1
|
Cheng S, Yin R, Wu K, Wang Q, Zhang H, Ling L, Chen W, Shi L. Trajectories and influencing factors of cognitive function and physical disability in Chinese older people. Front Public Health 2024; 12:1380657. [PMID: 39026589 PMCID: PMC11256785 DOI: 10.3389/fpubh.2024.1380657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Dementia and physical disability are serious problems faced by the aging population, and their occurrence and development interact. Methods Based on data from a national cohort of Chinese people aged 60 years and above from the China Health and Retirement Longitudinal Survey from 2011 to 2018, we applied the group-based trajectory model to identify the heterogeneous trajectories of cognitive function and physical disability in participants with different physical disability levels. Next, multinomial logistic regression models were used to explore the factors affecting these trajectories. Results The cognitive function trajectories of the Chinese older people could be divided into three characteristic groups: those who maintained the highest baseline level of cognitive function, those with a moderate baseline cognitive function and dramatic progression, and those with the worst baseline cognitive function and rapid-slow-rapid progression. The disability trajectories also fell into three characteristic groups: a consistently low baseline disability level, a low initial disability level with rapid development, and a high baseline disability level with rapid development. Compared with those free of physical disability at baseline, a greater proportion of participants who had physical disability at baseline experienced rapid cognitive deterioration. Education, income, type of medical insurance, gender, and marital status were instrumental in the progression of disability and cognitive decline in the participants. Discussion We suggest that the Chinese government, focusing on the central and western regions and rural areas, should develop education for the older people and increase their level of economic security to slow the rate of cognitive decline and disability among this age group. These could become important measures to cope with population aging.
Collapse
Affiliation(s)
- Shuyuan Cheng
- International Cooperation and Exchange Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Health Policy and Management Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Rong Yin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kunpeng Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
2
|
Alzola P, Carnero C, Bermejo-Pareja F, Sánchez-Benavides G, Peña-Casanova J, Puertas-Martín V, Fernández-Calvo B, Contador I. Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights. J Clin Med 2024; 13:3442. [PMID: 38929971 PMCID: PMC11204334 DOI: 10.3390/jcm13123442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.
Collapse
Affiliation(s)
- Patricia Alzola
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
| | - Cristóbal Carnero
- Neurology Department, Granada University Hospital Complex, 18014 Granada, Spain
| | - Félix Bermejo-Pareja
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | | | | | | | | | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
| |
Collapse
|
3
|
Park I, Lee SK, Choi HC, Ahn ME, Ryu OH, Jang D, Lee U, Kim YJ. Machine Learning Model for Mild Cognitive Impairment Stage Based on Gait and MRI Images. Brain Sci 2024; 14:480. [PMID: 38790458 PMCID: PMC11119859 DOI: 10.3390/brainsci14050480] [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: 04/13/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
In patients with mild cognitive impairment (MCI), a lower level of cognitive function is associated with a higher likelihood of progression to dementia. In addition, gait disturbances and structural changes on brain MRI scans reflect cognitive levels. Therefore, we aimed to classify MCI based on cognitive level using gait parameters and brain MRI data. Eighty patients diagnosed with MCI from three dementia centres in Gangwon-do, Korea, were recruited for this study. We defined MCI as a Clinical Dementia Rating global score of ≥0.5, with a memory domain score of ≥0.5. Patients were classified as early-stage or late-stage MCI based on their mini-mental status examination (MMSE) z-scores. We trained a machine learning model using gait and MRI data parameters. The convolutional neural network (CNN) resulted in the best classifier performance in separating late-stage MCI from early-stage MCI; its performance was maximised when feature patterns that included multimodal features (GAIT + white matter dataset) were used. The single support time was the strongest predictor. Machine learning that incorporated gait and white matter parameters achieved the highest accuracy in distinguishing between late-stage MCI and early-stage MCI.
Collapse
Affiliation(s)
- Ingyu Park
- Department of Electronic Engineering, Hallym University, Chuncheon 24252, Republic of Korea; (I.P.); (D.J.)
| | - Sang-Kyu Lee
- Department of Psychiatry, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Hui-Chul Choi
- Department of Neurology, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Moo-Eob Ahn
- Department of Emergency Medicine, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Ohk-Hyun Ryu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University-Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Daehun Jang
- Department of Electronic Engineering, Hallym University, Chuncheon 24252, Republic of Korea; (I.P.); (D.J.)
| | - Unjoo Lee
- Division of Software, School of Information Science, Hallym University, Chuncheon 24252, Republic of Korea
| | - Yeo Jin Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea
| |
Collapse
|
4
|
Yang H, Mao J, Ye Q, Bucholc M, Liu S, Gao W, Pan J, Xin J, Ding X. Distance-based novelty detection model for identifying individuals at risk of developing Alzheimer's disease. Front Aging Neurosci 2024; 16:1285905. [PMID: 38685909 PMCID: PMC11057441 DOI: 10.3389/fnagi.2024.1285905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Novelty detection (ND, also known as one-class classification) is a machine learning technique used to identify patterns that are typical of the majority class and can discriminate deviations as novelties. In the context of Alzheimer's disease (AD), ND could be employed to detect abnormal or atypical behavior that may indicate early signs of cognitive decline or the presence of the disease. To date, few research studies have used ND to discriminate the risk of developing AD and mild cognitive impairment (MCI) from healthy controls (HC). Methods In this work, two distinct cohorts with highly heterogeneous data, derived from the Australian Imaging Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing project and the Fujian Medical University Union Hospital (FMUUH) China, were employed. An innovative framework with built-in easily interpretable ND models constructed solely on HC data was introduced along with proposing a strategy of distance to boundary (DtB) to detect MCI and AD. Subsequently, a web-based graphical user interface (GUI) that incorporates the proposed framework was developed for non-technical stakeholders. Results Our experimental results indicate that the best overall performance of detecting AD individuals in AIBL and FMUUH datasets was obtained by using the Mixture of Gaussian-based ND algorithm applied to single modality, with an AUC of 0.8757 and 0.9443, a sensitivity of 96.79% and 89.09%, and a specificity of 89.63% and 90.92%, respectively. Discussion The GUI offers an interactive platform to aid stakeholders in making diagnoses of MCI and AD, enabling streamlined decision-making processes. More importantly, the proposed DtB strategy could visually and quantitatively identify individuals at risk of developing AD.
Collapse
Affiliation(s)
- Hongqin Yang
- Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, China
| | - Jiangbing Mao
- Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Magda Bucholc
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry-Londonderry, Derry, United Kingdom
| | - Shuo Liu
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry-Londonderry, Derry, United Kingdom
| | - Wenzhao Gao
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry-Londonderry, Derry, United Kingdom
| | - Jie Pan
- Xiamen Jingyi Zhikang Technology Co., Ltd., Xiamen, China
| | - Jiawei Xin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuemei Ding
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry-Londonderry, Derry, United Kingdom
- Fujian Provincial Engineering Research Centre for Public Service Big Data Mining and Application, Fujian Provincial University Engineering Research Centre for Big Data Analysis and Application, Fujian Normal University, Fuzhou, China
| |
Collapse
|
5
|
Wang T, Zhang W, Maclin JMA, Xu H, Hong B, Yan F, Liu Y, He H, Liang H, Li C, Fang Y, Xiao S. Novel Panel of Long Noncoding RNAs as Diagnostic Biomarkers for Amnestic Mild Cognitive Impairment in Peripheral Blood. J Alzheimers Dis 2024; 99:1385-1396. [PMID: 38788072 DOI: 10.3233/jad-231446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Long noncoding RNAs (lncRNAs) regulate the pathogenesis of Alzheimer's disease (AD). Objective To identify lncRNAs in the peripheral blood as potential diagnostic biomarkers for amnestic mild cognitive impairment. Methods In the discovery group, a microarray was used to screen for significant differences in lncRNA expression between patients with mild cognitive impairment (MCI) caused by AD and normal controls (NCs) (n = 10; MCI, 5; NC, 5). Furthermore, two analytic groups were assessed (analytic group 1: n = 10; amnestic MCI (aMCI), 5; NC, 5; analytic group 2: n = 30; AD, 10; aMCI, 10; NC, 10) and finalized in the validation group (n = 150; AD, 50; aMCI, 50; NC, 50). In the analytic and validation groups, real-time quantitative reverse-transcription polymerase chain reaction was used to identify differentially expressed lncRNAs between the aMCI and NC groups. Results We identified 67 upregulated and 220 downregulated lncRNAs among the expression profiles. The panel with lncRNAs T324988, NR_024049, ENST00000567919, and ENST00000549762 displayed the highest discrimination ability between patients with aMCI and NCs. The area under the receiver operating characteristic curve of this combined model was 0.941, with a sensitivity of 92.00% and specificity of 84.00%. Conclusions This study reports on a panel of four lncRNAs as promising biomarkers to diagnose aMCIs.
Collapse
Affiliation(s)
- Tao Wang
- Department of Neurology, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi, China
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Joshua M A Maclin
- Biological Sciences Department, Laboratory for Tissue Engineering and Morphogenesis, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Hua Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Yan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanyuan Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Haining He
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Huafeng Liang
- Department of Neurology, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi, China
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Department of Psychiatry and Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shifu Xiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
6
|
Du Y, Zhang Y, Diao J, Fu P, Jiang R, Wang P, Yang H, Zheng X, Zhang L, Bi J, Zhou Q. Decoding the diagnostic potential of T cell repertoires in peripheral blood of patients from amnestic mild cognitive impairment to Alzheimer's disease. FASEB J 2024; 38:e23317. [PMID: 38095240 DOI: 10.1096/fj.202301485r] [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: 07/20/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
Alzheimer's disease (AD) is currently an incurable neurodegenerative disorder and is the most common etiological cause of dementia. Consequently, it has severe burden on its patients and on their caregivers and represents a global health concern. Clinical investigations have indicated that a dysregulation of peripheral T cell immune homeostasis may be involved in the pathogenesis of AD, as well as in the early stages of AD, characterized by mild cognitive impairment (MCI). However, the characteristics and concomitant feasibility of the use of T-cell receptor (TCR) typing for disease diagnosis remains largely unknown. We employed a high-throughput sequencing and multidimensional bioinformatics analyses for the identification of TCR repertoires present in peripheral blood samples of 10 patients with amnestic MCI (aMCI), 10 patients with AD, and 10 healthy controls (HCs). Based on the characteristics of the TCR repertoires in the amount and diversity of combinations of V-J, the spectrum of immune defense, and differentially expressed genes (DEGs), single and specific TCR profiles were observed in the patient samples of aMCI and AD compared to profiles of HCs. In particular, the diversity of TCR clonotypes manifested a pattern of "decreased first and then increased" pattern during the progression from aMCI to AD, a pattern that was not observed in HC samples. Additionally, a total of 46 and 35 amino acid CDR3 sequences with consistent and reverse expressive abundance with diversity of TCR clonotypes were identified, respectively. Taken together, we provide novel and essential preliminary evidence demonstrating the presence of diversity of T cell repertoires from differentially expressed V-J gene segments and amino acid clonotypes using peripheral blood samples from patients with AD, aMCI, and from HC. Such findings have the potential to reveal potential mechanisms through which aMCI progresses to AD and provide a reference for the future development of immune-related diagnoses and therapies for AD.
Collapse
Affiliation(s)
- Yansheng Du
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yichen Zhang
- Department of Critical Care Medicine, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jiuzhou Diao
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Pengrui Fu
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Runze Jiang
- Department of Translational Medicine Research Institute, Shandong Jingwei Biotechnology Co. Ltd, Jinan, China
| | - Ping Wang
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Yang
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaolei Zheng
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Leisheng Zhang
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province & NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou, China
- Key Laboratory of Radiation Technology and Biophysics, Hefei Institute of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Jianzhong Bi
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingbo Zhou
- Department of Neurology Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
7
|
Gaur A, Rivet L, Mah E, Bawa KK, Gallagher D, Herrmann N, Lanctôt KL. Novel fluid biomarkers for mild cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2023; 91:102046. [PMID: 37647995 DOI: 10.1016/j.arr.2023.102046] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/01/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
Mild cognitive impairment (MCI) is a well-established prodromal stage of dementia (e.g., Alzheimer's disease) that is often accompanied by early signs of neurodegeneration. To facilitate a better characterization of the underlying pathophysiology, we assessed the available literature to evaluate potential fluid biomarkers in MCI. Peer-reviewed articles that measured cerebrospinal fluid (CSF) and/or peripheral biomarkers of neuronal injury (total-tau [T-tau], neurofilament light chain [NfL], heart-type fatty acid binding protein [HFABP], neuron-specific enolase, ubiquitin C-terminal hydrolase L1) and/or astroglial pathology (glial fibrillary acidic protein [GFAP], S100 calcium-binding protein B) in MCI and healthy controls were assessed. Group differences were summarized by standardized mean differences (SMDs) and 95% confidence intervals calculated using a random-effects model. Heterogeneity was quantified using I2. A total of 107 studies were included in the meta-analysis and 10 studies were qualitatively reviewed. In CSF, concentrations of NfL (SMD = 0.69 [0.56, 0.83]), GFAP (SMD = 0.41 [0.07, 0.75]), and HFABP (SMD = 0.57 [0.26, 0.89]) were elevated in MCI. In blood, increased concentrations of T-tau (SMD = 0.19 [0.09, 0.29]), NfL (SMD = 0.41 [0.32, 0.49]), and GFAP (SMD = 0.39 [0.23, 0.55]) were found in MCI. Heterogeneity that was identified in all comparisons was explored using meta-regression and subgroup analysis. Elevated NfL and GFAP can be detected in both CSF and peripheral blood. Monitoring these biomarkers in clinical settings may provide important insight into underlying neurodegenerative processes in MCI.
