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Kanser RJ, VandenBussche Jantz AB, Logan PM, Bailey EK, Kamper JE. Comparing Detection of Alzheimer's and Vascular Disease-Related Cognitive Impairment With Brief Cognitive Screens. J Neuropsychiatry Clin Neurosci 2022; 34:361-366. [PMID: 35578799 DOI: 10.1176/appi.neuropsych.21040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: The study compared the accuracy of the Mini-Mental State Examination (MMSE) with its modified version (3MS) in distinguishing healthy older adults from adults with cognitive impairment due to suspected Alzheimer’s disease (AD) or vascular disease (VaD). Method: Participants were 98 veterans who underwent comprehensive neuropsychological evaluation due to concern for cognitive decline. Participants were selected via retrospective chart review on the basis of diagnosis. They had diagnoses of mild or major neurocognitive disorder due to suspected AD (N=20), mild or major neurocognitive disorder due to suspected VaD (N=44), or no neurocognitive diagnosis (i.e., healthy adult comparisons; HC, N=34). Results: The 3MS demonstrated superior detection of cognitive impairment. The extent of this enhanced detection was influenced by the suspected etiology of cognitive impairment. The 3MS and MMSE had comparable discrimination of AD and HC. With respect to VaD, the 3MS showed superior discriminability compared to the MMSE. Conclusions: Overall, results support the adoption of the 3MS over that of the MMSE. The 3MS is a superior (and free) tool for detecting cognitive impairment in geriatric populations. Its use is recommended for first-line screening of cognitive symptoms in older adult populations, especially those with concern for VaD.
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Affiliation(s)
- Robert J Kanser
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | | | - Patrick M Logan
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Erin K Bailey
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Joel E Kamper
- Department of Mental Health & Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida
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Khalifa K, Bergland AK, Soennesyn H, Oppedal K, Oesterhus R, Dalen I, Larsen AI, Fladby T, Brooker H, Wesnes KA, Ballard C, Aarsland D. Effects of Purified Anthocyanins in People at Risk for Dementia: Study Protocol for a Phase II Randomized Controlled Trial. Front Neurol 2020; 11:916. [PMID: 32982933 PMCID: PMC7492209 DOI: 10.3389/fneur.2020.00916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The number of people with dementia is increasing, with huge challenges for society and health-care systems. There are no disease-modifying therapies available. There is, therefore, an urgent need to identify strategies to reduce the risk of developing dementia. Anthocyanins are a class of compounds found in dark berries and fruits with some effects that might reduce the risk for cognitive decline and the development of dementia in older people. Aim: This phase II three-center, randomized, 24-week, placebo-controlled study, ongoing in Norway, aims to evaluate the safety, and efficacy of anthocyanins in modifying key dementia-related mechanisms and maintain cognitive functioning in older people at risk for dementia. Methods: Participants (220 individuals aged 60–80 years) who meet the inclusion criteria (either mild cognitive impairment or two or more cardiometabolic disorders) are being enrolled in this study at three different centers in Norway. Participants are block randomized to identically appearing capsules containing 80 mg of naturally purified anthocyanins or placebo 1:1. Dosage is 2 + 2 capsules per day for 24 weeks. The primary outcome will be the quality of episodic memory score, a composite measure from the extensively validated online cognitive test battery CogTrack®, which is administered at baseline and monthly for the next 6 months. Secondary outcomes include other major scores from CogTrack, as well as a range of neuroimaging and other biomarkers. Anthocyanin metabolites will be measured in blood and cerebrospinal fluid. The change from baseline scores will be subject to a mixed model for repeated measures analysis of covariance. The primary comparison will be the contrast (difference in the least-square means) between active and placebo at the end of the study (week 24). The primary study population will be a modified intention-to-treat population (ClinicalTrials.gov, NCT03419039). Discussion: This study aims to demonstrate whether there are beneficial effects of purified anthocyanins on cognition and relevant biological functions in people at increased risk for dementia. Forthcoming results may contribute to further improvement of intervention strategies to prevent or delay the onset of dementia, including a potential decision to take anthocyanins toward phase III trials.
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Affiliation(s)
- Khadija Khalifa
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Anne Katrine Bergland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hogne Soennesyn
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Ketil Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Ragnhild Oesterhus
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Dalen
- Section of Biostatistics, Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helen Brooker
- Medical School, University of Exeter, Exeter, United Kingdom.,Ecog Pro Ltd., Bristol, United Kingdom
| | - Keith A Wesnes
- Medical School, University of Exeter, Exeter, United Kingdom.,Wesnes Cognition Ltd., Streatley, United Kingdom.,Department of Psychology, Northumbria University, Newcastle, United Kingdom.,Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Clive Ballard
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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3
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Washida K, Hattori Y, Ihara M. Animal Models of Chronic Cerebral Hypoperfusion: From Mouse to Primate. Int J Mol Sci 2019; 20:ijms20246176. [PMID: 31817864 PMCID: PMC6941004 DOI: 10.3390/ijms20246176] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/17/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Vascular cognitive impairment (VCI) or vascular dementia occurs as a result of brain ischemia and represents the second most common type of dementia after Alzheimer’s disease. To explore the underlying mechanisms of VCI, several animal models of chronic cerebral hypoperfusion have been developed in rats, mice, and primates. We established a mouse model of chronic cerebral hypoperfusion by narrowing the bilateral common carotid arteries with microcoils, eventually resulting in hippocampal atrophy. In addition, a mouse model of white matter infarct-related damage with cognitive and motor dysfunction has also been established by asymmetric common carotid artery surgery. Although most experiments studying chronic cerebral hypoperfusion have been performed in rodents because of the ease of handling and greater ethical acceptability, non-human primates appear to represent the best model for the study of VCI, due to their similarities in much larger white matter volume and amyloid β depositions like humans. Therefore, we also recently developed a baboon model of VCI through three-vessel occlusion (both the internal carotid arteries and the left vertebral artery). In this review, several animal models of chronic cerebral hypoperfusion, from mouse to primate, are extensively discussed to aid in better understanding of pathophysiology of VCI.
