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Ahmad F, Sachdeva P, Sarkar J, Izhaar R. Circadian dysfunction and Alzheimer's disease - An updated review. Aging Med (Milton) 2023; 6:71-81. [PMID: 36911088 PMCID: PMC10000289 DOI: 10.1002/agm2.12221] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Alzheimer's disease (AD) is considered to be the most typical form of dementia that provokes irreversible cognitive impairment. Along with cognitive impairment, circadian rhythm dysfunction is a fundamental factor in aggravating AD. A link among circadian rhythms, sleep, and AD has been well-documented. The etiopathogenesis of circadian system disruptions and AD serves some general characteristics that also open up the possibility of viewing them as a mutually reliant path. In this review, we have focused on different factors that are related to circadian rhythm dysfunction. The various pathogenic factors, such as amyloid-beta, neurofibrillary tangles, oxidative stress, neuroinflammation, and circadian rhythm dysfunction may all contribute to AD. In this review, we also tried to focus on melatonin which is produced from the pineal gland and can be used to treat circadian dysfunction in AD. Aside from amyloid beta, tau pathology may have a notable influence on sleep. Conclusively, the center of this review is primarily based on the principal mechanistic complexities associated with circadian rhythm disruption, sleep deprivation, and AD, and it also emphasizes the potential therapeutic strategies to treat and prevent the progression of AD.
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Affiliation(s)
- Faizan Ahmad
- Department of Medical Elementology and Toxicology Jamia Hamdard University Delhi India
| | - Punya Sachdeva
- Amity Institute of Neuropsychology and Neurosciences Amity University Noida Uttar Pradesh India
| | - Jasmine Sarkar
- Amity Institute of Neuropsychology and Neurosciences Amity University Noida Uttar Pradesh India
| | - Raafiah Izhaar
- Department of Biosciences Jamia Millia Islamia Delhi India
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2
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Sáiz-Vazquez O, Puente-Martínez A, Pacheco-Bonrostro J, Ubillos-Landa S. Blood pressure and Alzheimer's disease: A review of meta-analysis. Front Neurol 2023; 13:1065335. [PMID: 36712428 PMCID: PMC9874700 DOI: 10.3389/fneur.2022.1065335] [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: 10/09/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Background Alzheimer's disease (AD) is a neurological disorder of unknown cause, resulting in the death of brain cells. Identifying some of the modifiable risk factors for AD could be crucial for primary prevention and could lead to a reduction in the incidence of AD. Objective This study aimed to perform a meta-meta-analysis of studies in order to assess the effect of blood pressure (BP) on the diagnosis of AD. Method The search was restricted to meta-analyses assessing high systolic BP (SBP) and diastolic BP (DBP) and AD. We applied the PRISMA guidelines. Results A total of 214 studies were identified from major databases. Finally, five meta-analyses (52 studies) were analyzed in this review. Results confirm that high SBP is associated with AD. The exploration of parameters (sex, age, study design, region, and BP measurements) shows that only region significantly moderates the relationship between BP and AD. Asian people are those whose SBP levels >140 mmHg are associated with AD. BP is associated with AD in both people aged ≤65 years and those aged ≥65 years and in cross-sectional and longitudinal studies. In the case of DBP, only women are at a higher risk of AD, particularly when its levels are >90. Conclusion SBP is associated with both cerebrovascular disease and AD. Therefore, future studies should use other uncontrolled factors, such as cardiovascular diseases, diabetes, and stroke, to explain the relationship between SBP and AD.