Collapse
Affiliation(s)
- Amish Gaur
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Luc Rivet
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Ethan Mah
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Kritleen K Bawa
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Damien Gallagher
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada.
| |
Collapse
|
8
|
Wallensten J, Ljunggren G, Nager A, Wachtler C, Bogdanovic N, Petrovic P, Carlsson AC. Stress, depression, and risk of dementia - a cohort study in the total population between 18 and 65 years old in Region Stockholm. Alzheimers Res Ther 2023; 15:161. [PMID: 37779209 PMCID: PMC10544453 DOI: 10.1186/s13195-023-01308-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Chronic stress and depression are potential risk factors for mild cognitive impairment and dementia, including Alzheimer disease. The aim was to investigate whether any such risk is additive. METHODS Cohort study including 1 362 548 people (665 997 women, 696 551 men) with records in the Region Stockholm administrative healthcare database (VAL). Exposure was a recorded ICD-10 diagnosis of chronic stress, depression, or both, recorded in 2012 or 2013. Outcome was a diagnosis of Alzheimer disease, other dementia, or mild cognitive impairment recorded from 2014 through 2022. Odds ratios with 99% confidence intervals (CI) adjusted for age, sex, neighborhood socioeconomic status, diabetes, and cardiovascular disorders were calculated. RESULTS During the exposure period, 4 346 patients were diagnosed with chronic stress, 40 101 with depression, and 1 898 with both. The average age at baseline was around 40 years in all groups. In the fully adjusted model, the odds ratio of Alzheimer disease was 2.45 (99% CI 1.22-4.91) in patients with chronic stress, 2.32 (99% CI 1.85-2.90) in patients with depression, and 4.00 (99% CI 1.67-9.58) in patients with chronic stress and depression. The odds ratio of mild cognitive impairment was 1.87 (99% CI 1.20-2.91) in patients with chronic stress, 2.85 (99% CI 2.53-3.22) in patients with depression, and 3.87 (99% CI 2.39-6.27) in patients with both. When other dementia was analyzed, the odds ratio was significant only in patients with depression, 2.39 (99% CI 1.92-2.96). CONCLUSIONS Documented chronic stress increased the risk of mild cognitive impairment and Alzheimer disease. The same was seen with depression. The novel finding is the potential additive effect of chronic stress to depression, on risk of MCI and AD.
Collapse
Affiliation(s)
- Johanna Wallensten
- Department of Clinical Sciences, Danderyd Hospital, 18288, Stockholm, Sweden.
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden.
| | - Gunnar Ljunggren
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Anna Nager
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Caroline Wachtler
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Nenad Bogdanovic
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Predrag Petrovic
- Center for Cognitive Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Cognitive and Computational Neurosceince (CCNP), Karolinska Institutet, Stockholm, Sweden
| | - Axel C Carlsson
- Academic Primary Health Care Centre, Solnavägen 1E, 104 31, Stockholm, Sweden
- Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177, Stockholm, Sweden
| |
Collapse
|
9
|
Neal DP, Ettema TP, Zwan MD, Dijkstra K, Finnema E, Graff M, Muller M, Dröes RM. FindMyApps compared with usual tablet use to promote social health of community-dwelling people with mild dementia and their informal caregivers: a randomised controlled trial. EClinicalMedicine 2023; 63:102169. [PMID: 37680943 PMCID: PMC10480525 DOI: 10.1016/j.eclinm.2023.102169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Background FindMyApps is a tablet-based eHealth intervention designed to help people learn to use a tablet and find easy-to-use apps. This study evaluated the effectiveness of FindMyApps for supporting social health of people living with dementia, and sense of competence of their informal caregivers. Methods A single-centre, two-arm, non-blinded randomised controlled trial was conducted (Netherlands Trial Register NL8157). From 1st January 2020 to 31st July 2022, community-dwelling people in the Netherlands with a pre-established diagnosis of mild cognitive impairment (MCI) or dementia (Brief Cognitive Rating Scale 17-32), an informal caregiver and internet connection were allocated by block randomisation to receive FindMyApps or digital care-as-usual. Primary outcomes (measured at baseline and after three months) for people with dementia/MCI were self-management (Adult Social Care Outcomes Toolkit total score) and social participation (Maastricht Social Participation Profile frequency and diversity scores), and for caregivers, sense of competence (Short Sense of Competence Questionnaire total score). Between-group differences were tested by MANCOVA or ANCOVA (alpha = 0.05). Findings 150 dyads were randomised (FindMyApps n = 76, care-as-usual n = 74). Follow-up data were available for 128 dyads (FindMyApps n = 64, care-as-usual n = 64), who were included in the analysis in the trial arm to which they were assigned. No harms of the intervention were identified. There were no statistically significant differences in outcomes for people with dementia/MCI at group level. Diagnosis and experiencing apathy appeared to be relevant effect modifiers of secondary outcomes (neuropsychiatric symptoms, positive affect, sense of belonging, and pleasurable activities). Caregivers who received FindMyApps had higher sense of competence at three months (F [1,123] = 7.01, p = 0.0092, η2 = 0.054). Interpretation Overall we found no evidence that the FindMyApps intervention better supported social participation or self-management of people with MCI/dementia than digital care-as-usual. FindMyApps does seem to better support informal caregivers' sense of competence. For people with a diagnosis of mild dementia and older people, better tailored interventions, implementation and outcome measures may be needed. Funding Marie Skłodowska Curie Actions Innovative Training Network H2020 MSCA ITN, grant agreement number 813196.
Collapse
Affiliation(s)
- David P. Neal
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, the Netherlands
| | - Teake P. Ettema
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, the Netherlands
| | - Marissa D. Zwan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, 1081 HZ, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
| | - Karin Dijkstra
- Saxion University of Applied Sciences, School of Health, Research Group Smart Health, Handelskade 75, 7417 DH, Deventer, the Netherlands
| | - Evelyn Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, P.O. Box 1080, 8900 CB, Leeuwarden, the Netherlands
- Department of Health Science, Section of Nursing Research & Education, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maud Graff
- Radboud University Medical Center, Radboudumc Research Institute, Scientific Center for Quality of Healthcare (IQ Healthcare), 6525 GA, Nijmegen, the Netherlands
- Radboud Alzheimer Center, Radboud University Medical Center, 6525 GA, Nijmegen, the Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics Section, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Sari YM, Hill KD, Lee DCA, Burton E. Effectiveness of exercise programmes in improving physical function and reducing behavioural symptoms of community living older adults with dementia living in Asia, and impact on their informal carers: A systematic review and meta-analysis. Hong Kong Physiother J 2023; 43:3-17. [PMID: 37584051 PMCID: PMC10423677 DOI: 10.1142/s101370252350004x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 08/17/2023] Open
Abstract
Background There is a growing evidence on the benefits of exercise for older people living with dementia in developed countries. However, cultural, health-care systems and environmental differences may impact on the uptake of exercise and outcomes in different regions of the world. Objective This study synthesised the available evidence examining the effectiveness of exercise interventions on improving physical function and reducing behavioural symptoms in community-dwelling older people living with dementia in Asia, and the impact on their informal carers. Methods Six databases were searched to November 2021. Randomised controlled trials (RCTs) or quasi-experimental studies evaluating exercise interventions for community-dwelling older people with dementia living in Asia were included. The Cochrane risk-of-bias tool for randomised trials and Downs and Black checklist had been used to assess methodological quality of the studies. Meta-analyses using a fixed effects model assessed the effects of exercise interventions where sufficient data were available. Mean difference (MD) with 95% confidence interval (CI) was used to pool results. Results Nine studies (five RCTs) were included (Hong Kong-4, China-1, South Korea-2, Taiwan-1, Indonesia-1). Exercise improved dynamic balance [Functional Reach (2 studies, n = 111 people with dementia), MD = 2 . 61 , 95% CI (1.55, 3.67)], but not for the Berg Balance Scale (MD = 1 . 10 , 95% CI [-2.88, 5.07]), Timed Up and Go (MD =- 3 . 47 , 95% CI [-7.27, 0.33]) and 5 times sit to stand tests (MD =- 1 . 86 , 95% CI [-5.27, 1.54]). Single studies where data could not be pooled showed no effect of exercise on behavioural symptoms or impact on informal carers. Conclusion Exercise appeared to have a beneficial effect on improving balance performance among older people with dementia living in Asia, however, this evidence is limited and inconsistent, and should be interpreted with caution. Further high-quality large RCTs are necessary for advancing the evidence base of exercise interventions for this population.
Collapse
Affiliation(s)
- Yulisna Mutia Sari
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Den-Ching A Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
- School of Primary and Allied Health Care Monash University, Melbourne, Victoria, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University Perth, Western Australia, Australia
- enAble Institute, Curtin University Perth, Western Australia, Australia
| |
Collapse
|
11
|
Rennie A, Ekman U, Wallert J, Muehlboeck JS, Eriksdotter M, Wahlund LO, Ferreira D, Westman E. Comparing three neuropsychological subgrouping approaches in subjective and mild cognitive impairment from a naturalistic multicenter study. Neurobiol Aging 2023; 129:41-49. [PMID: 37269645 DOI: 10.1016/j.neurobiolaging.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 06/05/2023]
Abstract
Subjective cognitive impairment (SCI) and mild cognitive impairment (MCI) are two clinical groups with an increased risk to develop dementia, but they are highly heterogeneous. This study compared three different approaches to subgroup SCI and MCI patients and investigated their capacity to disentangle cognitive and biomarker heterogeneity. We included 792 patients from the MemClin-cohort (142 SCI and 650 MCI). Biomarkers included cerebrospinal fluid measures of beta-amyloid-42 and phosphorylated tau, as well as visual ratings of medial temporal lobe atrophy and white matter hyperintensities on magnetic resonance imaging. We found that a more inclusive approach identified individuals with a positive beta-amyloid-42 biomarker; a less inclusive approach captured individuals with higher medial temporal lobe atrophy; and a data-driven approach captured individuals with high white matter hyperintensities burden. The three approaches also captured some neuropsychological differences. We conclude that choice of approach may differ depending on the purpose. This study helps to advance our current understanding of the clinical and biological heterogeneity within SCI and MCI, particularly in the unselected memory clinic setting.
Collapse
Affiliation(s)
- Anna Rennie
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Urban Ekman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Medical Unit, Medical Psychology, Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Stockholm, Sweden
| | - John Wallert
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - J-Sebastian Muehlboeck
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience: King's College London, London, UK.
| |
Collapse
|
12
|
Akkoyun M, Koçoğlu K, Eraslan Boz H, Keskinoğlu P, Akdal G. Saccadic Eye Movements in Patients with Mild Cognitive Impairment: A Longitudinal Study. J Mot Behav 2023; 55:354-372. [PMID: 37080551 DOI: 10.1080/00222895.2023.2202620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/28/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Saccadic eye movements are one of the sensitive and noninvasive methods to help monitor the cognitive course of mild cognitive impairment (MCI). The study aimed to evaluate both pro and anti-saccade longitudinally and the relationship between cognitive functions and eye movements in MCI subgroups and healthy controls (HCs) at a two-year follow-up. This study revealed that the anti-saccade anticipatory responses decreased in amnestic MCI (aMCI). Correct vertical pro-saccades increased in non-amnestic MCI (naMCI), while the express saccades decreased. Our study demonstrated that longer than two years of follow-up is necessary to monitor the course of MCI. Findings of the relationships between longitudinal changes of saccades and cognitive measurements demonstrated the usability of eye movements in evaluating the process of MCI.