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Affiliation(s)
- Kazuo Washida
- Correspondence: ; Tel.: +81-6-6170-1070; Fax: +81-6-6170-1782
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4
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Liang Y, Qu LB, Liu H. Non-linear associations between sleep duration and the risks of mild cognitive impairment/dementia and cognitive decline: a dose-response meta-analysis of observational studies. Aging Clin Exp Res 2019; 31:309-320. [PMID: 30039452 DOI: 10.1007/s40520-018-1005-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mount evidence from observational studies suggested that associations between sleep duration and the risks of mild cognitive impairment (MCI)/dementia or cognitive decline had been recognized. METHODS To explore the precise and continuous effect of sleep duration on these risks, we conducted a dose-response meta-analysis to quantitatively assess it. RESULTS Five prospective cohort studies and 4 cross-sectional studies were eligible for inclusion criteria, which involved 62937 individuals, and documented 2718 MCI/dementia cases and 5596 cognitive decline cases. The pooled RR per 1 h increases in sleep duration was 0.99 (95% CI 0.97-1.01, I2 = 62.40%, P = 0.02, n = 6) for cognitive decline risk, and 0.98 (95% CI 0.97-1.00, I2 = 0%, P = 0.42, n = 4) for MCI/dementia risk. Similar U-shaped non-linear relationship of sleep duration and the risks of MCI/dementia and cognitive decline was revealed, respectively (all Pnon-linearity < 0.001), whose peaks are approximately 7 h. CONCLUSION In conclusion, 7 h sleep duration tends to acquire the least risk of MCI/dementia or cognitive decline; however, more well-designed randomized controlled trials are urgently needed to balance potential modifiers.
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Affiliation(s)
- Ying Liang
- School of Pharmacy, Guangdong Food and Drug Vocational College, Guangzhou, 510520, Guangdong, China
| | - Ling-Bo Qu
- Department of Chemistry, Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Hao Liu
- School of Pharmacy, Guangdong Food and Drug Vocational College, Guangzhou, 510520, Guangdong, China.
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Furtado D, Björnmalm M, Ayton S, Bush AI, Kempe K, Caruso F. Overcoming the Blood-Brain Barrier: The Role of Nanomaterials in Treating Neurological Diseases. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:e1801362. [PMID: 30066406 DOI: 10.1002/adma.201801362] [Citation(s) in RCA: 312] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/09/2018] [Indexed: 05/24/2023]
Abstract
Therapies directed toward the central nervous system remain difficult to translate into improved clinical outcomes. This is largely due to the blood-brain barrier (BBB), arguably the most tightly regulated interface in the human body, which routinely excludes most therapeutics. Advances in the engineering of nanomaterials and their application in biomedicine (i.e., nanomedicine) are enabling new strategies that have the potential to help improve our understanding and treatment of neurological diseases. Herein, the various mechanisms by which therapeutics can be delivered to the brain are examined and key challenges facing translation of this research from benchtop to bedside are highlighted. Following a contextual overview of the BBB anatomy and physiology in both healthy and diseased states, relevant therapeutic strategies for bypassing and crossing the BBB are discussed. The focus here is especially on nanomaterial-based drug delivery systems and the potential of these to overcome the biological challenges imposed by the BBB. Finally, disease-targeting strategies and clearance mechanisms are explored. The objective is to provide the diverse range of researchers active in the field (e.g., material scientists, chemists, engineers, neuroscientists, and clinicians) with an easily accessible guide to the key opportunities and challenges currently facing the nanomaterial-mediated treatment of neurological diseases.
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Affiliation(s)
- Denzil Furtado
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, and the Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Mattias Björnmalm
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, and the Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, 3010, Australia
- Department of Materials, Department of Bioengineering, and the Institute of Biomedical Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Scott Ayton
- Melbourne Dementia Research Centre, The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Ashley I Bush
- Melbourne Dementia Research Centre, The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, 3052, Australia
- Cooperative Research Center for Mental Health, Parkville, Victoria, 3052, Australia
| | - Kristian Kempe
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, and Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, 3052, Australia
| | - Frank Caruso
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, and the Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, 3010, Australia
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Lin WC, Hu LY, Tsai SJ, Yang AC, Shen CC. Depression and the risk of vascular dementia: a population-based retrospective cohort study. Int J Geriatr Psychiatry 2017; 32:556-563. [PMID: 27161941 DOI: 10.1002/gps.4493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the association between the risks of depression and vascular dementia (VaD) based on Taiwan's National Health Insurance Research Database. METHODS This retrospective longitudinal matched-cohort study used National Health Insurance Research Database data from 49,955 participants (9,991 with new onset depression, 39,964 controls). A Cox regression analysis was performed on the whole sample and the subgroup of patients with depression. We further excluded patients who developed VaD within 3 or 5 years after enrollment to evaluate depression as an independent risk factor for or a prodrome of VaD. RESULTS During the 10-year follow-up period, the incidence rate ratio of VaD between patients with depression and controls was 4.24 [95% confidence interval (CI) 2.90-6.21, P < 0.001]. After adjustment for covariates, the hazard ratio (HR) of VaD in patients with depression was 3.10 (95% CI 2.13-4.52, P < 0.001). In the whole sample, risk factors for VaD besides depression were aged ≥60 years (HR = 20.08), hypertension (HR = 1.70), diabetes (HR = 1.61), coronary artery disease (HR = 2.26), head injury (HR = 2.20), and cerebrovascular disease (HR = 3.02). In patients with depression, aged ≥60 years (HR = 32.16), coronary artery disease (HR = 2.82), head injury (HR = 2.06), and cerebrovascular disease (HR = 2.37) remained risk factors for VaD. After excluding those who developed VaD within 3 or 5 years, HRs remained high (3.28, 95% CI 2.03-5.31, P < 0.001; 2.12, 95% CI 1.05-4.25, P = 0.035, respectively). CONCLUSIONS Our findings suggest that depression is an independent risk factor for subsequent VaD. Older age, cerebrovascular disease, head injury, and coronary artery disease might increase the risk of VaD among patients with depression.
