; 30:280-91. [PMID: 25724515 DOI: 10.1093/arclin/acv005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/12/2022] Open
Abstract
The current study developed regression-based normative adjustments for a bi-factor model of the The Brief Test of Adult Cognition by Telephone (BTACT). Archival data from the Midlife Development in the United States-II Cognitive Project were used to develop eight separate linear regression models that predicted bi-factor BTACT scores, accounting for age, education, gender, and occupation-alone and in various combinations. All regression models provided statistically significant fit to the data. A three-predictor regression model fit best and accounted for 32.8% of the variance in the global bi-factor BTACT score. The fit of the regression models was not improved by gender. Eight different regression models are presented to allow the user flexibility in applying demographic corrections to the bi-factor BTACT scores. Occupation corrections, while not widely used, may provide useful demographic adjustments for adult populations or for those individuals who have attained an occupational status not commensurate with expected educational attainment.
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Affiliation(s)
- Ashita S Gurnani
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Samantha E John
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Brandon E Gavett
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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49
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Jensen RE, Rothrock NE, DeWitt EM, Spiegel B, Tucker CA, Crane HM, Forrest CB, Patrick DL, Fredericksen R, Shulman LM, Cella D, Crane PK. The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care. Med Care 2015; 53:153-9. [PMID: 25588135 PMCID: PMC4801509 DOI: 10.1097/mlr.0000000000000289] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are gaining recognition as key measures for improving the quality of patient care in clinical care settings. Three factors have made the implementation of PROs in clinical care more feasible: increased use of modern measurement methods in PRO design and validation, rapid progression of technology (eg, touchscreen tablets, Internet accessibility, and electronic health records), and greater demand for measurement and monitoring of PROs by regulators, payers, accreditors, and professional organizations. As electronic PRO collection and reporting capabilities have improved, the challenges of collecting PRO data have changed. OBJECTIVES To update information on PRO adoption considerations in clinical care, highlighting electronic and technical advances with respect to measure selection, clinical workflow, data infrastructure, and outcomes reporting. METHODS Five practical case studies across diverse health care settings and patient populations are used to explore how implementation barriers were addressed to promote the successful integration of PRO collection into the clinical workflow. The case studies address selecting and reporting of relevant content, workflow integration, previsit screening, effective evaluation, and electronic health record integration. CONCLUSIONS These case studies exemplify elements of well-designed electronic systems, including response automation, tailoring of item selection and reporting algorithms, flexibility of collection location, and integration with patient health care data elements. They also highlight emerging logistical barriers in this area, such as the need for specialized technological and methodological expertise, and design limitations of current electronic data capture systems.
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Affiliation(s)
- Roxanne E. Jensen
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Nan E. Rothrock
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Esi Morgan DeWitt
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Brennan Spiegel
- VA Greater Los Angeles Healthcare System
- David Geffen School of Medicine at UCLA
- UCLA Fielding School of Public Health
| | - Carole A. Tucker
- College of Health Professions & Social Work, Temple University, Philadelphia PA
| | - Heidi M. Crane
- Division of Allergy & Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Christopher B. Forrest
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Donald L. Patrick
- DP Department of Health Services, University of Washington, Seattle, WA
- Seattle Quality of Life Group, Seattle, WA
| | - Rob Fredericksen
- Division of Allergy & Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Lisa M. Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Paul K. Crane
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, WA
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50
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Yang J, Fan C, Pan L, Xie M, He Q, Li D, Wang S. C-reactive protein plays a marginal role in cognitive decline: a systematic review and meta-analysis. Int J Geriatr Psychiatry 2015; 30:156-65. [PMID: 25475551 DOI: 10.1002/gps.4236] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 09/30/2014] [Accepted: 10/23/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of the study was to investigate the association between peripheral levels of C-reactive protein (CRP) and cognitive decline that is defined by 2-5 years of cognitive change in general cognitive function or specific cognitive domain. METHODS We searched PubMed and Google for prospective/longitudinal studies that report the association between peripheral levels of CRP and risk of cognitive decline in the nondementia population. RESULTS Out of 479 related articles from PubMed and Google, four studies with a total of 5255 non-demented subjects that report odds ratio (OR)/relative risk/hazard ratio of CRP levels and decline in general cognition met our criteria for meta-analysis. The association between higher levels of CRP and risk of global cognitive decline was weak but significant (OR, 1.27 [95% CI, 1.02 to 1.58]). However, the systematic review from six other articles that were not suitable for meta-analysis revealed a marginal association between CRP and cognitive decline in certain domains. CONCLUSION Our analysis demonstrated a weak association between peripheral CRP level and global cognitive decline. Because of the small number of included studies and varied methodologies that they applied, caution should be taken when generalizing our finding to the full range of cognitive changes in different cognitive domains observed in non-demented people.
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Affiliation(s)
- Jin Yang
- School of Public Health, Wuhan University, Wuhan, China
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