Collapse
Affiliation(s)
- Müge Akkoyun
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
| | - Koray Koçoğlu
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
| | - Hatice Eraslan Boz
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Pembe Keskinoğlu
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Gülden Akdal
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Türkiye
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| |
Collapse
|
13
|
Mao S, Xie L, Lu N. Activity engagement and cognitive function among chinese older adults: moderating roles of gender and age. BMC Geriatr 2023; 23:223. [PMID: 37024815 PMCID: PMC10080791 DOI: 10.1186/s12877-023-03912-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Many studies have found that engaging in activities, including physical exercise, social interaction, and cognitive training, is beneficial for preventing cognitive decline among older adults; however, the demographic differences in the association between activity engagement and cognitive functions remain understudied. This study investigates: (a) the influence of activity engagement on cognitive functions among Chinese older adults, and (b) the moderating roles of age and gender in these associations . METHODS The data were derived from the China Health and Retirement Longitudinal Study in 2018, which included 9803 participants aged 60 or older. A multiple regression model was used to test the study hypotheses. RESULTS Engaging in physical activity (b = 1.578, p < .001), social interaction (b = 1.199, p < .001), and cognitive activity (b = 1.468, p < .001) was positively associated with cognitive functions, whereas the effect of volunteer activities on cognitive functions was not significant (b = -.167, p = .390). Light- and moderate-intensity activities were beneficial for cognition (light: b = .847, p < .001; moderate: b = 1.189, p < .001), but vigorous-intensity activity was negatively related to cognition (b = -.767, p < .001). In addition, women and participants with advanced age appeared to benefit more from cognitive activities than their male and younger counterparts, respectively (gender: b = 1.217, p = .002; age: b = .086, p = .004). The adverse effects of vigorous-intensity activities (including agricultural work) on cognitive health were stronger for women and younger participants (gender: b = -1.472, p < .001; age: b = .115, p < .001). The protective effects of moderate-intensity activities on people's cognition increased with increasing age (b = .055, p = .012). CONCLUSIONS The findings indicate that participating in physical, social, and cognitive activities can help older adults to maintain cognitive health. They suggest that older adults should select activities while considering activity intensity and their individual characteristics.
Collapse
Affiliation(s)
- Shan Mao
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Lili Xie
- Center for Population and Development Studies, Renmin University of China, Room 604, Chongde Building, No. 59, Zhongguancun Street, Haidian District, Beijing, 100872, China.
- School of Interdisciplinary Studies, Renmin University of China, Beijing, China.
| | - Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| |
Collapse
|
14
|
Wang X, Ye T, Zhou W, Zhang J. Uncovering heterogeneous cognitive trajectories in mild cognitive impairment: a data-driven approach. Alzheimers Res Ther 2023; 15:57. [PMID: 36941651 PMCID: PMC10026406 DOI: 10.1186/s13195-023-01205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Given the complex and progressive nature of mild cognitive impairment (MCI), the ability to delineate and understand the heterogeneous cognitive trajectories is crucial for developing personalized medicine and informing trial design. The primary goals of this study were to examine whether different cognitive trajectories can be identified within subjects with MCI and, if present, to characterize each trajectory in relation to changes in all major Alzheimer's disease (AD) biomarkers over time. METHODS Individuals with a diagnosis of MCI at the first visit and ≥ 1 follow-up cognitive assessment were selected from the Alzheimer's Disease Neuroimaging Initiative database (n = 936; age 73 ± 8; 40% female; 16 ± 3 years of education; 50% APOE4 carriers). Based on the Alzheimer's Disease Assessment Scale-Cognitive Subscale-13 (ADAS-Cog-13) total scores from baseline up to 5 years follow-up, a non-parametric k-means longitudinal clustering method was performed to obtain clusters of individuals with similar patterns of cognitive decline. We further conducted a series of linear mixed-effects models to study the associations of cluster membership with longitudinal changes in other cognitive measures, neurodegeneration, and in vivo AD pathologies. RESULTS Four distinct cognitive trajectories emerged. Cluster 1 consisted of 255 individuals (27%) with a nearly non-existent rate of change in the ADAS-Cog-13 over 5 years of follow-up and a healthy-looking biomarker profile. Individuals in the cluster 2 (n = 336, 35%) and 3 (n = 240, 26%) groups showed relatively mild and moderate cognitive decline trajectories, respectively. Cluster 4, comprising about 11% of our study sample (n = 105), exhibited an aggressive cognitive decline trajectory and was characterized by a pronouncedly abnormal biomarker profile. CONCLUSIONS Individuals with MCI show substantial heterogeneity in cognitive decline. Our findings may potentially contribute to improved trial design and patient stratification.
Collapse
Affiliation(s)
- Xiwu Wang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Teng Ye
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenjun Zhou
- Research and Development, Hangzhou Shansier Medical Technologies Co., Ltd., Hangzhou, China.
| | - Jie Zhang
- Department of Data Science, Hangzhou Shansier Medical Technologies Co., Ltd., Hangzhou, China.
| |
Collapse
|
15
|
Nousia A, Pappa E, Siokas V, Liampas I, Tsouris Z, Messinis L, Patrikelis P, Manouilidou C, Dardiotis E, Nasios G. Evaluation of the Efficacy and Feasibility of a Telerehabilitation Program Using Language and Cognitive Exercises in Multi-Domain Amnestic Mild Cognitive Impairment. Arch Clin Neuropsychol 2023; 38:224-235. [PMID: 36156732 DOI: 10.1093/arclin/acac078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the efficacy and feasibility of a telerehabilitation program in multi-domain amnestic Mild Cognitive Impairment (md-aMCI). The study sample consisted of 30 patients with md-aMCI and aged 60-80 years. METHODS The participants were randomly divided into two groups. The Training Group (TG), which received cognitive training by using the RehaCom software as well as paper-pencil language training and the Control Group (CG) which received standard clinical care (e.g., psychotherapy or/and physiotherapy). Duration of the telerehabilitation intervention was 15 weeks (twice a week for 60 min/session). RESULTS Our results revealed that the neuropsychological performance of the TG group after the telerehabilitation intervention improved on a statistically significant level on the domains of delayed and working memory, confrontation naming, verbal fluency, and global cognition. Comparison between the TG and CG revealed a significant impact of the telerehabilitation program on the domains of memory (delay and working) and language (naming and verbal fluency) as well as global cognition performance. CONCLUSION The findings of the study are promising in that the telerehabilitation intervention appears to be a useful method in improving or stabilizing cognitive decline in md-aMCI individuals and was a particularly effective alternative approach during the period of the pandemic lockdown. Specifically, the beneficial impact of the telerehabilitation intervention on episodic memory (which is one of the first domains to show impairment in md-aMCI patients) provides us with hope and evidence that these types of interventions may be applied with similar success using face-to-face interventions.
Collapse
Affiliation(s)
- Anastasia Nousia
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Evangelia Pappa
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Lambros Messinis
- Departement of Psychology, Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Panayiotis Patrikelis
- Departement of Psychology, Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Christina Manouilidou
- Department of Comparative and General Linguistics, University of Ljubljana, Ljubljana, Slovenia
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| |
Collapse
|
16
|
Dang M, Yang C, Chen K, Lu P, Li H, Zhang Z. Hippocampus-centred grey matter covariance networks predict the development and reversion of mild cognitive impairment. Alzheimers Res Ther 2023; 15:27. [PMID: 36732782 PMCID: PMC9893696 DOI: 10.1186/s13195-023-01167-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) has been thought of as the transitional stage between normal ageing and Alzheimer's disease, involving substantial changes in brain grey matter structures. As most previous studies have focused on single regions (e.g. the hippocampus) and their changes during MCI development and reversion, the relationship between grey matter covariance among distributed brain regions and clinical development and reversion of MCI remains unclear. METHODS With samples from two independent studies (155 from the Beijing Aging Brain Rejuvenation Initiative and 286 from the Alzheimer's Disease Neuroimaging Initiative), grey matter covariance of default, frontoparietal, and hippocampal networks were identified by seed-based partial least square analyses, and random forest models were applied to predict the progression from normal cognition to MCI (N-t-M) and the reversion from MCI to normal cognition (M-t-N). RESULTS With varying degrees, the grey matter covariance in the three networks could predict N-t-M progression (AUC = 0.692-0.792) and M-t-N reversion (AUC = 0.701-0.809). Further analyses indicated that the hippocampus has emerged as an important region in reversion prediction within all three brain networks, and even though the hippocampus itself could predict the clinical reversion of M-t-N, the grey matter covariance showed higher prediction accuracy for early progression of N-t-M. CONCLUSIONS Our findings are the first to report grey matter covariance changes in MCI development and reversion and highlight the necessity of including grey matter covariance changes along with hippocampal degeneration in the early detection of MCI and Alzheimer's disease.
Collapse
Affiliation(s)
- Mingxi Dang
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - Caishui Yang
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875 China ,grid.20513.350000 0004 1789 9964School of Systems Science, Beijing Normal University, Beijing, 100875 China
| | - Kewei Chen
- grid.418204.b0000 0004 0406 4925Banner Alzheimer’s Institute, Phoenix, AZ 85006 USA
| | - Peng Lu
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - He Li
- grid.410318.f0000 0004 0632 3409Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700 China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China.
| | | |
Collapse
|
17
|
The Effects of a New Integrated and Multidisciplinary Cognitive Rehabilitation Program Based on Mindfulness and Reminiscence Therapy in Patients with Parkinson's Disease and Mild Cognitive Impairment: A Pilot Study. Brain Sci 2023; 13:brainsci13020201. [PMID: 36831744 PMCID: PMC9954653 DOI: 10.3390/brainsci13020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Background: Mindfulness trainings have shown promising results as treatment for behavioural symptoms in several pathologies. In addition, mindfulness protocols induced an improvement in memory and attention. Therefore, mindfulness could be an effective intervention for patients affected by Parkinson's disease (PD) and mild cognitive impairment (MCI), who are characterized by both behavioural and cognitive dysfunctions. Methods: We assessed differences in Montreal Cognitive Assessment (MoCA) scores and in Beck Depression Inventory II (BDI-II) scores in patients affected by PD and MCI enrolled in two different rehabilitation programs (an experimental vs. an usual structured program for cognitive rehabilitation). Participants in the experimental group (MILC-tr) underwent innovative rehabilitation program involving mindfulness and reminiscence activities. Assessments were performed before (T0) and at the end of the rehabilitation program (T1). Results: Friedman test showed a significant improvement between timepoints in MoCA global score (x2 = 4.000, p = 0.046), MoCA memory sub-scale score (x2 = 4.571, p = 0.033), and BDI-II cognitive and affective factors (x2 = 4.000, p = 0.046) only for patients in MILC-tr group. Mann-Whitney test showed a significant difference between group comparing differences in Δ scores between T0 and T1 in the MoCA memory sub-scale score (U = 190.50, p = 0.035). Conclusions: Mindfulness-based rehabilitation programs could be effective in patients affected by PD and MCI.
Collapse
|
18
|
Qin Y, Han H, Li Y, Cui J, Jia H, Ge X, Ma Y, Bai W, Zhang R, Chen D, Yi F, Yu H. Estimating Bidirectional Transitions and Identifying Predictors of Mild Cognitive Impairment. Neurology 2023; 100:e297-e307. [PMID: 36220593 PMCID: PMC9869761 DOI: 10.1212/wnl.0000000000201386] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Various resources exist for treating mild cognitive impairment (MCI) or dementia separately as terminal events or for focusing solely on a 1-way path from MCI to dementia without taking into account heterogeneous transitions. Little is known about the trajectory of reversion from MCI to normal cognition (NC) or near-NC and patterns of postreversion, which refers to cognitive trajectories of patients who have reversed from MCI to NC. Our objectives were to (1) quantitatively predict bidirectional transitions of MCI (reversion and progression), (2) explore patterns of future cognitive trajectories for postreversion, and (3) estimate the effects of demographic characteristics, APOE, cognition, daily activity ability, depression, and neuropsychiatric symptoms on transition probabilities. METHODS We constructed a retrospective cohort by reviewing patients with an MCI diagnosis at study entry and at least 2 follow-up visits between June 2005 and February 2021. Defining NC or near-NC and MCI as transient states and dementia as an absorbing state, we used continuous-time multistate Markov models to estimate instantaneous transition intensity between states, transition probabilities from one state to another at any given time during follow-up, and hazard ratios of reversion-related variables. RESULTS Among 24,220 observations from 6,651 participants, there were 2,729 transitions to dementia and 1,785 reversions. As for postreversion, there were 630 and 73 transitions of progression to MCI and dementia, respectively. The transition intensity of progression to MCI for postreversion was 0.317 (2.48-fold greater than that for MCI progression or reversion). For postreversion participants, the probability of progressing to dementia increased by 2% yearly. Participants who progressed to MCI were likely to reverse again (probability of 40% over 15 years). Age, independence level, APOE, cognition, daily activity ability, depression, and neuropsychiatric symptoms were significant predictors of bidirectional transitions. DISCUSSION The nature of bidirectional transitions cannot be ignored in multidimensional MCI research. We found that postreversion participants remained at an increased risk of progression to MCI or dementia over the longer term and experienced recurrent reversions. Our findings may serve as a valuable reference for future research and enable health care professionals to better develop proactive management plans and targeted interventions.