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Affiliation(s)
- Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Che Shen
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.,Department of Information Management, National Chung-Cheng University, Chiayi, Taiwan
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7
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Bednarska-Makaruk M, Graban A, Sobczyńska-Malefora A, Harrington DJ, Mitchell M, Voong K, Dai L, Łojkowska W, Bochyńska A, Ryglewicz D, Wiśniewska A, Wehr H. Homocysteine metabolism and the associations of global DNA methylation with selected gene polymorphisms and nutritional factors in patients with dementia. Exp Gerontol 2016; 81:83-91. [DOI: 10.1016/j.exger.2016.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 04/27/2016] [Accepted: 05/06/2016] [Indexed: 02/02/2023]
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Ostojic J, Kozic D, Pavlovic A, Semnic M, Todorovic A, Petrovic K, Covickovic-Sternic N. Hippocampal diffusion tensor imaging microstructural changes in vascular dementia. Acta Neurol Belg 2015; 115:557-62. [PMID: 25555903 DOI: 10.1007/s13760-014-0419-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/21/2014] [Indexed: 02/07/2023]
Abstract
To explore microstructural integrity of hippocampus in vascular dementia (VD) using DTI. Twenty-five individuals with VD, without magnetic resonance imaging (MRI) evidence of gray matter pathology, and 25 matched healthy control (HC) individuals underwent a 3T MRI protocol including T2, FLAIR, and PD in the axial plane, 3D whole-brain T1-weighted with an isotropic resolution of 1 mm, and DTI acquired using 64 diffusion sensitizing directions, b value of 1,500 s/mm(2), 65 axial slices, isotropic resolution of 1.8 mm. Images were processed to obtain indices of microstructural variations of bilateral hippocampi. Mean diffusivity (MD) in the hippocampus of patients with VD was significantly increased (p < 0.05) bilaterally with respect to that of the group of HC examinees. In VD group left hippocampal MD (10(-6 )× mm(2)/s) was 833.4 ± 92.8; in HC group left MD was 699.8 ± 56. In VD group, right hippocampal MD was 859.1 ± 69.8; in HC group right MD was 730.4 ± 40.2. No group differences were found in hippocampal FA. DTI shows microstructural hippocampal damage in VD in patients with normal appearing gray matter structures on conventional MRI, indicating the need for further research on the link between VD and AD.
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Affiliation(s)
- Jelena Ostojic
- Center of Radiology, Clinical Center of Vojvodina, School of Medicine, University of Novi Sad, 1-7 Hajduk Veljkova Street, 21000, Novi Sad, Serbia.
| | - Dusko Kozic
- Diagnostic Imaging Center, Institute of Oncology, School of Medicine, University of Novi Sad, 4 Institutski put, 21204, Sremska Kamenica, Serbia.
| | - Aleksandra Pavlovic
- Clinic of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6 Dr. Subotica Street, 11000, Belgrade, Serbia.
| | - Marija Semnic
- Clinic for Neurology, Clinical Center of Vojvodina, School of Medicine, University of Novi Sad, 1-7 Hajduk Veljkova Street, 21000, Novi Sad, Serbia.
| | - Aleksandar Todorovic
- Diagnostic Imaging Center, Institute of Oncology, School of Medicine, University of Novi Sad, 4 Institutski put, 21204, Sremska Kamenica, Serbia.
| | - Kosta Petrovic
- Center of Radiology, Clinical Center of Vojvodina, School of Medicine, University of Novi Sad, 1-7 Hajduk Veljkova Street, 21000, Novi Sad, Serbia.
| | - Nadezda Covickovic-Sternic
- Clinic of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6 Dr. Subotica Street, 11000, Belgrade, Serbia.
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Çalık AN, Özcan KS, Yüksel G, Güngör B, Aruğarslan E, Varlibas F, Ekmekci A, Osmonov D, Tatlısu MA, Karaca M, Bolca O, Erdinler İ. Altered diastolic function and aortic stiffness in Alzheimer's disease. Clin Interv Aging 2014; 9:1115-21. [PMID: 25075180 PMCID: PMC4107181 DOI: 10.2147/cia.s63337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Alzheimer’s disease (AD) is closely linked to cardiovascular risk factors. Methods Echocardiographic studies were performed, including left ventricular diastolic functions, left and right atrial conduction times, and arterial stiffness parameters, namely stiffness index, pressure-strain elastic modulus, and distensibility, on 29 patients with AD and 24 age-matched individuals with normal cognitive function. Results The peak mitral flow velocity of the early rapid filling wave (E) was lower, and the peak velocity of the late filling wave caused by atrial contraction (A), deceleration time of peak E velocity, and isovolumetric relaxation time were higher in the AD group. The early myocardial peak (Ea) velocity was significantly lower in AD patients, whereas the late diastolic (Aa) velocity and E/Ea ratio were similar between the two groups. In Alzheimer patients, stiffness index and pressure-strain elastic modulus were higher, and distensibility was significantly lower in the AD group compared to the control. Interatrial electromechanical delay was significantly longer in the AD group. Conclusion Our findings suggest that patients with AD are more likely to have diastolic dysfunction, higher atrial conduction times, and increased arterial stiffness compared to the controls of same sex and similar age.