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Affiliation(s)
- Olalla Sáiz-Vazquez
- Department of Occupational Therapy, Faculty of Health Science, University of Burgos, Burgos, Spain
| | - Alicia Puente-Martínez
- Department of Social Psychology and Anthropology, Faculty of Social Sciences, University of Salamanca (USAL), Salamanca, Spain
| | - Joaquín Pacheco-Bonrostro
- Department of Applied Economy, Faculty of Economics and Business Sciences, University of Burgos, Burgos, Spain
| | - Silvia Ubillos-Landa
- Department of Social Psychology, Faculty of Health Science, University of Burgos, Burgos, Spain,*Correspondence: Silvia Ubillos-Landa ✉
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Korhonen K, Leinonen T, Tarkiainen L, Einiö E, Martikainen P. Childhood socio-economic circumstances and dementia: prospective register-based cohort study of adulthood socio-economic and cardiovascular health mediators. Int J Epidemiol 2022; 52:523-535. [PMID: 36343014 PMCID: PMC10114069 DOI: 10.1093/ije/dyac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
This study analysed the association between childhood socio-economic circumstances and the risk of dementia, and investigated the mediating role of potentially modifiable risk factors including adulthood socio-economic position and cardiovascular health.
Methods
We used a 10% sample of the 1950 Finnish population census linked with subsequent population and health registers (n = 95 381). Information of socio-economic characteristics, family structure and housing conditions at the age of 0–15 years was obtained from the 1950 census. We identified cohort members who developed dementia in 2000–2018 using national hospital, medication and death registers. Discrete time survival analysis using logistic regression and mediation analysis applying the Karlson–Holm–Breen (KHB) method were employed.
Results
An excess risk of dementia was observed for household crowding [odds ratio (OR) = 1.10; 95% CI 1.02–1.18 for 3 to <4 persons per heated room; OR = 1.19; 95% CI 1.11–1.27 for ≥4 persons], single-father family (OR = 1.27; 95% CI 1.07–1.51) and eastern and northern region of residence (OR = 1.19; 95% CI 1.10–1.28). The effects of single-father family and region of residence were mostly direct with adulthood characteristics mediating 14% and 29% of the total effect, respectively. The largest indirect effect was observed for household crowding mediated through adulthood socio-economic position (47–65%).
Conclusions
The study shows that childhood socio-economic circumstances are associated with dementia, and that the underlying mechanisms only partly relate to adulthood socio-economic position and cardiovascular health. Socio-economic and health interventions targeted at families with children may carry long-term benefits by contributing to a lower dementia risk in later life.
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Affiliation(s)
- Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Taina Leinonen
- Finnish Institute of Occupational Health , Helsinki, Finland
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Helsinki Institute of Urban and Regional Studies (URBARIA), University of Helsinki , Helsinki, Finland
| | - Elina Einiö
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Max Planck Institute for Demographic Research , Rostock, Germany
- Department of Public Health Sciences, Stockholm University , Stockholm, Sweden
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Rubin L, Ingram LA, Resciniti NV, Ashford-Carroll B, Leith KH, Rose A, Ureña S, McCollum Q, Friedman DB. Genetic Risk Factors for Alzheimer's Disease in Racial/Ethnic Minority Populations in the U.S.: A Scoping Review. Front Public Health 2021; 9:784958. [PMID: 35004586 PMCID: PMC8739784 DOI: 10.3389/fpubh.2021.784958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Design: Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical studies or Genome-Wide Association Studies that had been published 2005-2018 and focused on ADRD-related genes or genetic factors among underrepresented racial/ethnic minority population in the U.S. Results: Sixty-six articles met the inclusion criteria for full text review. Well-established ADRD genetic risk factors for Caucasian populations including APOE, APP, PSEN1, and PSEN2 have not been studied to the same degree in minority U.S. populations. Compared to the amount of research that has been conducted with Caucasian populations in the U.S., racial/ethnic minority communities are underrepresented. Conclusion: Given the projected growth of the aging population and incidence of ADRDs, particularly among racial/ethnic minorities, increased focus on this important segment of the population is warranted. Our review can aid researchers in developing fundamental research questions to determine the role that ADRD risk genes play in the heavier burden of ADRDs in racial/ethnic minority populations.