Collapse
Affiliation(s)
- Yao Qin
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Hongjuan Han
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Yang Li
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Jing Cui
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Haixia Jia
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Xiaoyan Ge
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Yifei Ma
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Wenlin Bai
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Rong Zhang
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Durong Chen
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Fuliang Yi
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Hongmei Yu
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China.
| |
Collapse
|
19
|
Zhang D, Liu S, Huang Y, Gao J, Liu W, Liu W, Ai K, Lei X, Zhang X. Altered Functional Connectivity Density in Type 2 Diabetes Mellitus with and without Mild Cognitive Impairment. Brain Sci 2023; 13:brainsci13010144. [PMID: 36672125 PMCID: PMC9856282 DOI: 10.3390/brainsci13010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Although disturbed functional connectivity is known to be a factor influencing cognitive impairment, the neuropathological mechanisms underlying the cognitive impairment caused by type 2 diabetes mellitus (T2DM) remain unclear. To characterize the neural mechanisms underlying T2DM-related brain damage, we explored the altered functional architecture patterns in different cognitive states in T2DM patients. Thirty-seven T2DM patients with normal cognitive function (DMCN), 40 T2DM patients with mild cognitive impairment (MCI) (DMCI), and 40 healthy controls underwent neuropsychological assessments and resting-state functional MRI examinations. Functional connectivity density (FCD) analysis was performed, and the relationship between abnormal FCD and clinical/cognitive variables was assessed. The regions showing abnormal FCD in T2DM patients were mainly located in the temporal lobe and cerebellum, but the abnormal functional architecture was more extensive in DMCI patients. Moreover, in comparison with the DMCN group, DMCI patients showed reduced long-range FCD in the left superior temporal gyrus (STG), which was correlated with the Rey auditory verbal learning test score in all T2DM patients. Thus, DMCI patients show functional architecture abnormalities in more brain regions involved in higher-level cognitive function (executive function and auditory memory function), and the left STG may be involved in the neuropathology of auditory memory in T2DM patients. These findings provide some new insights into understanding the neural mechanisms underlying T2DM-related cognitive impairment.
Collapse
Affiliation(s)
- Dongsheng Zhang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
| | - Shasha Liu
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
| | - Yang Huang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
| | - Jie Gao
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
| | - Weirui Liu
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
| | - Wanting Liu
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
| | - Kai Ai
- Department of Clinical Science, Philips Healthcare, Xi’an 710000, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
- Correspondence: ; Tel.: +86-13087581380
| |
Collapse
|
20
|
Bruña R, López-Sanz D, Maestú F, Cohen AD, Bagic A, Huppert T, Kim T, Roush RE, Snitz B, Becker JT. MEG Oscillatory Slowing in Cognitive Impairment is Associated with the Presence of Subjective Cognitive Decline. Clin EEG Neurosci 2023; 54:73-81. [PMID: 35188831 PMCID: PMC9392809 DOI: 10.1177/15500594221072708] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The mechanisms behind Alzheimer's disease are not yet fully described, and changes in the electrophysiology of patients across the continuum of the disease could help to understand them. In this work, we study the power spectral distribution of a set of 129 individuals from the Connectomics of Brian Aging and Dementia project.From this sample, we acquired task-free data, with eyes closed, and estimated the power spectral distribution in source space. We compared the spectral profiles of three groups of individuals: 70 healthy controls, 27 patients with amnestic MCI, and 32 individuals showing cognitive impairment without subjective complaints (IWOC).The results showed a slowing of the brain activity in the aMCI patients, when compared to both the healthy controls and the IWOC individuals. These differences appeared both as a decrease in power for high frequency oscillations and an increase in power in alpha oscillations. The slowing of the spectrum was significant mainly in parietal and medial frontal areas.We were able to validate the slowing of the brain activity in individuals with aMCI, appearing in our sample in areas related to the default mode network. However, this pattern did not appear in the IWOC individuals, suggesting that their condition is not part of the AD continuum. This work raises interesting questions about this group of individuals, and the underlying brain mechanisms behind their cognitive impairment.
Collapse
Affiliation(s)
- Ricardo Bruña
- Electrical Engineering, Universidad de La Laguna, La Laguna, Tenerife, Spain
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - David López-Sanz
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
- Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de Madrid, Madrid, Madrid, Spain
| | - Fernando Maestú
- Experimental Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Ann D. Cohen
- Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anto Bagic
- Neurology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Ted Huppert
- Electrical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tae Kim
- Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca E. Roush
- Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Betz Snitz
- Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James T. Becker
- Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
21
|
Cardelo MP, Corina A, Leon-Acuña A, Quintana-Navarro GM, Alcala-Diaz JF, Rangel-Zuñiga OA, Camargo A, Conde-Gavilan C, Carmona-Medialdea C, Vallejo-Casas JA, Carmona-Asenjo E, Ochoa-Sepulveda JJ, Aguera-Morales E, Delgado-Lista J, Katsiki N, Lopez-Miranda J, Perez-Jimenez F, Yubero-Serrano EM, Perez-Martínez P. Effect of the Mediterranean diet and probiotic supplementation in the management of mild cognitive impairment: Rationale, methods, and baseline characteristics. Front Nutr 2022; 9:1037842. [PMID: 36570150 PMCID: PMC9773830 DOI: 10.3389/fnut.2022.1037842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Mild cognitive impairment (MCI) can progress to Alzheimer's disease (AD). When MCI is not properly controlled, the speed of deterioration can dramatically increase. Reduction of oxidative stress/inflammation and the modulation of the gut-brain axis could be new potential therapeutic targets for the prevention and treatment of AD. Consumption of specific nutrients, diets and probiotic supplementation have been evaluated for neurodegenerative disorders. We focus on a detailed description of the study methods and baseline characteristics of a clinical trial aiming to evaluate the efficacy of a combined nutritional intervention, i.e., a Mediterranean diet with probiotics, on cognitive capacity in a population with MCI. Methods In this randomized, latin-square crossover, double-blind, and controlled dietary intervention trial (clinicaltrials.gov NCT05029765), 47 MCI patients were randomized to consume three dietary interventions for 24-weeks each: (1) A Mediterranean diet supplemented with probiotics (109 colony-forming units of Lactobacillus rhamnosus and Bifidobacterium longum); (2) A Mediterranean diet + placebo; and (3) A Healthy diet according to the World Health Organization (WHO) recommendations. Participants will be evaluated before and after each of the three intervention periods (each 24-weeks, with a total of 72-weeks) for adherence to the assigned diet, blood tests, cognitive performance, gut microbiota analysis and functional neuroimaging studies. Results Fifty patients, ≥60 years-old and diagnosed with MCI, underwent randomization. A total of 47 patients completed follow-up dietary interventions (57.4% males), with a good glycemic control (HbA1c 5.8 ± 0.1%, fasting glucose and insulin 99.7 ± 3.3 mg/dL and 10.4 ± 0.9 mU/L, respectively), elevated systolic blood pressure (136.9 ± 2.1 mmHg) and increased degree of inflammation (high-sensitivity C-reactive protein, 8.8 ± 0.9 mg/dL). Baseline adherence to the Mediterranean diet was medium (7.5 ± 0.3 points on the score that ranged from 0 to 14 points). Conclusion The results of this clinical study would provide more evidence on the need for dietary therapeutic strategies, for clinical and individual practice, in the management of MCI patients to reduce the risk of AD development. Targeting lifestyle modifications in high-risk populations could prevent substantial cases of cognitive decline. Clinical trial registration [ClinicalTrials.gov], identifier [NCT05029765].
Collapse
Affiliation(s)
- Magdalena P. Cardelo
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Andreea Corina
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Ana Leon-Acuña
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Gracia M. Quintana-Navarro
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Juan F. Alcala-Diaz
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Oriol Alberto Rangel-Zuñiga
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Antonio Camargo
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Cristina Conde-Gavilan
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Claudia Carmona-Medialdea
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Juan A. Vallejo-Casas
- Unidad de Gestión Clinica de Medicina Nuclear, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Elvira Carmona-Asenjo
- Unidad de Gestión Clinica de Medicina Nuclear, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Juan J. Ochoa-Sepulveda
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Eduardo Aguera-Morales
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Javier Delgado-Lista
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - José Lopez-Miranda
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Francisco Perez-Jimenez
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Elena M. Yubero-Serrano
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Pablo Perez-Martínez
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain,*Correspondence: Pablo Perez-Martínez,
| |
Collapse
|
22
|
Ang SH, Hsu NW, Tsai PH, Pan PJ, Chen HC, Chou P, Lin KC. Different item characteristics of a mild cognitive impairment screening tool in the community-based Yilan Study: application of the item response theory. Psychogeriatrics 2022; 22:813-821. [PMID: 36054326 DOI: 10.1111/psyg.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to use item response theory (IRT) to explore the item-by-item characteristics of a mild cognitive impairment (MCI) screening tool using community-based data. METHODS The Yilan Study is a community-based study that has been conducted since 2012. Until March 2020, 2230 older adults were interviewed according to the household registration data. IRT was applied to determine the item-by-item distinctive characteristics of the Eight-item Interview to Differentiate Aging and Dementia (AD8). RESULTS The MCI characteristics in the AD8 items have varying degrees of item response threshold. In all circumstances, item AD8-8, which is related to self-rated memory ability, had a low item response threshold. AD8-5 and AD8-7, which are related to the comparisons of time-oriented functional status, had slightly lower thresholds, especially for those aged 65-79 years or without activity limitations. Conversely, AD8-1, AD8-2, AD8-3, AD8-4, and AD8-6 had similar item response thresholds and discriminative power; these items have more detailed functional descriptions or examples for illustration. CONCLUSIONS Concise and understandable elements are often expected in community-based screening tools. For community-based health screening and population empowerment in the early detection of MCI, assessment tool items with detailed functional descriptions and examples for illustration have similar validities in most of the population. Items related to self-rated memory ability might be less valid. More examples may be needed for items constructed for comparing time-oriented functional status, especially in extremely old adults and individuals with activity limitations.
Collapse
Affiliation(s)
- Sin-Ho Ang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Master of Public Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nai-Wei Hsu
- Community Medicine Research Center and Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yilan City, Taiwan.,Public Health Bureau, Yilan City, Taiwan
| | - Ping-Huang Tsai
- Department of Neurology, National Yang Ming Chiao Tung University Hospital, Yilan City, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Kaillan Group Practice Clinic, Yilan City, Taiwan
| | - Po-Jung Pan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan City, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry and Center of Sleep Disorders, National Taiwan University Hospital, Taipei City, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Chia Lin
- Community Medicine Research Center and Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
23
|
Eastus CC, Baez DE, Buckley ML, Lee J, Adami A. The role of structured exercise interventions on cognitive function in older individuals with stable Chronic Obstructive Pulmonary Disease: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:987356. [PMID: 36386775 PMCID: PMC9659625 DOI: 10.3389/fresc.2022.987356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
UNLABELLED A decline in cognitive performance has been associated with disease severity, exacerbations rate, presence of comorbidities, and low activity level in people with chronic obstructive pulmonary disease (COPD). Participation in exercise programs appears to have neuroprotective effects and to improve cognitive performance in older people. The present work undertook a scoping review of the effects of exercise-based interventions on cognitive function in older individuals with stable COPD. METHODS The methodological framework for scoping review was used and electronic searches of five databases performed. Original research and observational studies published between January 2010 and December 2021, administering exercise-based interventions and cognitive function evaluation, were included. RESULTS Of 13 full-text manuscripts assessed for eligibility, five were allocated to analysis. Three studies administered exercise training within pulmonary outpatient rehabilitation program (PR), and one inpatient PR. The fifth study conducted a structured training intervention in which either aerobic or a combination with resistance exercises were included. Twelve cognitive function screening tools were used in the five studies included in the analysis. Results extracted were based on 245 COPD (33% female) with moderate to very-severe airflow limitation. Interventions ranged from 12 to 36 sessions. Studies reported statistically significant improvements after intervention in different cognitive function domains, such as global cognition, immediate and delayed recall ability, cognitive flexibility, verbal fluency, attention, abstract reasoning, praxis ability. CONCLUSIONS Exercise-based interventions improve several areas of cognitive function in patients with stable COPD. However, the magnitude of gain varies among studies, and this is possibly due to the heterogeneity of tests used. Future research is needed to validate the optimal battery of screening tests, and to support the definition of guidelines for cognitive function evaluation in COPD.