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Affiliation(s)
- Ali Nazmi Çalık
- Department of Cardiology, Yozgat State Hospital, Yozgat, Turkey
| | - Kazım Serhan Özcan
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Gülbün Yüksel
- Department of Neurology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Barısş Güngör
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Emre Aruğarslan
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Figen Varlibas
- Department of Neurology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ekmekci
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Damirbek Osmonov
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Mustafa Adem Tatlısu
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Mehmet Karaca
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Osman Bolca
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - İzzet Erdinler
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
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Ramos AR, Dong C, Elkind MSV, Boden-Albala B, Sacco RL, Rundek T, Wright CB. Association between sleep duration and the mini-mental score: the Northern Manhattan study. J Clin Sleep Med 2013; 9:669-73. [PMID: 23853560 DOI: 10.5664/jcsm.2834] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Short and long sleep duration are associated with increased mortality and worse global cognitive function, but is unclear if these relations persist after accounting for the risk of sleep disordered breathing (SDB). The aim of our study is determine the association between short and long sleep duration with worse global cognitive function in a racially/ethnically diverse elderly cohort. METHODS We examined sleep hours and global cognitive function cross-sectionally within the population-based Northern Manhattan Study cohort. We conducted nonparametric and logistic regression to examine associations between continuous, short (< 6 h) and long (≥ 9 h) sleep hours with performance on the Mini Mental State Examination (MMSE). RESULTS There were 927 stroke-free participants with data on self-reported sleep hours and MMSE scores (mean age 75 ± 9 years, 61% women, 68% Hispanics). The median (interquartile range) MMSE was 28 (10-30). Sleep hours (centered at 7 h) was associated with worse MMSE (β = -0.01; SE [0.004], p = 0.0113) adjusting for demographics, vascular risk factors, medications, and risk for SDB. Reporting long sleep (≥ 9 h) compared to 6 to 8 h of sleep (reference) was significantly and inversely associated with MMSE (adjusted β = -0.06; SE [0.03], p = 0.012), while reporting short sleep was not significantly associated with MMSE performance. Long sleep duration was also associated with low MMSE score when dichotomized (adjusted OR: 2.4, 95% CI: 1.1-5.0). CONCLUSION In this cross-sectional analysis among an elderly community cohort, long sleep duration was associated with worse MMSE performance.
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Affiliation(s)
- Alberto R Ramos
- Evelyn F. McKnight Brain Institute, Department of Neurology, Miller School of Medicine University of Miami, Miami, FL 33136, USA
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Abstract
The purpose of this review is to highlight existing literature on the epidemiology, pathophysiology, and novel risk factors for vascular dementia. We further examine the evidence linking chronic brain hypoperfusion induced by a variety of cardiovascular diseases to the development of vascular dementia. In the elderly, in whom cerebral perfusion is diminished by the aging process, additional reduction in cerebral blood flow stemming from exposure to potentially modifiable vascular risk factors increases the probability of developing vascular dementia. Finally, we discuss the association between obstructive sleep apnea, an underrecognized risk factor for stroke, and vascular dementia. Obstructive sleep apnea is linked to cerebrovascular disease through many intermediary vascular risk factors and may directly cause cerebrovascular damage through microvacular disease. Insight into how cardiovascular risk factors induce vascular dementia offers an enhanced understanding of the multifactorial pathophysiology by this disorder and ways of preventing and managing the cerebrovascular precursors of vascular dementia. Many vital questions about the relation of obstructive sleep apnea with stroke and vascular dementia are still unanswered and await future well-designed studies.
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Krol S, Macrez R, Docagne F, Defer G, Laurent S, Rahman M, Hajipour MJ, Kehoe PG, Mahmoudi M. Therapeutic Benefits from Nanoparticles: The Potential Significance of Nanoscience in Diseases with Compromise to the Blood Brain Barrier. Chem Rev 2012; 113:1877-903. [DOI: 10.1021/cr200472g] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Silke Krol
- Fondazione IRCCS Institute of Neurology “Carlo Besta”, Milan, Italy
| | - Richard Macrez
- Inserm U919, University Caen Basse Normandie, Serine Proteases and Pathophysiology of the Neurovascular Unit, GIP CYCERON, F-14074 Caen, France
- Department of Neurology, University Hospital of Caen, Caen, France
| | - Fabian Docagne
- Inserm U919, University Caen Basse Normandie, Serine Proteases and Pathophysiology of the Neurovascular Unit, GIP CYCERON, F-14074 Caen, France
| | - Gilles Defer
- Inserm U919, University Caen Basse Normandie, Serine Proteases and Pathophysiology of the Neurovascular Unit, GIP CYCERON, F-14074 Caen, France
- Department of Neurology, University Hospital of Caen, Caen, France
| | - Sophie Laurent
- Department of General, Organic, and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons, Avenue Maistriau, 19, B-7000 Mons, Belgium
| | - Masoud Rahman
- Laboratory of NanoBio Interactions , Department of Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad J. Hajipour
- Laboratory of NanoBio Interactions , Department of Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Patrick G. Kehoe
- Dementia Research Group, School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, John James Laboratories, Frenchay Hospital, Bristol, U.K
| | - Morteza Mahmoudi
- Laboratory of NanoBio Interactions , Department of Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Current address: School of Chemical Sciences, University of Illinois at Urbana−Champaign, 600 South Mathews Avenue, Urbana, Illinois 61801, United States
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Vascular risk factors in Alzheimer's disease - preliminary report. J Neurol Sci 2012; 322:166-9. [PMID: 22938734 DOI: 10.1016/j.jns.2012.07.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND The vascular risk factors are associated with an increased risk for vascular cognitive decline (VCD), but also with Alzheimer disease (AD). OBJECTIVE To investigate vascular risk factors in relation to AD and VCD, with a non-invasive neurosonological methods in a clinical settings. RESULTS A total of 296 patients with AD and 237 patients with VCD were included in the study. Hypertension, hyperlipidemia, diabetes mellitus, stroke, and white matter changes (p<0.001) were significantly more prevalent in VCD, although they were also present in AD patients. No statistically significant differences were obtained between groups regarding coronary disease, atrial fibrillation, average degree of carotid artery stenosis and carotid intima-media thickness (cITM). However, the patients with AD had carotid artery stenosis ">50%" (p=0.007) and present plaques (p<0.001) more frequently compared to vascular group. The significant associations between robust cognitive measure and vascular factors, diabetes mellitus, carotid stenosis, cITM, and type of plaques were identified only in VCD, but not in AD group. CONCLUSIONS The vascular risk factors were more prevalent in VCD group, although they were also present in AD. With few treatment options available in AD, it may be important not to neglect the vascular risk factors.