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Affiliation(s)
- Lindsey Rubin
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Lucy A. Ingram
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Brianna Ashford-Carroll
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Katherine Henrietta Leith
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Aubrey Rose
- School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Stephanie Ureña
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Quentin McCollum
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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He JT, Zhao X, Xu L, Mao CY. Vascular Risk Factors and Alzheimer's Disease: Blood-Brain Barrier Disruption, Metabolic Syndromes, and Molecular Links. J Alzheimers Dis 2021; 73:39-58. [PMID: 31815697 DOI: 10.3233/jad-190764] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder, marked by cortical and hippocampal deposition of amyloid-β (Aβ) plaques and neurofibrillary tangles and cognitive impairment. Studies indicate a prominent link between cerebrovascular abnormalities and the onset and progression of AD, where blood-brain barrier (BBB) dysfunction and metabolic disorders play key risk factors. Pericyte degeneration, endothelial cell damage, astrocyte depolarization, diminished tight junction integrity, and basement membrane disarray trigger BBB damage. Subsequently, the altered expression of low-density lipoprotein receptor-related protein 1 and receptor for advanced glycation end products at the microvascular endothelial cells dysregulate Aβ transport across the BBB. White matter lesions and microhemorrhages, dyslipidemia, altered brain insulin signaling, and insulin resistance contribute to tau and Aβ pathogenesis, and oxidative stress, mitochondrial damage, inflammation, and hypoperfusion serve as mechanistic links between pathophysiological features of AD and ischemia. Deregulated calcium homeostasis, voltage gated calcium channel functioning, and protein kinase C signaling are also common mechanisms for both AD pathogenesis and cerebrovascular abnormalities. Additionally, APOE polymorphic alleles that characterize impaired cerebrovascular integrity function as primary genetic determinants of AD. Overall, the current review enlightens key vascular risk factors for AD and underscores pathophysiologic relationship between AD and vascular dysfunction.
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Affiliation(s)
- Jin-Ting He
- Department of Neurology, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - Xin Zhao
- Department of Paediatrics, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Lei Xu
- Department of Neurology, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - Cui-Ying Mao
- Department of Cardiology, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
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Deciphering the Interacting Mechanisms of Circadian Disruption and Alzheimer's Disease. Neurochem Res 2021; 46:1603-1617. [PMID: 33871799 DOI: 10.1007/s11064-021-03325-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/21/2021] [Accepted: 04/09/2021] [Indexed: 12/29/2022]
Abstract
Alzheimer's disease (AD) is one of the crucial causative factors for progressive dementia. Neuropathologically, AD is characterized by the extracellular accumulation of amyloid beta plaques and intracellular neurofibrillary tangles in cortical and limbic regions of the human brain. The circadian system is one of the many affected physiological processes in AD, the dysfunction of which may reflect in the irregularity of the sleep/wake cycle. The interplay of circadian and sleep disturbances inducing AD progression is bidirectional. Sleep-associated pathological alterations are frequently evident in AD. Understanding the interrelation between circadian disruption and AD may allow for earlier identification of AD pathogenesis as well as better suited approaches and potential therapies to combat dementia. In this article, we examine the existing literature related to the molecular mechanisms of the circadian clock and interacting mechanisms of circadian disruption and AD pathogenesis.