Collapse
Affiliation(s)
- Caroline C. Eastus
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Daniel E. Baez
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Maria L. Buckley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI, United States
| | - Alessandra Adami
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States,Correspondence: Alessandra Adami
| |
Collapse
|
24
|
Associations of genetic liability for Alzheimer's disease with cognition and eye movements in a large, population-based cohort study. Transl Psychiatry 2022; 12:337. [PMID: 35982049 PMCID: PMC9388528 DOI: 10.1038/s41398-022-02093-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 11/08/2022] Open
Abstract
To identify cognitive measures that may be particularly sensitive to early cognitive decline in preclinical Alzheimer's disease (AD), we investigated the relation between genetic risk for AD and cognitive task performance in a large population-based cohort study. We measured performance on memory, processing speed, executive function, crystallized intelligence and eye movement tasks in 5182 participants of the Rhineland Study, aged 30 to 95 years. We quantified genetic risk for AD by creating three weighted polygenic risk scores (PRS) based on the genome-wide significant single-nucleotide polymorphisms coming from three different genetic association studies. We assessed the relation of AD PRS with cognitive performance using generalized linear models. Three PRS were associated with lower performance on the Corsi forward task, and two PRS were associated with a lower probability of correcting antisaccade errors, but none of these associations remained significant after correction for multiple testing. Associations between age and trail-making test A (TMT-A) performance were modified by AD genetic risk, with individuals at high genetic risk showing the strongest association. We conclude that no single measure of our cognitive test battery robustly captures genetic liability for AD as quantified by current PRS. However, Corsi forward performance and the probability of correcting antisaccade errors may represent promising candidates whose ability to capture genetic liability for AD should be investigated further. Additionally, our finding on TMT-A performance suggests that processing speed represents a sensitive marker of AD genetic risk in old age and supports the processing speed theory of age-related cognitive decline.
Collapse
|
25
|
Menezes AC, Drumond G, Shigaeff N. Dance therapy and cognitive impairment in older people: A review of clinical data. Dement Neuropsychol 2022; 16:373-383. [DOI: 10.1590/1980-5764-dn-2021-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/10/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The growing interest for nonpharmacological treatment alternatives to older people with mild cognitive impairment or dementia has increased exponentially for the past few years; in this context, dance therapy is an effective therapeutic tool in improving the cognition of older people. The aim of this study was to verify whether dance therapy is a viable tool in promoting benefits with regard to the cognition and mood of older people with cognitive impairment. A database search covering the past 10 years was carried out. Result: The search found 193 papers; after title, abstract, and duplicity analysis, 14 of those were selected, of which 10 were fully revised. The studies showed positive results regarding the improvement of cognitive function after dance stimulations, as well as beneficial effects on the mood of older people with cognitive impairment.
Collapse
Affiliation(s)
- Ana Clara Menezes
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | - Gabrielle Drumond
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | - Nadia Shigaeff
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| |
Collapse
|
26
|
Boccalini C, Peretti DE, Ribaldi F, Scheffler M, Stampacchia S, Tomczyk S, Rodriguez C, Montandon ML, Haller S, Giannakopoulos P, Frisoni GB, Perani D, Garibotto V. Early-phase 18F-Florbetapir and 18F-Flutemetamol images as proxies of brain metabolism in a memory clinic setting. J Nucl Med 2022; 64:jnumed.122.264256. [PMID: 35863896 PMCID: PMC9902851 DOI: 10.2967/jnumed.122.264256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Alzheimer's disease (AD) neuropathologic changes are β-amyloid (Aβ) deposition, pathologic tau, and neurodegeneration. Dual-phase amyloid-PET might be able to evaluate Aβ deposition and neurodegeneration with a single tracer injection. Early-phase amyloid-PET scans provide a proxy for cerebral perfusion, which has shown good correlations with neural dysfunction measured through metabolic consumption, while the late frames depict amyloid distribution. Our study aims to assess the comparability between early-phase amyloid-PET scans and 18F-fluorodeoxyglucose (18F-FDG)-PET brain topography at the individual level, and their ability to discriminate patients. Methods: 166 subjects evaluated at the Geneva Memory Center, ranging from cognitively unimpaired to Mild Cognitive Impairment (MCI) and dementia, underwent early-phase amyloid-PET - using either 18F-florbetapir (eFBP) (n = 94) or 18F-flutemetamol (eFMM) (n = 72) - and 18F-FDG-PET. Aβ status was assessed. Standardized uptake value ratios (SUVR) were extracted to evaluate the correlation of eFBP/eFMM and their respective 18F-FDG-PET scans. The single-subject procedure was applied to investigate hypometabolism and hypoperfusion maps and their spatial overlap by Dice coefficient. Receiver operating characteristic analyses were performed to compare the discriminative power of eFBP/eFMM, and 18F-FDG-PET SUVR in AD-related metaROI between Aβ-negative healthy controls and cases in the AD continuum. Results: Positive correlations were found between eFBP/eFMM and 18F-FDG-PET SUVR independently of Aβ status and Aβ radiotracer (R>0.72, p<0.001). eFBP/eFMM single-subject analysis revealed clusters of significant hypoperfusion with good correspondence to hypometabolism topographies, independently of the underlying neurodegenerative patterns. Both eFBP/eFMM and 18F-FDG-PET SUVR significantly discriminated AD patients from controls in the AD-related metaROIs (AUCFBP = 0.888; AUCFMM=0.801), with 18F-FDG-PET performing slightly better, however not significantly (all p-value higher than 0.05), than others (AUCFDG=0.915 and 0.832 for subjects evaluated with 18F-FBP and 18F-FMM, respectively). Conclusion: The distribution of perfusion was comparable to that of metabolism at the single-subject level by parametric analysis, particularly in the presence of a high neurodegeneration burden. Our findings indicate that eFBP/eFMM imaging can replace 18F-FDG-PET imaging, as they reveal typical neurodegenerative patterns, or allow to exclude the presence of neurodegeneration. The finding shows cost-saving capacities of amyloid-PET and supports the routine use of the modality for individual classification in clinical practice.
Collapse
Affiliation(s)
- Cecilia Boccalini
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Vita-Salute San Raffaele University, Milan, Italy
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Débora Elisa Peretti
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Federica Ribaldi
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - Max Scheffler
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Sara Stampacchia
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Szymon Tomczyk
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
| | - Cristelle Rodriguez
- Division of Institutional Measures, Medical Direction, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marie-Louise Montandon
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Sven Haller
- CIMC–Centre d’Imagerie Médicale de Cornavin, Geneva, Switzerland
- Faculty of Medicine of University of Geneva, Geneva, Switzerland
- Division of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Panteleimon Giannakopoulos
- Division of Institutional Measures, Medical Direction, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland; and
- CIBM Center for Biomedical Imaging, Geneva, Switzerland
| |
Collapse
|
27
|
Sanderson-Cimino M, Elman JA, Tu XM, Gross AL, Panizzon MS, Gustavson DE, Bondi MW, Edmonds EC, Eppig JS, Franz CE, Jak AJ, Lyons MJ, Thomas KR, Williams ME, Kremen WS. Practice Effects in Mild Cognitive Impairment Increase Reversion Rates and Delay Detection of New Impairments. Front Aging Neurosci 2022; 14:847315. [PMID: 35547623 PMCID: PMC9083463 DOI: 10.3389/fnagi.2022.847315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
Objective Cognitive practice effects (PEs) can delay detection of progression from cognitively unimpaired to mild cognitive impairment (MCI). They also reduce diagnostic accuracy as suggested by biomarker positivity data. Even among those who decline, PEs can mask steeper declines by inflating cognitive scores. Within MCI samples, PEs may increase reversion rates and thus impede detection of further impairment. Within an MCI sample at baseline, we evaluated how PEs impact prevalence, reversion rates, and dementia progression after 1 year. Methods We examined 329 baseline Alzheimer's Disease Neuroimaging Initiative MCI participants (mean age = 73.1; SD = 7.4). We identified test-naïve participants who were demographically matched to returnees at their 1-year follow-up. Since the only major difference between groups was that one completed testing once and the other twice, comparison of scores in each group yielded PEs. PEs were subtracted from each test to yield PE-adjusted scores. Biomarkers included cerebrospinal fluid phosphorylated tau and amyloid beta. Cox proportional models predicted time until first dementia diagnosis using PE-unadjusted and PE-adjusted diagnoses. Results Accounting for PEs increased MCI prevalence at follow-up by 9.2% (272 vs. 249 MCI), and reduced reversion to normal by 28.8% (57 vs. 80 reverters). PEs also increased stability of single-domain MCI by 12.0% (164 vs. 147). Compared to PE-unadjusted diagnoses, use of PE-adjusted follow-up diagnoses led to a twofold increase in hazard ratios for incident dementia. We classified individuals as false reverters if they reverted to cognitively unimpaired status based on PE-unadjusted scores, but remained classified as MCI cases after accounting for PEs. When amyloid and tau positivity were examined together, 72.2% of these false reverters were positive for at least one biomarker. Interpretation Even when PEs are small, they can meaningfully change whether some individuals with MCI retain the diagnosis at a 1-year follow-up. Accounting for PEs resulted in increased MCI prevalence and altered stability/reversion rates. This improved diagnostic accuracy also increased the dementia-predicting ability of MCI diagnoses.
Collapse
Affiliation(s)
- Mark Sanderson-Cimino
- University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, United States,Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,*Correspondence: Mark Sanderson-Cimino,
| | - Jeremy A. Elman
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Xin M. Tu
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, United States
| | - Matthew S. Panizzon
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Daniel E. Gustavson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mark W. Bondi
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Emily C. Edmonds
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Joel S. Eppig
- Rehabilitation Institute of Washington, Seattle, WA, United States
| | - Carol E. Franz
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Amy J. Jak
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Kelsey R. Thomas
- Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - McKenna E. Williams
- University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, United States,Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States
| | - William S. Kremen
- Center for Behavior Genetics of Aging, University of California, San Diego, San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California, San Diego, San Diego, CA, United States,Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| |
Collapse
|
28
|
Thaipisuttikul P, Jaikla K, Satthong S, Wisajun P. Rate of conversion from mild cognitive impairment to dementia in a Thai hospital-based population: A retrospective cohort. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12272. [PMID: 35386122 PMCID: PMC8970424 DOI: 10.1002/trc2.12272] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/05/2023]
Abstract
Introduction Mild cognitive impairment (MCI) is the state between normal cognition and dementia. This study objective was to estimate an average 1-year rate of conversion from MCI to dementia and explore the associated factors of conversion in a hospital-based cohort. Methods A retrospective cohort study of participants with MCI was conducted in a tertiary care hospital in Thailand. Two hundred fifty participants, 50 years of age or older, were enrolled. Results An average 1-year conversion rate from MCI to dementia was 18.4%. MCI patients who converted to dementia were likely older (P < .001), predominantly female (P = .028), vitamin D deficient (P = .012), and associated with lower Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores during first assessments (P < .001, P < .001 respectively) and follow-up assessments (P < .045, P < .001 respectively). We conducted two models of multivariate analysis, using binary logistic regression. In the first model, adjusted for age, sex, education, vitamin D deficiency, and first assessment MMSE scores, we found that underlying vitamin D deficiency (odds ratio [OR] = 3.13, 95% confidence interval [CI] 1.04 to 9.44) and first assessment MMSE scores (OR = 0.83, 95% CI 0.73 to 0.93) were significantly associated with conversion to dementia. In the second model, adjusted for age, sex, education, vitamin D deficiency and first assessment MoCA scores, only first assessment MoCA scores (OR = 0.58, 95% CI 0.45 to 0.76) were significantly associated with conversion to dementia. Discussion The 1-year conversion rate from MCI to dementia was 18.4%. MMSE and MoCA were useful tools to assess baseline cognitive status in MCI patients and predict dementia progression. The association between vitamin D deficiency and risk of conversion from MCI to dementia requires further investigations.
Collapse
Affiliation(s)
- Papan Thaipisuttikul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Kriengsak Jaikla
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Sirikorn Satthong
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Pattarabhorn Wisajun
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| |
Collapse
|
29
|
Wu M, Mei F, Hu K, Feng L, Wang Z, Gao Q, Chen F, Zhao L, Li X, Ma B. Diabetic retinopathy and cognitive dysfunction: a systematic review and meta-analysis. Acta Diabetol 2022; 59:443-459. [PMID: 35112186 DOI: 10.1007/s00592-021-01829-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study aims to determine the relationship between diabetic retinopathy (DR) and cognitive dysfunction as well as explores the effects of DR on different cognitive domains. METHODS A systematic search of PubMed, Embase, Web of Science, Wanfang data, CBM, CNKI, and VIP databases from their inception to October 2021. The pooled odds ratio (ORs), hazard ratio (HRs), and 95% confidence interval (CIs) were calculated. RESULTS Twenty-two studies met the inclusion criteria and meta-analysis included 15 studies. The presence of DR reflects a higher risk of cognitive dysfunction (OR = 2.45; 95% CI: 1.76-3.41; HR = 1.34 95% CI: 1.10-1.62). Cohort study combined risk was 2.62 (95% CI: 1.93-3.56), in cross-sectional study was 2.07 (95% CI: 1.11-3.88). The pooled OR was 2.38 (95% CI: 1.83-3.10) and 3.11 (95% CI: 1.15-8.40) in Asia and Oceania. No such association was found in North America (OR = 2.22; 95% CI: 0.77-6.38). The pooled risk was 2.47 (95% CI: 1.76-3.48) in patients with T2DM, while did not identify an association between these two conditions in T1DM. The combined unadjusted and adjusted ORs were 2.72 (95% CI: 1.99-3.73) and 2.06 (95% CI: 1.49-2.85). DR severity and the risk of cognitive impairment showed a positive correlation and mainly impaired the speeds of psychomotor and information processing. CONCLUSIONS DR can help to identify people at high risk of cognitive dysfunction. Further studies are indispensable for exploring the relationship between DR and cognitive impairment in the patients for different age, gender and race, as well as to assess the risk of cognitive impairment in different populations.