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Rektor I, Goldemund D, Bednařík P, Sheardová K, Michálková Z, Telecká S, Dufek M, Rektorová I. Impairment of brain vessels may contribute to mortality in patients with Parkinson's disease. Mov Disord 2012; 27:1169-72. [PMID: 22692677 DOI: 10.1002/mds.25066] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 04/25/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The effect of brain-vessel pathology on mortality in 57 consecutive PD patients was studied. METHODS Baseline clinical, neuropsychological, ultrasonographic (US), and MR data obtained from patients who died (n = 18) during a 4-year follow-up period were compared with the data of patients who survived. RESULTS US/MRI data displayed a more-severe vascular impairment in deceased patients. Differences were significant between both groups with respect to age, clinical and cognitive status, intima-media thickness, and resistance index (indicators of large and small vessel impairment). The sum score of white-matter hyperintensities was significantly higher among decedents. A cluster analysis displayed two clusters that differed in the two parameters (i.e. in age and in sum score). CONCLUSIONS This study provides evidence that comorbid atherosclerosis and otherwise subclinical impairment of brain vessels may contribute to mortality in PD. The vascular pathology may act in association with other comorbidities on the terrain of progressive neurodegenerative pathology.
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Affiliation(s)
- Ivan Rektor
- Central European Institute of Technology, Brno, Czech Republic.
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Hallacoglu B, Sassaroli A, Fantini S, Troen AM. Cerebral perfusion and oxygenation are impaired by folate deficiency in rat: absolute measurements with noninvasive near-infrared spectroscopy. J Cereb Blood Flow Metab 2011; 31:1482-92. [PMID: 21386853 PMCID: PMC3130317 DOI: 10.1038/jcbfm.2011.13] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Brain microvascular pathology is a common finding in Alzheimer's disease and other dementias. However, the extent to which microvascular abnormalities cause or contribute to cognitive impairment is unclear. Noninvasive near-infrared spectroscopy (NIRS) can address this question, but its use for clarifying the role of microvascular dysfunction in dementia has been limited due to theoretical and practical considerations. We developed a new noninvasive NIRS method to obtain quantitative, dynamic measurements of absolute brain hemoglobin concentration and oxygen saturation and used it to show significant cerebrovascular impairments in a rat model of diet-induced vascular cognitive impairment. We fed young rats folate-deficient (FD) and control diets and measured absolute brain hemoglobin and hemodynamic parameters at rest and during transient mild hypoxia and hypercapnia. With respect to control animals, FD rats featured significantly lower brain hemoglobin concentration (72±4 μmol/L versus 95±6 μmol/L) and oxygen saturation (54%±3% versus 65%±2%). By contrast, resting arterial oxygen saturation was the same for both groups (96%±4%), indicating that decrements in brain hemoglobin oxygenation were independent of blood oxygen carrying capacity. Vasomotor reactivity in response to hypercapnia was also impaired in FD rats. Our results implicate microvascular abnormality and diminished oxygen delivery as a mechanism of cognitive impairment.
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Affiliation(s)
- Bertan Hallacoglu
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, USA
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Toward a pathological definition of vascular dementia. J Neurol Sci 2011; 299:136-8. [PMID: 20920816 DOI: 10.1016/j.jns.2010.08.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 08/25/2010] [Indexed: 01/16/2023]
Abstract
To date, there are no widely accepted neuropathological criteria for vascular dementia, although creating such a standard is ranked high on the wish list of all the researchers in this field. Such criteria would make it possible to perform large multicentre clinicopathological studies and, consequently, to better understand which, how, and where vascular brain lesions lead to cognitive decline, as it is possible to do in Alzheimer's disease or Parkinson's disease. However, a major obstacle in the standardization of diagnosis is the fact that vascular brain lesions are a large group comprising heterogeneous changes that have different pathogeneses. Although it is accepted that some kinds of vascular changes cause cognitive impairment, it is not uncommon to find reports of the assumed same histological changes in control subjects. An indispensable first step in the unequivocal establishment of neuropathological criteria is to uniform the definitions used for each one of the lesions, preferably based on its pathogenesis. In the present, non-standardized state of ambiguity, a given lesion is designated by different names between and within the clinical, radiological, and pathological settings, and several definitions simply overlap. Before attempting to create new criteria, a multidisciplinary group-task is urged to identify and minimize the uncontrolled proliferation of definitions. Only then, it will be possible to advance the understanding of how vascular brain changes affect cognition.