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[The future of dementia prevention and treatment strategies]. Nihon Ronen Igakkai Zasshi 2020; 57:374-396. [PMID: 33268621 DOI: 10.3143/geriatrics.57.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Maccora J, Peters R, Anstey KJ. What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education. SSM Popul Health 2020; 12:100654. [PMID: 33313373 PMCID: PMC7721642 DOI: 10.1016/j.ssmph.2020.100654] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 12/19/2022] Open
Abstract
Low education is considered an important modifiable risk factor for dementia worldwide, despite the lack of a formal consensus definition of low education. The primary aim of this systematic review was to document and address the inconsistency in measuring and operationalising education in dementia studies. A secondary aim was to consider the dose of education required to reduce dementia risk. The protocol was registered at PROSPERO with registration ID CRD42018096168. CINAHL, Cochrane, PsycInfo, and Pubmed databases were searched using terms related to education, dementia and/or MCI, and incidence. Studies were eligible for inclusion if a risk ratio for education and any dementia, Alzheimer's Disease (AD), Vascular Dementia (VaD) or Mild Cognitive Impairment (MCI) was reported in a population cognitively healthy at baseline. Sample sizes for 65 studies meeting selection criteria ranged from 152 to 12,881, representing populations from 24 countries. Risk of bias, assessed using a tool designed specifically for dementia risk studies, was found to be medium or low for all studies. There were 23 continuous, 29 dichotomous, and 31 categorical operationalisations of education reported. Random effects meta-analyses from continuous operationalisations suggested each year of education reduced risk by eight percent for AD (95% CI:5-12%) and seven percent for any dementia (95% CI:6-9%). Dichotomous operationalisations indicated an increased risk for low education of 45% (95% CI:29-63%) for any dementia and 85% (95% CI:56-118%) for AD, however definitions of low education were heterogeneous, ranging from zero to 12 years. There were too few studies to produce summary ratios for VaD or MCI. We conclude that, while the evidence of an association between low education and dementia incidence is robust, inconsistency in the definition, measurement and operationalisation of education hinders the translation of this evidence into practical policy recommendations to reduce dementia risk.
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Affiliation(s)
- Janet Maccora
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence in Populating Ageing Research (CEPAR), Australia
| | - Ruth Peters
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- Australian Research Council Centre of Excellence in Populating Ageing Research (CEPAR), Australia
| | - Kaarin J. Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
- Australian Research Council Centre of Excellence in Populating Ageing Research (CEPAR), Australia
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Li L, Cavuoto M, Biddiscombe K, Pike KE. Diabetes Mellitus Increases Risk of Incident Dementia in APOE ɛ4 Carriers: A Meta-Analysis. J Alzheimers Dis 2020; 74:1295-1308. [DOI: 10.3233/jad-191068] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lily Li
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Marina Cavuoto
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Karen Biddiscombe
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kerryn E. Pike
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
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Shinohara M, Tashiro Y, Suzuki K, Fukumori A, Bu G, Sato N. Interaction between APOE genotype and diabetes in cognitive decline. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12006. [PMID: 32211501 PMCID: PMC7085280 DOI: 10.1002/dad2.12006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/10/2019] [Accepted: 11/01/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Although diabetes and apolipoprotein E (apoE) are both significant risk factors for dementia, including Alzheimer's disease, it remains to be clarified how they are related to each other in contributing to the risk of dementia. METHODS By reviewing the National Alzheimer's Coordinating Center (NACC) clinical records, we investigated whether diabetes affects cognitive decline depending on APOE genotype and their potential relationships with neuropathology. RESULTS A significant interaction between diabetes and APOE genotype exists, where diabetes affected cognitive decline in APOE3 carriers and APOE2 carriers, but not APOE4 carriers. Moreover, the presence of vascular pathology was increased by diabetes in APOE3 carriers, while APOE4 carriers nearly reached plateau levels irrespective of diabetes. DISCUSSION Diabetes accelerates cognitive decline, in part, through accelerating vascular impairment in non-APOE ε4 carriers, but such effects are negligible in APOE4 carriers, who themselves are already vulnerable to vascular impairment.