Collapse
Affiliation(s)
- Mei Wu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Fan Mei
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Kaiyan Hu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Liyuan Feng
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Zhe Wang
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Qianqian Gao
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Fei Chen
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Li Zhao
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xiaohui Li
- Lanzhou University second hospital, Lanzhou University, Lanzhou, China.
| | - Bin Ma
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| |
Collapse
|
30
|
Deardorff WJ, Lee SJ. Mild cognitive impairment as a clinical and research outcome: Ready for prime time? J Am Geriatr Soc 2022; 70:1361-1364. [PMID: 35293612 PMCID: PMC9714338 DOI: 10.1111/jgs.17744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- William James Deardorff
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| |
Collapse
|
31
|
Angevaare MJ, Vonk JMJ, Bertola L, Zahodne L, Watson CWM, Boehme A, Schupf N, Mayeux R, Geerlings MI, Manly JJ. Predictors of Incident Mild Cognitive Impairment and Its Course in a Diverse Community-Based Population. Neurology 2022; 98:e15-e26. [PMID: 34853178 PMCID: PMC8726570 DOI: 10.1212/wnl.0000000000013017] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 09/29/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate sociodemographic and medical predictors of incident mild cognitive impairment (MCI) and subsequent course of MCI at follow-up, including sustained MCI diagnosis, classification as cognitively normal, and progression to dementia. METHODS Within a community-based cohort, diagnoses of MCI were made with a published algorithm. Diagnosis of dementia was based on clinical consensus. Cox regressions estimated hazard ratios of incident MCI associated with several predictors. Modified Poisson regressions estimated relative risks associated with predictors of diagnostic status at follow-up after incidence. RESULTS Among 2,903 cognitively normal participants at baseline, 752 developed MCI over an average of 6.3 (SD 4.5) years (incidence rate 56 per 1,000 person-years). Presence of APOE ε4 and higher medical burden increased risk of incident MCI, while more years of education, more leisure activities, and higher income decreased this risk. Of the incident MCI cases, after an average of 2.4 years of follow-up, 12.9% progressed to dementia, 9.6% declined in functioning and did not meet the algorithmic criteria for MCI but did not meet the clinical criteria for dementia, 29.6% continued to meet MCI criteria, and 47.9% no longer met MCI criteria. Multidomain MCI, presence of APOE ε4, depressive symptoms, and antidepressant use increased the risk of progression to dementia. DISCUSSION This community-based study showed that almost half of the individuals with incident MCI diagnoses were classified as cognitively normal at follow-up. Predictors of incident MCI demonstrably differed from those of subsequent MCI course; these findings can refine expectations for cognitive and functional course of those presenting with MCI.
Collapse
Affiliation(s)
- Milou J Angevaare
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jet M J Vonk
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Laiss Bertola
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Laura Zahodne
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Caitlin Wei-Ming Watson
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amelia Boehme
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Nicole Schupf
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Richard Mayeux
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mirjam I Geerlings
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jennifer J Manly
- From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil.
| |
Collapse
|
32
|
Urrunaga-Pastor D, Chambergo-Michilot D, Runzer-Colmenares FM, Pacheco-Mendoza J, Benites-Zapata VA. Prevalence of Cognitive Impairment and Dementia in Older Adults Living at High Altitude: A Systematic Review and Meta-Analysis. Dement Geriatr Cogn Disord 2021; 50:124-134. [PMID: 34139687 DOI: 10.1159/000514471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Dementia is a chronic disease with a variable prevalence throughout the world; however, this could be higher at high-altitude populations. We aimed to summarize the prevalence of cognitive impairment and dementia in older adults living at high altitude. METHODS We searched in PubMed, Medline, Scopus, Web of Science, and Embase and included the studies published from inception to July 20, 2020, with no language restriction, which reported the frequency of cognitive impairment or dementia in older adults living at high-altitude populations. Random-effects meta-analyses were performed to calculate the overall prevalence and 95% confidence intervals (95% CI) of cognitive impairment and dementia. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. RESULTS Six studies were included (3,724 participants), and 5 of the 6 included studies were carried out in Latin America. The altitude ranged from 1,783 to 3,847 m, the proportion of women included varied from 38.7 to 65.6%, and the proportion of participants with elementary or illiterate educational level ranged from 71.7 to 97.6%. The overall prevalence of cognitive impairment was 22.0% (95% CI: 8-40, I2: 99%), and the overall prevalence of dementia was 11.0% (95% CI: 6-17, I2: 92%). In a subgroup analysis according to the instrument used to evaluate cognitive impairment, the prevalence of cognitive impairment was 21.0% (95% CI: 5-42, I2: 99%) in the MMSE group while the prevalence was 29.0% (95% CI: 0-78) in the non-MMSE group. CONCLUSIONS The prevalence of cognitive impairment and dementia in older adults living at high altitude is almost twice the number reported in some world regions.
Collapse
Affiliation(s)
- Diego Urrunaga-Pastor
- Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru
| | - Diego Chambergo-Michilot
- Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru.,Department of Cardiology Research, Torres de Salud National Research Center, Lima, Peru.,Red Latinoamericana de Cardiología, Lima, Peru
| | | | | | - Vicente A Benites-Zapata
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| |
Collapse
|
33
|
Guan H, Wang C, Tao D. MRI-based Alzheimer's disease prediction via distilling the knowledge in multi-modal data. Neuroimage 2021; 244:118586. [PMID: 34563678 DOI: 10.1016/j.neuroimage.2021.118586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
Mild cognitive impairment (MCI) conversion prediction, i.e., identifying MCI patients of high risks converting to Alzheimer's disease (AD), is essential for preventing or slowing the progression of AD. Although previous studies have shown that the fusion of multi-modal data can effectively improve the prediction accuracy, their applications are largely restricted by the limited availability or high cost of multi-modal data. Building an effective prediction model using only magnetic resonance imaging (MRI) remains a challenging research topic. In this work, we propose a multi-modal multi-instance distillation scheme, which aims to distill the knowledge learned from multi-modal data to an MRI-based network for MCI conversion prediction. In contrast to existing distillation algorithms, the proposed multi-instance probabilities demonstrate a superior capability of representing the complicated atrophy distributions, and can guide the MRI-based network to better explore the input MRI. To our best knowledge, this is the first study that attempts to improve an MRI-based prediction model by leveraging extra supervision distilled from multi-modal information. Experiments demonstrate the advantage of our framework, suggesting its potentials in the data-limited clinical settings.
Collapse
Affiliation(s)
- Hao Guan
- School of Computer Science, The University of Sydney, Australia
| | - Chaoyue Wang
- School of Computer Science, The University of Sydney, Australia.
| | - Dacheng Tao
- School of Computer Science, The University of Sydney, Australia; JD Explore Academy, China.
| |
Collapse
|
34
|
Yuan S, Li H, Wu J, Sun X. Classification of Mild Cognitive Impairment With Multimodal Data Using Both Labeled and Unlabeled Samples. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2021; 18:2281-2290. [PMID: 33471765 DOI: 10.1109/tcbb.2021.3053061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mild Cognitive Impairment (MCI) is a preclinical stage of Alzheimer's Disease (AD) and is clinical heterogeneity. The classification of MCI is crucial for the early diagnosis and treatment of AD. In this study, we investigated the potential of using both labeled and unlabeled samples from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort to classify MCI through the multimodal co-training method. We utilized both structural magnetic resonance imaging (sMRI) data and genotype data of 364 MCI samples including 228 labeled and 136 unlabeled MCI samples from the ADNI-1 cohort. First, the selected quantitative trait (QT) features from sMRI data and SNP features from genotype data were used to build two initial classifiers on 228 labeled MCI samples. Then, the co-training method was implemented to obtain new labeled samples from 136 unlabeled MCI samples. Finally, the random forest algorithm was used to obtain a combined classifier to classify MCI patients in the independent ADNI-2 dataset. The experimental results showed that our proposed framework obtains an accuracy of 85.50 percent and an AUC of 0.825 for MCI classification, respectively, which showed that the combined utilization of sMRI and SNP data through the co-training method could significantly improve the performances of MCI classification.
Collapse
|
35
|
Discovery of a Metabolic Signature Predisposing High Risk Patients with Mild Cognitive Impairment to Converting to Alzheimer's Disease. Int J Mol Sci 2021; 22:ijms222010903. [PMID: 34681563 PMCID: PMC8535253 DOI: 10.3390/ijms222010903] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Assessing dementia conversion in patients with mild cognitive impairment (MCI) remains challenging owing to pathological heterogeneity. While many MCI patients ultimately proceed to Alzheimer’s disease (AD), a subset of patients remain stable for various times. Our aim was to characterize the plasma metabolites of nineteen MCI patients proceeding to AD (P-MCI) and twenty-nine stable MCI (S-MCI) patients by untargeted metabolomics profiling. Alterations in the plasma metabolites between the P-MCI and S-MCI groups, as well as between the P-MCI and AD groups, were compared over the observation period. With the help of machine learning-based stratification, a 20-metabolite signature panel was identified that was associated with the presence and progression of AD. Furthermore, when the metabolic signature panel was used for classification of the three patient groups, this gave an accuracy of 73.5% using the panel. Moreover, when specifically classifying the P-MCI and S-MCI subjects, a fivefold cross-validation accuracy of 80.3% was obtained using the random forest model. Importantly, indole-3-propionic acid, a bacteria-generated metabolite from tryptophan, was identified as a predictor of AD progression, suggesting a role for gut microbiota in AD pathophysiology. Our study establishes a metabolite panel to assist in the stratification of MCI patients and to predict conversion to AD.
Collapse
|
36
|
Sanz-Blasco R, Ruiz-Sánchez de León JM, Ávila-Villanueva M, Valentí-Soler M, Gómez-Ramírez J, Fernández-Blázquez MA. Transition from mild cognitive impairment to normal cognition: Determining the predictors of reversion with multi-state Markov models. Alzheimers Dement 2021; 18:1177-1185. [PMID: 34482637 DOI: 10.1002/alz.12448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The theoretical framework of the Alzheimer's disease continuum considers transition between stages in a unidirectional manner. Here we examine the rate of reversion from mild cognitive impairment (MCI) to normal cognition (NC) and explore a set of potential variables associated with this phenomenon. METHODS A total of 985 Spanish community-dwelling individuals aged 70 years and over at baseline were monitored for 5 years. During this time, 173 MCI and 36 dementia cases were identified. Multi-state Markov models were performed to characterize transitions between states through the dementia continuum. RESULTS The rate of reversion from MCI to NC was 11%. There were significant non-modifiable (age, socioeconomic status, or apolipoprotein E) and modifiable factors (cognitive training or absence of affective symptoms) associated with reversion. DISCUSSION Overall, our results highlight that the likelihood of progression from MCI to dementia is very similar to that of reversion from MCI to NC.
Collapse
Affiliation(s)
- Rubén Sanz-Blasco
- Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | | | - Marina Ávila-Villanueva
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofía Foundation Alzheimer Center, Madrid, Spain
| | - Meritxel Valentí-Soler
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofía Foundation Alzheimer Center, Madrid, Spain
| | - Jaime Gómez-Ramírez
- Instituto de Investigación Biomédica de Cádiz (INIBICA), Department of Psychology, Universidad de Cádiz, Cádiz, Spain
| | | |
Collapse
|
37
|
The Use of Home-Based Nonimmersive Virtual Reality to Encourage Physical and Cognitive Exercise in People With Mild Cognitive Impairment: A Feasibility Study. J Aging Phys Act 2021; 30:297-307. [PMID: 34453024 DOI: 10.1123/japa.2021-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
Individuals with mild cognitive impairment are at risk of cognitive and physical decline. Virtual reality (VR) exercise may provide beneficial physical and cognitive exercise. The objectives of this study were to assess the feasibility and safety of home-based VR exercise and to provide pilot data for physical and cognitive efficacy. Eleven individuals with mild cognitive impairment (seven males/four females, average 78 years old, and average 3 years since diagnosis) performed a 30-min home-based VR exercise program 5 days a week for 6 weeks. The VR platform was successfully installed in participants' homes, and all participants were able to learn the VR program and progress. Participants completed 99% of the prescribed exercise. There were no major adverse events. Most participants enjoyed the VR program and reported physical benefits; fewer reported cognitive benefits. No physical or cognitive outcome measures showed change after 6 weeks. Home-based VR exercise is safe and feasible in individuals with mild cognitive impairment.