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Muresanu DF, Alvarez XA, Moessler H, Novak PH, Stan A, Buzoianu A, Bajenaru O, Popescu BO. Persistence of the effects of Cerebrolysin on cognition and qEEG slowing in vascular dementia patients: Results of a 3-month extension study. J Neurol Sci 2010; 299:179-83. [DOI: 10.1016/j.jns.2010.08.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 08/22/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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Nilsson K, Gustafson L, Hultberg B. The clinical use of N-terminal-pro brain natriuretic peptide in elderly patients with mental illness. Clin Biochem 2010; 43:1282-6. [PMID: 20727348 DOI: 10.1016/j.clinbiochem.2010.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 08/07/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Serum N-terminal-pro brain natriuretic peptide (NT-proBNP) is regarded as a marker of vascular disease and has previously been shown to exhibit an increased frequency of pathological values in elderly patients with mental illness with vascular disease compared to patients without vascular disease. Vascular disease plays an important role in cognitive impairment in elderly patients with mental illness. METHOD We have investigated the relation between NT-proBNP, vascular disease and cognition in consecutively enrolled elderly patients with mental illness. RESULTS NT-proBNP level is increased in patients with vascular disease compared to patients without vascular disease, and a logistic regression analysis showed that NT-proBNP was a significant predictor of vascular disease. However, NT-proBNP level did not predict cognition as assessed by MMSE score. NT-proBNP level also showed a highly significant relation to mortality in all patients. CONCLUSION Determinations of NT-proBNP could be used in elderly patients with mental illness to detect patients in need of control and treatment of vascular risk factors. The levels of NT-proBNP may also provide prognostic information.
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Affiliation(s)
- Karin Nilsson
- Department of Geriatric Psychiatry, Clinical Science, Lund University Hospital, S-22185 Lund, Sweden
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Dietary fat intake in relation to cognitive change in high-risk women with cardiovascular disease or vascular factors. Eur J Clin Nutr 2010; 64:1134-40. [PMID: 20648044 DOI: 10.1038/ejcn.2010.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Dietary fat intake may influence the rate of cognitive change among those at high risk due to vascular disease or risk factors. SUBJECTS/METHODS Women's Antioxidant Cardiovascular Study began in 1995-1996 as a randomized trial of antioxidants and B vitamin supplementation for secondary prevention in women with cardiovascular disease or ≥3 coronary risk factors. From 1998-1999, eligible participants aged ≥65 years were administered a telephone cognitive battery including five tests of general cognition, memory and category fluency (n=2551). Tests were administered four times over 5.4 years. The primary outcome was a global composite score averaging z-scores of all tests. Multivariable generalized linear models for repeated measures were used to evaluate the difference in cognitive decline rates across tertiles of total fat and various types of fat. RESULTS Total fat intake or different types of fat were not related to cognitive decline. However, older age significantly modified the association: among the oldest participants, higher intakes of mono- and polyunsaturated fat were inversely related to cognitive decline (P-interaction: 0.06 and 0.04, respectively), and the rate differences between the highest and lowest tertiles were cognitively equivalent to the rate differences observed with being 4-6 years younger. CONCLUSIONS In women at high risk of cognitive decline due to vascular disease or risk factors, dietary fat intake was not associated with 5-year cognitive change. However, a possible protective relation of unsaturated fats with cognitive decline in the oldest women warrants further study.
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Schmidt KG, Bergert H, Funk RHW. Neurodegenerative diseases of the retina and potential for protection and recovery. Curr Neuropharmacol 2010; 6:164-78. [PMID: 19305795 PMCID: PMC2647152 DOI: 10.2174/157015908784533851] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 10/29/2007] [Accepted: 11/11/2007] [Indexed: 12/27/2022] Open
Abstract
Recent advances in our understanding of the mechanisms in the cascade of events resulting in retinal cell death in ocular pathologies like glaucoma, diabetic retinopathy and age-related macular degeneration led to the common descriptive term of neurodegenerative diseases of the retina. The final common pathophysiologic pathway of these diseases includes a particular form of metabolic stress, resulting in an insufficient supply of nutrients to the respective target structures (optic nerve head, retina). During metabolic stress, glutamate is released initiating the death of neurones containing ionotropic glutamate (N-methyl-D-aspartat, NMDA) receptors present on ganglion cells and a specific type of amacrine cells. Experimental studies demonstrate that several drugs reduce or prevent the death of retinal neurones deficient of nutrients. These agents generally block NMDA receptors to prevent the action of glutamate or halt the subsequent pathophysiologic cycle resulting in cell death. The major causes for cell death following activation of NMDA receptors are the influx of calcium and sodium into cells, the generation of free radicals linked to the formation of advanced glycation endproducts (AGEs) and/or advanced lipoxidation endproducts (ALEs) as well as defects in the mitochondrial respiratory chain. Substances preventing these cytotoxic events are considered to be potentially neuroprotective.
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Affiliation(s)
- K-G Schmidt
- Department of Ophthalmology, Starnberg, Josef-Jägerhuberstr. 7, D-82319 Starnberg, Germany.
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May BH, Lit M, Xue CCL, Yang AWH, Zhang AL, Owens MD, Head R, Cobiac L, Li CG, Hugel H, Story DF. Herbal medicine for dementia: a systematic review. Phytother Res 2009; 23:447-59. [DOI: 10.1002/ptr.2656] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Helzner EP, Luchsinger JA, Scarmeas N, Cosentino S, Brickman AM, Glymour MM, Stern Y. Contribution of vascular risk factors to the progression in Alzheimer disease. ARCHIVES OF NEUROLOGY 2009; 66:343-8. [PMID: 19273753 PMCID: PMC3105324 DOI: 10.1001/archneur.66.3.343] [Citation(s) in RCA: 213] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vascular factors including medical history (heart disease, stroke, diabetes, and hypertension), smoking, and prediagnosis blood lipid measurements (cholesterol: total, high-density lipoprotein, low-density lipoprotein [LDL-C], and triglyceride concentrations) may be predictors for progression of Alzheimer disease (AD). OBJECTIVE To determine whether prediagnosis vascular risk factors are associated with progression of AD. DESIGN Inception cohort followed up longitudinally for a mean of 3.5 (up to 10.2) years. SETTING Washington Heights/Inwood Columbia Aging Project, New York, New York. Patients One hundred fifty-six patients with incident AD (mean age at diagnosis, 83 years). Main Outcome Measure Change in a composite score of cognitive ability from diagnosis onward. RESULTS In generalized estimating equation models (adjusted for age, race/ethnicity, and years of education), higher cholesterol (total cholesterol and LDL-C) concentrations and history of diabetes were associated with faster cognitive decline. Each 10-U increase in cholesterol and LDL-C was associated with a 0.10-SD decrease in cognitive score per year of follow-up (P < .001 for total cholesterol; P = .001 for LDL-C). High-density lipoprotein cholesterol and triglyceride concentrations were not associated with rate of decline. A history of diabetes was associated with an additional 0.05-SD decrease in cognitive score per year (P = .05). History of heart disease and stroke were associated with cognitive decline only in carriers of the apolipoprotein E epsilon4 (APOE-epsilon4) gene. In a final generalized estimating equation model that included high-density lipoprotein cholesterol and LDL-C concentrations and history of diabetes, only higher LDL-C was independently associated with faster cognitive decline. CONCLUSION Higher prediagnosis total cholesterol and LDL-C concentrations and history of diabetes were associated with faster cognitive decline in patients with incident AD, which provides further evidence for the role of vascular risk factors in the course of AD.
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Affiliation(s)
- Elizabeth P. Helzner
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
| | - José A. Luchsinger
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
- Department of Neurology, Columbia University Medical Center, New York, N.Y
| | - Nikolaos Scarmeas
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
- Department of Neurology, Columbia University Medical Center, New York, N.Y
| | - Stephanie Cosentino
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
| | - Adam M. Brickman
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
| | - M. Maria Glymour
- Department of Epidemiology, Mailman School of Public Health at Columbia University
| | - Yaakov Stern
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
- Department of Neurology, Columbia University Medical Center, New York, N.Y
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The role of the −427T/C apolipoprotein E promoter polymorphism in the pathogenesis of Alzheimer’s disease, vascular dementia and mixed dementia. J Neural Transm (Vienna) 2009; 116:339-44. [DOI: 10.1007/s00702-008-0178-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 12/17/2008] [Indexed: 11/26/2022]
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Rektor I, Goldemund D, Sheardová K, Rektorová I, Michálková Z, Dufek M. Vascular pathology in patients with idiopathic Parkinson's disease. Parkinsonism Relat Disord 2009; 15:24-9. [DOI: 10.1016/j.parkreldis.2008.02.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 01/30/2008] [Accepted: 02/12/2008] [Indexed: 11/25/2022]
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Irie F, Masaki KH, Petrovitch H, Abbott RD, Ross GW, Taaffe DR, Launer LJ, White LR. Apolipoprotein E epsilon4 allele genotype and the effect of depressive symptoms on the risk of dementia in men: the Honolulu-Asia Aging Study. ACTA ACUST UNITED AC 2008; 65:906-12. [PMID: 18678795 DOI: 10.1001/archpsyc.65.8.906] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The apolipoprotein E epsilon4 (APOE epsilon4) allele is a genetic risk factor for Alzheimer disease. Recently, depression has also become recognized as a risk factor for dementia. However, the possible effect of the APOE genotype on the association between depression and dementia is unexamined. OBJECTIVE To examine the independent and combined effects of depression and APOE epsilon4 on the risk of dementia and its subtypes. DESIGN The Honolulu-Asia Aging Study, a population-based prospective cohort study of Japanese American men. SETTINGS AND PARTICIPANTS Depressive symptoms and presence of the APOE epsilon4 allele were assessed between March 1991 and October 1993 in 1932 cognitively healthy men aged 71 to 90 years. Incident cases of dementia were diagnosed during approximately 6 years of follow-up based on neurologic assessment at 2 repeated examinations (April 1994-April 1996 and October 1997-February 1999). MAIN OUTCOME MEASURES Overall dementia, Alzheimer disease, and vascular dementia. RESULTS The interaction of depression and APOE epsilon4 was statistically significant in the analytical models. Compared with men with neither APOE epsilon4 nor depression, the risk of dementia in nondepressed men with APOE epsilon4 was not significant (hazard ratio, 1.1; 95% confidence interval [CI], 0.6-1.8); however, depressed men without APOE epsilon4 had a 1.6-fold greater risk (95% CI, 0.8-3.0), whereas depressed men with APOE epsilon4 had a 7.1-fold greater risk (95% CI, 3.0-16.7) of dementia. For subtypes, we found similar increased risks of Alzheimer disease. CONCLUSIONS The APOE epsilon4 status modifies the association between depressive symptoms and dementia in elderly men. Because individuals with depressive symptoms and the APOE epsilon4 allele had a markedly increased risk of dementia, one might be especially watchful for early signs of dementia in the older person with depression who is also positive for the APOE epsilon4 allele. Because this cohort includes only men, further investigation in women is required.
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Affiliation(s)
- Fumiko Irie
- Pacific Health Research Institute, Honolulu, Hawaii, USA.
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Mills S, Cain J, Purandare N, Jackson A. Biomarkers of cerebrovascular disease in dementia. Br J Radiol 2008; 80 Spec No 2:S128-45. [PMID: 18445743 DOI: 10.1259/bjr/79217686] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There is increasing recognition that cerebrovascular disease contributes significantly to the development and progression of patients with dementia. The concepts of pure vascular and pure degenerative dementia have been replaced with a recognition that, in many patients, there is a spectrum of neurodegenerative and vascular processes. This is supported by preliminary studies showing response to vascular therapeutics and ventriculo-peritoneal shunting in patients with Alzheimer's disease. This article examines the imaging biomarkers that are available for the characterization of microvascular abnormality in the ageing brain, with particular reference to microvascular angiopathy, cerebral embolic disease, orthostatic hypotension and abnormalities of Monro-Kellie homeostasis.