Collapse
|
38
|
Chao LL, Lee JA, Martinez S, Barlow C, Chesney MA, Mehling WE, Barnes DE. Preventing Loss of Independence through Exercise (PLIÉ): A Pilot Trial in Older Adults with Subjective Memory Decline and Mild Cognitive Impairment. J Alzheimers Dis 2021; 82:1543-1557. [PMID: 34180414 PMCID: PMC8461710 DOI: 10.3233/jad-210159] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preventing Loss of Independence through Exercise (PLIÉ) is a group movement program initially developed for people with mild-to-moderate dementia that integrates principles from several well-established traditions to specifically address the needs of people with cognitive impairment. OBJECTIVE To investigate whether PLIÉ would benefit cognitive and behavioral outcomes and functional brain connectivity in older adults with milder forms of cognitive impairment. METHODS Participants (≥55 y) with subjective memory decline (SMD) or mild cognitive impairment (MCI) were assessed with tests of cognitive and physical function, self-report questionnaires, and resting state functional magnetic resonance imaging (rs-fMRI) on a 3 Tesla scanner before and after participating in twice weekly PLIÉ classes for 12 weeks at the San Francisco Veterans Affairs Medical Center. RESULTS Eighteen participants completed the pre-post intervention pilot trial. We observed significant improvements on the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog; effect size 0.34, p = 0.002) and enhanced functional connections between the medial prefrontal cortex (mPFC) and other nodes of the default mode network (DMN) after PLIÉ. Improvements (i.e., lower scores) on ADAS-cog were significantly correlated with enhanced functional connectivity between the mPFC and left lateral parietal cortex (Spearman's ρ= -0.74, p = 0.001) and between the mPFC and right hippocampus (Spearman's ρ= -0.83, p = 0.001). After completing PLIÉ, participants reported significant reductions in feelings of social isolation and improvements in well-being and interoceptive self-regulation. CONCLUSION These preliminary findings of post-PLIÉ improvements in DMN functional connectivity, cognition, interoceptive self-regulation, well-being and reduced feelings of social isolation warrant larger randomized, controlled trials of PLIÉ in older adults with SMD and MCI.
Collapse
Affiliation(s)
- Linda L Chao
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Jennifer A Lee
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Steven Martinez
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Cody Barlow
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Margaret A Chesney
- Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
| | - Wolf E Mehling
- Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA.,Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Deborah E Barnes
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| |
Collapse
|
39
|
Darmanthé N, Tabatabaei-Jafari H, Cherbuin N. Combination of Plasma Neurofilament Light Chain and Mini-Mental State Examination Score Predicts Progression from Mild Cognitive Impairment to Alzheimer's Disease within 5 Years. J Alzheimers Dis 2021; 82:951-964. [PMID: 34120902 DOI: 10.3233/jad-210092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals with mild cognitive impairment (MCI) are at high risk of progression to Alzheimer's disease (AD) dementia, but some remain stable. There is a need to identify those at higher risk of progression to improve patient management and outcomes. OBJECTIVE To evaluate the trajectory of plasma neurofilament light chain (pNFL) prior to progression from MCI to AD dementia, the performance of pNFL, in combination with the Mini-Mental State Examination (MMSE), as a predictor of progression from MCI to AD dementia and to inform clinicians on the use of pNFL as a predictive biomarker. METHODS Participants (n = 440) with MCI and longitudinal follow-up (mean = 4.2 years) from the AD Neuroimaging Initiative dataset were included. pNFL as a marker for neurodegeneration and the MMSE as a cognitive measure were investigated as simple/practical predictors of progression. The risk of progressing from MCI to AD dementia associated with pNFL and MMSE scores was assessed using Cox and logistic regression models. RESULTS The current risk of progression to AD dementia was 37%higher in individuals with high pNFL (> 56 ng/L) compared to those with average pNFL (≤40 ng/L). A combination of baseline pNFL and MMSE could differentiate those who progressed within 5 years (AUC = 0.75) from stable individuals. Including change in MMSE over 6-12 months further improved the model (AUC = 0.84). CONCLUSION Our findings reveal that combining pNFL with a simple dementia screener (MMSE) can reliably predict whether a person with MCI is likely to progress to AD dementia within 5 years.
Collapse
Affiliation(s)
- Nicolas Darmanthé
- ANU Medical School, Australian National University, Canberra, Australia
| | - Hossein Tabatabaei-Jafari
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
| | | |
Collapse
|
40
|
Association Between Gait, Cognition, and Gray Matter Volumes in Mild Cognitive Impairment and Healthy Controls. Alzheimer Dis Assoc Disord 2021; 34:231-237. [PMID: 31977569 DOI: 10.1097/wad.0000000000000371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS To assess the correlation between cognitive functioning and 3 gait parameters (gait speed, cadence, and stride length) in persons with mild cognitive impairment (MCI) and cognitively healthy controls and investigate linear correlations between gait and gray matter volumes. MATERIALS AND METHODS Participants were recruited at IRCCS San Camillo Hospital, Venice, Italy (MCI=43; age-matched controls=43). Participants underwent comprehensive neuropsychological assessment. Gait speed, cadence, and stride length, were assessed with the BTS FREEMG 300 device. Three-dimensional (3D) T1-weighted MR images were acquired using a 1.5 T Philips Achieva MRI system with a Turbo Field Echo sequence. RESULTS In MCI there was a positive correlation between gait speed and memory tests (P<0.05). In controls all 3 gait parameters correlated with executive functioning (P<0.01). Temporal and limbic areas (ie, superior temporal gyrus, thalamus and parahippocampal gyrus) were associated with gait parameters in MCI whereas in controls the associations were with frontal areas (ie, middle, inferior, and superior frontal gyrus) and in the cerebellum (anterior and posterior lobe). CONCLUSIONS Our results highlight a distinct pattern of association between gray matter volume and gait parameters in MCI patients and controls (temporal areas in MCI and frontal areas in healthy elderly), suggesting a relationship between dementia-related pathology and gait dysfunction.
Collapse
|
41
|
Welstead M, Luciano M, Muniz-Terrera G, Taylor AM, Russ TC. Prevalence of Mild Cognitive Impairment in the Lothian Birth Cohort 1936. Alzheimer Dis Assoc Disord 2021; 35:230-236. [PMID: 33480611 PMCID: PMC8386587 DOI: 10.1097/wad.0000000000000433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Lothian Birth Cohort 1936 (LBC1936) is a highly phenotyped longitudinal study of cognitive and brain ageing. Given its substantial clinical importance, we derived an indicator of mild cognitive impairment (MCI) and amnestic and nonamnestic subtypes at 3 time points. METHODS MCI status was derived at 3 waves of the LBC1936 at ages 76 (n=567), 79 (n=441), and 82 years (n=341). A general MCI category was derived as well as amnestic MCI (aMCI) and nonamnestic MCI (naMCI). A comparison was made between MCI derivations using normative data from the LBC1936 cohort versus the general UK population. RESULTS MCI rates showed a proportional increase at each wave between 76 and 82 years from 15% to 18%. Rates of MCI subtypes also showed a proportional increase over time: aMCI 4% to 6%; naMCI 12% to 16%. Higher rates of MCI were found when using the LBC1936 normative data to derive MCI classification rather than UK-wide norms. CONCLUSIONS We found that MCI and aMCI rates in the LBC1936 were consistent with previous research. However, naMCI rates were higher than expected. Future LBC1936 research should assess the predictive factors associated with MCI prevalence to validate previous findings and identify novel risk factors.
Collapse
Affiliation(s)
| | | | | | | | - Tom C. Russ
- Lothian Birth Cohorts, Department of Psychology
- Edinburgh Dementia Prevention
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
42
|
Zhao J, Jin X, Chen B, Fu C, Ji S, Shen W, Wei J, Zheng H, Zhang Y. Apathy symptoms increase the risk of dementia conversion: a case-matching cohort study on patients with post-stroke mild cognitive impairment in China. Psychogeriatrics 2021; 21:149-157. [PMID: 33395732 DOI: 10.1111/psyg.12634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 10/04/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Apathy is a neuropsychiatric symptom frequently observed in patients with cognitive impairment. It has been found to be a predictor of conversion from mild cognitive impairment (MCI) to dementia of Alzheimer disease type. However, this association between apathy and dementia conversion has not yet been confirmed in vascular MCI, especially post-stroke MCI. The aim of this study was to evaluate whether apathy would increase the risk of dementia conversion in patients with post-stroke MCI after 6 months. METHOD A prospective multi-centre cohort study was performed in 14 clinics in seven provinces and cities of China. A total of 989 subjects were included 2 weeks to 6 months after stroke, and met the diagnostic criteria of International Working Group for MCI. Symptoms of apathy were assessed using the apathy subscale of Geriatric Depression Scale. Subjects were divided into an apathy group (n = 128) and a non-apathy group (n = 861). The primary outcome was the dementia conversion after 6 months. To eliminate potential biases, subjects were chosen from 861 non-apathy patients with similarity in seven potential predictors of cognitive impairment to match with the apathy group (n = 128) at a 1:1 ratio, as a matched non-apathy group (n = 128). The dementia conversion rate was compared between the apathy group (n = 128) and its correspondingly matched non-apathy group (n = 128), and the relative risk (RR) was calculated. RESULTS The prevalence of apathy in post-stroke MCI was 12.9%. After 6 months, 5.2% of patients with post-stroke MCI converted to dementia. The dementia conversion rate of the apathy group was significantly higher than that of the non-apathy group before case-matching (17.2% vs 3.4%, P < 0.001), and also after case-matching (17.2% vs 6.3%, P < 0.001). Symptoms of apathy increased the risk of conversion from MCI to dementia (RR 2.75, 95% CI 1.272-5.947, P < 0.001). CONCLUSIONS For patients with post-stroke MCI, apathy symptoms increase the risk of conversion from MCI to dementia.
Collapse
Affiliation(s)
- Jiayi Zhao
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xianglan Jin
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Baoxin Chen
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Fu
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shaozhen Ji
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Shen
- Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Wei
- Beijing University of Chinese Medicine, Beijing, China
| | - Hong Zheng
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yunling Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
43
|
Tabatabaei-Jafari H, Shaw ME, Walsh E, Cherbuin N. Cognitive/Functional Measures Predict Alzheimer's Disease, Dependent on Hippocampal Volume. J Gerontol B Psychol Sci Soc Sci 2021; 75:1393-1402. [PMID: 30668830 DOI: 10.1093/geronb/gbz011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 01/18/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the predictive value of cognitive/functional measures in combination with hippocampal volume (HCV) on the probability of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD). METHODS The Rey Auditory Verbal Learning Test for immediate memory, Mini-Mental State Examination, a functional assessment for independent daily activities and Alzheimer's Disease Assessment Scale were used as cognitive/functional measures and HCV as neuroimaging measure. Logistic regression and Cox proportional hazard analyses were used to explore the measures' predictive values for AD conversion and time to conversion. RESULTS The probability of conversion from MCI to AD was associated with cognitive function, but this was moderated by HCV: higher at lower HCV and lower at higher HCV. General cognitive/functional measures were less predictive than immediate memory in predicting time to conversion to AD at small HCVs. CONCLUSION Effectiveness of cognitive measures and subtle functional abnormality in predicting conversion from MCI to AD is dependent on HCV, thus combined evaluation should be considered. A combination of HCV and immediate memory appear to perform best in predicting time to conversion.
Collapse
Affiliation(s)
| | - Marnie E Shaw
- College of Engineering and Computer Science, The Australian National University, Canberra, Australia
| | - Erin Walsh
- Centre for Research on Ageing, Health and Wellbeing
| | | |
Collapse
|
44
|
Katayama O, Lee S, Bae S, Makino K, Shinkai Y, Chiba I, Harada K, Shimada H. Lifestyle changes and outcomes of older adults with mild cognitive impairment: A 4-year longitudinal study. Arch Gerontol Geriatr 2021; 94:104376. [PMID: 33588157 DOI: 10.1016/j.archger.2021.104376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Longitudinal studies have shown that mild cognitive impairment (MCI) reverts to normal cognition (NC). However, we could not find any reports on the examination of changes in lifestyle activity patterns in older adults diagnosed with MCI and their outcomes, in a longitudinal study. We determined the changes in lifestyle activity patterns among older adults with MCI. METHODS The participants in this study were 769 community-dwelling older adults aged ≥65 years with MCI at baseline. Four years later, participants were categorized into reverters, maintainers, and converters who reverted from MCI to NC, maintained MCI, and had global cognitive impairment or Alzheimer disease, respectively. We used latent class analysis to classify changes in instrumental activities of daily living, and in cognitive, social, and productive activities of the participants. Subsequently, a multinomial logistic regression analysis was performed with reversion status and class membership as the dependent and independent variables, respectively. RESULTS The reversion rate of 769 participants was 33.3%. The reverters maintained multidomain lifestyle activities, converters discontinued multidomain lifestyle activities or were inactive, and maintainers maintained productive activities. According to the logistic regression analysis, the activity patterns of those who continued to engage in multidomain lifestyle activities and start activities, were more likely to help in reverting from MCI to NC (P < 0.05). CONCLUSIONS Community-dwelling older adults with MCI who continued their multidomain lifestyle activities were more likely to revert to NC. Even if it does not revert to NC, continuing productive activities is important to maintaining MCI without converting.
Collapse
Affiliation(s)
- Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan.
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan
| | - Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-City, Aichi 474-8511, Japan
| |
Collapse
|
45
|
Zhang Y, Natale G, Clouston S. Incidence of Mild Cognitive Impairment, Conversion to Probable Dementia, and Mortality. Am J Alzheimers Dis Other Demen 2021; 36:15333175211012235. [PMID: 34032119 PMCID: PMC8715729 DOI: 10.1177/15333175211012235] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few studies have jointly estimated incidence of MCI, conversion to probable dementia, and mortality in a nationally representatie sample. METHODS We used data from six waves of the National Health and Aging Trends Study (2011-2016). Multivariable-adjusted multi-state survival models (MSMs) were used to model incidence upon accounting for misclassification. RESULTS A total of 6,078 eligible NHATS participants were included (average age: 77.49 ± 7.79 years; 58.42% females; 68.99% non-Hispanic white). The incidence of MCI was estimated to be 41.0 [35.5, 47.3]/1,000 person-years (PY). Participants converted to probable dementia at a high rate of 241.3 [189.6, 307.0]/1,000 PY, though a small number also reverted from MCI to cognitively normal. Education was associated with lower incidence of MCI and conversion to probable dementia, but increased mortality in those with MCI. There were also substantial racial and ethnic disparities in the incidence of MCI and dementia. CONCLUSIONS Our results underscore the relatively common incidence of and conversions between MCI and dementia in community-dwelling older Americans and uncover the beneficial impact of education to withstand cognitive impairment before death.
Collapse
Affiliation(s)
- Yun Zhang
- Program in Public Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, NY, USA
| | - Ginny Natale
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, NY, USA
| | - Sean Clouston
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, NY, USA
| |
Collapse
|
46
|
Welstead M, Luciano M, Muniz-Terrera G, Saunders S, Mullin DS, Russ TC. Predictors of Mild Cognitive Impairment Stability, Progression, or Reversion in the Lothian Birth Cohort 1936. J Alzheimers Dis 2021; 80:225-232. [PMID: 33523010 PMCID: PMC8075399 DOI: 10.3233/jad-201282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) describes a borderland between healthy cognition and dementia. Progression to and reversion from MCI is relatively common but more research is required to understand the factors affecting this fluidity and improve clinical care interventions. OBJECTIVE We explore these transitions in MCI status and their predictive factors over a six-year period in a highly-phenotyped longitudinal study, the Lothian Birth Cohort 1936. METHODS MCI status was derived in the LBC1936 at ages 76 (n = 567) and 82 years (n = 341) using NIA-AA diagnostic guidelines. Progressions and reversions between healthy cognition and MCI over the follow-up period were assessed. Multinomial logistic regression assessed the effect of various predictors on the likelihood of progressing, reverting, or maintaining cognitive status. RESULTS Of the 292 participants who completed both time points, 41 (14%) participants had MCI at T1 and 56 (19%) at T2. Over the follow-up period, 74%remained cognitively healthy, 12%transitioned to MCI, 7%reverted to healthy cognition, and 7%maintained their baseline MCI status. Findings indicated that membership of these transition groups was affected by age, cardiovascular disease, and number of depressive symptoms. CONCLUSION Findings that higher baseline depressive symptoms increase the likelihood of reverting from MCI to healthy cognition indicate that there may be an important role for the treatment of depression for those with MCI. However, further research is required to identify prevention strategies for those at high risk of MCI and inform effective interventions that increase the likelihood of reversion to, and maintenance of healthy cognition.
Collapse
Affiliation(s)
- Miles Welstead
- Lothian Birth Cohorts, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Michelle Luciano
- Lothian Birth Cohorts, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Stina Saunders
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Donncha S. Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom C. Russ
- Lothian Birth Cohorts, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
47
|
Yuan J, Maserejian N, Liu Y, Devine S, Gillis C, Massaro J, Au R. Severity Distribution of Alzheimer's Disease Dementia and Mild Cognitive Impairment in the Framingham Heart Study. J Alzheimers Dis 2020; 79:807-817. [PMID: 33361590 DOI: 10.3233/jad-200786] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies providing Alzheimer's disease (AD) prevalence data have largely neglected to characterize the proportion of AD that is mild, moderate, or severe. Estimates of the severity distribution along the AD continuum, including the mild cognitive impairment (MCI) stage, are important to plan research and allocate future resources, particularly resources targeted at particular stages of disease. OBJECTIVE To characterize the distribution of severity of AD dementia and MCI among prevalent cases in the population-based Framingham Heart Study. METHODS Participants (aged 50-94) with prevalent MCI or AD dementia clinical syndrome were cross-sectionally selected from three time-windows of the population-based Framingham Heart Study in 2004-2005 (n = 381), 2006-2007 (n = 422), and 2008-2009 (n = 389). Summary estimates of the severity distribution were achieved by pooling results across time-windows. Diagnosis and severity were assessed by consensus dementia review. MCI-progressive was determined if the participant had documented progression to AD dementia clinical syndrome using longitudinal data. RESULTS Among AD dementia participants, the pooled percentages were 50.4%for mild, 30.3%for moderate, and 19.3%for severe. Among all MCI and AD participants, the pooled percentages were 29.5%, 19.6%, 25.7%, and 45.2%for MCI-not-progressive, MCI-progressive, mild AD dementia, and the combined group of MCI-progressive and mild AD dementia, respectively. Distributions by age and sex were presented. CONCLUSION The finding that half of the people living with AD have mild disease underscores the need for research and interventions to slow decline or prevent progression of this burdensome disease.
Collapse
Affiliation(s)
- Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Yulin Liu
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Sherral Devine
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Cai Gillis
- Department of Epidemiology, Biogen, Cambridge, MA, USA
| | - Joseph Massaro
- Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA.,Biostatistics Department, Boston University School of Public Health, Boston, MA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
48
|
Bermejo-Pareja F, Contador I, Del Ser T, Olazarán J, Llamas-Velasco S, Vega S, Benito-León J. Predementia constructs: Mild cognitive impairment or mild neurocognitive disorder? A narrative review. Int J Geriatr Psychiatry 2020. [PMID: 33340379 DOI: 10.1002/gps.5474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Predementia is a heuristic umbrella concept to classify older adults with cognitive impairment who do not suffer dementia. Many diagnostic entities have been proposed to address this concept, but most of them have not had widespread acceptance. AIMS To review clinical definitions, epidemiologic data (prevalence, incidence) and rate of conversion to dementia of the main predementia constructs, with special interest in the two most frequently used: mild cognitive impairment (MCI) and minor neurocognitive disorder (miNCD). METHODS We have selected in three databases (MEDLINE, Web of Science and Google scholar) the references from inception to 31 December 2019 of relevant reviews, population and community-based surveys, and clinical series with >500 participants and >3 years follow-up as the best source of evidence. MAIN RESULTS The history of predementia constructs shows that MCI is the most referred entity. It is widely recognized as a clinical syndrome harbinger of dementia of several etiologies, mainly MCI due to Alzheimer's disease. The operational definition of MCI has shortcomings: vagueness of its requirement of "preserved independence in functional abilities" and others. The recent miNCD construct presents analogous difficulties. Current data indicate that it is a stricter predementia condition, with lower prevalence than MCI, less sensitivity to cognitive decline and, possibly, higher conversion rate to dementia. CONCLUSIONS MCI is a widely employed research and clinical entity. Preliminary data indicate that the clinical use of miNCD instead of MCI requires more scientific evidence. Both approaches have common limitations that need to be addressed.
Collapse
Affiliation(s)
- Félix Bermejo-Pareja
- Research Institute (Imas12), University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science, University of Salamanca, Salamanca, Spain
| | - Teodoro Del Ser
- Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation Alzheimer Research, Madrid, Spain
| | - Javier Olazarán
- Department of Neurology, University Hospital "Gregorio Marañón", Madrid, Spain
| | - Sara Llamas-Velasco
- Research Institute (Imas12), University Hospital "12 de Octubre", Madrid, Spain
| | | | - Julián Benito-León
- Research Institute (Imas12), University Hospital "12 de Octubre", Madrid, Spain
| |
Collapse
|
49
|
Derby CA, Katz MJ, Rozner S, Lipton RB, Hall CB. A Birth Cohort Analysis of Amnestic Mild Cognitive Impairment Incidence in the Einstein Aging Study (EAS) Cohort. J Alzheimers Dis 2020; 70:S271-S281. [PMID: 31256119 PMCID: PMC6700647 DOI: 10.3233/jad-181141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The transition from normal cognition to Alzheimer's disease is considered a continuum, with amnestic mild cognitive impairment (aMCI) an intermediate clinical cognitive state. Although prior work suggests that dementia incidence rates may be declining, there is little information regarding temporal trends in aMCI incidence. OBJECTIVE To determine whether age specific rates of aMCI have changed over sequential birth cohorts among individuals included in the population-based Einstein Aging Study (EAS) cohort. A secondary objective was to examine trends in aMCI rates among Blacks and Whites and by sex. METHODS Age specific incidence of aMCI was examined by birth year among 1,233 individuals age 70 years and above enrolled in the population-based EAS cohort between November 1, 1993 and February 22, 2016 and who had at least one annual follow-up assessment (5,321 person years of follow-up). Poisson regression was used to determine whether there has been a change in age specific aMCI rates over sequential years of birth. RESULTS No significant change in aMCI rates was identified in the overall cohort, among Blacks or Whites, or among males or females born between 1899 and 1946. CONCLUSIONS Despite a trend for decreased dementia incidence in the EAS cohort, rates of incident aMCI have not changed. These apparently conflicting results may indicate a delay or decrease in the rates of transition from aMCI to dementia within the cohort. However, further studies are needed to confirm whether rates of aMCI have changed in other populations, and how aMCI rates are related to secular trends in dementia risk factors.
Collapse
Affiliation(s)
- Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sara Rozner
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles B Hall
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
50
|
Di Costanzo A, Paris D, Melck D, Angiolillo A, Corso G, Maniscalco M, Motta A. Blood biomarkers indicate that the preclinical stages of Alzheimer's disease present overlapping molecular features. Sci Rep 2020; 10:15612. [PMID: 32973179 PMCID: PMC7515866 DOI: 10.1038/s41598-020-71832-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/22/2020] [Indexed: 02/07/2023] Open
Abstract
It is still debated whether non-specific preclinical symptoms of Alzheimer's disease (AD) can have diagnostic relevance. We followed the evolution from cognitively normal to AD by NMR-based metabolomics of blood sera. Multivariate statistical analysis of the NMR profiles yielded models that discriminated subjective memory decline (SMD), mild cognitive impairment (MCI) and AD. We validated a panel of six statistically significant metabolites that predicted SMD, MCI and AD in a blind cohort with sensitivity values ranging from 88 to 95% and receiver operating characteristic values from 0.88 to 0.99. However, lower values of specificity, accuracy and precision were observed for the models involving SMD and MCI, which is in line with the pathological heterogeneity indicated by clinical data. This excludes a "linear" molecular evolution of the pathology, pointing to the presence of overlapping "gray-zones" due to the reciprocal interference of the intermediate stages. Yet, the clear difference observed in the metabolic pathways of each model suggests that pathway dysregulations could be investigated for diagnostic purposes.
Collapse
Affiliation(s)
- Alfonso Di Costanzo
- 1Centre for Research and Training in Medicine for Aging, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Debora Paris
- Institute of Biomolecular Chemistry, National Research Council, 80078, Pozzuoli, Naples, Italy.
| | - Dominique Melck
- Institute of Biomolecular Chemistry, National Research Council, 80078, Pozzuoli, Naples, Italy
| | - Antonella Angiolillo
- 1Centre for Research and Training in Medicine for Aging, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Gaetano Corso
- Department of Clinical and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA SB, Institute of Telese Terme, 82037, Telese Terme, Benevento, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078, Pozzuoli, Naples, Italy.
| |
Collapse
|