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Affiliation(s)
- S Mills
- Division of Imaging Science, University of Manchester, Wolfson Molecular Imaging Centre, 27 Palatine Rd, Withington, Manchester, UK
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A pilot study to evaluate the effects of Cerebrolysin on cognition and qEEG in vascular dementia: Cognitive improvement correlates with qEEG acceleration. J Neurol Sci 2008; 267:112-9. [DOI: 10.1016/j.jns.2007.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 09/26/2007] [Accepted: 10/04/2007] [Indexed: 11/24/2022]
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Auriacombe S, Amarenco P, Baron JC, Ceccaldi M, Dartigues JF, Lehéricy S, Hénon H, Hinaut P, Orgogozo JM. Mise au point sur les démences vasculaires. Rev Neurol (Paris) 2008; 164:22-41. [DOI: 10.1016/j.neurol.2007.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 05/10/2007] [Accepted: 06/20/2007] [Indexed: 11/26/2022]
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Sheridan PL, Hausdorff JM. The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer's disease. Dement Geriatr Cogn Disord 2007; 24:125-37. [PMID: 17622760 PMCID: PMC3163262 DOI: 10.1159/000105126] [Citation(s) in RCA: 211] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2005] [Indexed: 11/19/2022] Open
Abstract
Alzheimer's disease (AD) is generally understood as primarily affecting cognition while sparing motor function, at least until the later stages of the disease. Studies reported over the past 10 years, however, have documented a prevalence of falls in AD patients significantly higher than in age-matched normal elders; also persons with AD have been observed to have different walking patterns with characteristics that increase gait instability. Recent work in cognitive neuroscience has begun to demonstrate the necessity of intact cognition, particularly executive function, for competent motor control. We put the pieces of this puzzle together and review the current state of knowledge about gait and cognition in general along with an exploration of the association between dementia, gait impairment and falls in AD. We also briefly examine the current treatment of gait instability in AD, mainly exercise, and propose a new approach targeting cognition.
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Affiliation(s)
- Pamela L Sheridan
- Behavioral Neurology Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Reitz C, Patel B, Tang MX, Manly J, Mayeux R, Luchsinger JA. Relation between vascular risk factors and neuropsychological test performance among elderly persons with Alzheimer's disease. J Neurol Sci 2007; 257:194-201. [PMID: 17328914 PMCID: PMC2725022 DOI: 10.1016/j.jns.2007.01.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vascular risk factors increase the risk of Alzheimer's disease (AD). The mechanisms for these associations are unclear, and may be due to misdiagnosis of a vascular dementia syndrome as AD. OBJECTIVE To examine differences in neuropsychological profile among persons diagnosed clinically with AD with and without vascular risk factors or stroke. METHODS Community based cohort study. Individual and composite scores of neuropsychological tests at the time of clinical diagnosis of incident AD were compared among 243 persons with and without vascular risk factors or stroke. RESULTS Among subjects with incident AD, diabetes was associated with lower performance in Delayed Recall of the Selective Reminding Test (SRT), while persons diagnosed with hypertension scored lower in consistent long term recall (CLTR) of the SRT and current smokers scored lower in Category Fluency. None of the risk factors was associated with differences in composite scores in memory, abstract/visuospatial or language domain, nor was the number of risk factors per person. Persons with stroke had a higher delayed recall score at the time of AD diagnosis. CONCLUSION The presence of vascular risk factors among persons with clinically diagnosed AD was associated with subtle differences in neuropsychological profile at the time of diagnosis. This study needs to be replicated in samples with brain imaging, a comprehensive executive abilities battery, and pathological diagnosis of AD.
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Affiliation(s)
- Christiane Reitz
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Bindu Patel
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ming-Xix Tang
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Department of Biostatistics in the Mailman School of Public Health Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jennifer Manly
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Richard Mayeux
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jose A. Luchsinger
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
- The Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Corresponding author. Department of Medicine, 630 West 168th Street, Columbia University, New York, NY 10032, USA. Tel.: +1 212 305 4730; fax: +1 212 305 9349. E-mail address: (J.A. Luchsinger)
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White L, Small BJ, Petrovitch H, Ross GW, Masaki K, Abbott RD, Hardman J, Davis D, Nelson J, Markesbery W. Recent clinical-pathologic research on the causes of dementia in late life: update from the Honolulu-Asia Aging Study. J Geriatr Psychiatry Neurol 2005; 18:224-7. [PMID: 16306244 DOI: 10.1177/0891988705281872] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we compare neuropathological findings at autopsy with clinical dementia diagnoses, such as Alzheimer's disease and vascular dementia. Participants consisted of 363 aged Japanese-American men from the Honolulu-Asia Aging Study. Results indicated that the correspondence between clinical and neuropathologic diagnosis was not great, with 56% of patients diagnosed with probable or possible Alzheimer's disease during life but with only 19% having neuritic plaques and/or neurofibrillary tangles as the sole or dominant dementia-related lesions in the brain at autopsy. Although 16% of cases were attributed to mixed causes during life, almost 40% were found to have significant mixtures of dementia-related lesions at autopsy. Finally, both Alzheimer's disease and non-Alzheimer's disease neuropathologic lesions contributed independently to the explanation of variance on a test of overall cognitive performance. The results suggest that clinical diagnosis of dementia made during life may fail to reflect the pathogenic complexity of this condition in very elderly persons.
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Affiliation(s)
- Lon White
- Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, USA.
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