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Affiliation(s)
- Mitsuru Shinohara
- Department of Aging NeurobiologyCenter for Development of Advanced Medicine for DementiaNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of Aging NeurobiologyGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
- Department of NeuroscienceMayo ClinicJacksonvilleFloridaUSA
| | - Yoshitaka Tashiro
- Department of Aging NeurobiologyCenter for Development of Advanced Medicine for DementiaNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Kaoru Suzuki
- Department of Aging NeurobiologyCenter for Development of Advanced Medicine for DementiaNational Center for Geriatrics and GerontologyObuAichiJapan
| | - Akio Fukumori
- Department of Aging NeurobiologyCenter for Development of Advanced Medicine for DementiaNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of Aging NeurobiologyGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Guojun Bu
- Department of NeuroscienceMayo ClinicJacksonvilleFloridaUSA
| | - Naoyuki Sato
- Department of Aging NeurobiologyCenter for Development of Advanced Medicine for DementiaNational Center for Geriatrics and GerontologyObuAichiJapan
- Department of Aging NeurobiologyGraduate School of MedicineOsaka UniversitySuitaOsakaJapan
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Lim S, Mohaimin S, Min D, Roberts T, Sohn YJ, Wong J, Sivanesathurai R, Kwon SC, Trinh-Shevrin C. Alzheimer's Disease and its Related Dementias among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review. J Alzheimers Dis 2020; 77:523-537. [PMID: 32675416 PMCID: PMC8638681 DOI: 10.3233/jad-200509] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer's disease and its related dementias (ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely ADRD diagnosis and services; yet little is known about ADRD in this population. OBJECTIVE The study objective is to conduct a systematic review on the published literature on ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans. METHODS The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline, and Web of Science for peer-reviewed articles describing ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 168 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge and attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities. CONCLUSION To our knowledge, this is the first systematic review on ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on ADRD among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine
| | - Sadia Mohaimin
- Department of Population Health, New York University Grossman School of Medicine
| | - Deborah Min
- Department of Population Health, New York University Grossman School of Medicine
| | - Timothy Roberts
- Health Science Library, New York University Grossman School of Medicine
| | - Young-Jin Sohn
- Department of Population Health, New York University Grossman School of Medicine
| | - Jazmine Wong
- Department of Population Health, New York University Grossman School of Medicine
| | | | - Simona C. Kwon
- Department of Population Health, New York University Grossman School of Medicine
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine
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12
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Berkowitz CL, Mosconi L, Rahman A, Scheyer O, Hristov H, Isaacson RS. Clinical Application of APOE in Alzheimer's Prevention: A Precision Medicine Approach. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2019; 5:245-252. [PMID: 30298183 DOI: 10.14283/jpad.2018.35] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Population-attributable risk models estimate that up to one-third of Alzheimer's disease (AD) cases may be preventable through risk factor modification. The field of AD prevention has largely focused on addressing these factors through universal risk reduction strategies for the general population. However, targeting these strategies in a clinical precision medicine fashion, including the use of genetic risk factors, allows for potentially greater impact on AD risk reduction. Apolipoprotein E (APOE), and specifically the APOE ε4 variant, is one of the most well-established genetic influencers on late-onset AD risk. In this review, we evaluate the impact of APOE ε4 carrier status on AD prevention interventions, including lifestyle, nutrigenomic, pharmacogenomic, AD comorbidities, and other biological and behavioral considerations. Using a clinical precision medicine strategy that incorporates APOE ε4 carrier status may provide a highly targeted and distinct approach to AD prevention with greater potential for success.
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Affiliation(s)
- C L Berkowitz
- Richard S. Isaacson, MD, Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, 428 East 72nd St, Suite 500, Room 407, New York, NY, 10021; Tel: (212) 746-3645,
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13
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Abell JG, Kivimäki M, Dugravot A, Tabak AG, Fayosse A, Shipley M, Sabia S, Singh-Manoux A. Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension. Eur Heart J 2018; 39:3119-3125. [PMID: 29901708 PMCID: PMC6122131 DOI: 10.1093/eurheartj/ehy288] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/24/2017] [Accepted: 05/03/2018] [Indexed: 01/04/2023] Open
Abstract
Aims To examine associations of diastolic and systolic blood pressure (SBP) at age 50, 60, and 70 years with incidence of dementia, and whether cardiovascular disease (CVD) over the follow-up mediates this association. Methods and results Systolic and diastolic blood pressure were measured on 8639 persons (32.5% women) from the Whitehall II cohort study in 1985, 1991, 1997, and 2003. Incidence of dementia (n dementia/n total = 385/8639) was ascertained from electronic health records followed-up until 2017. Cubic splines using continuous blood pressure measures suggested SBP ≥130 mmHg at age 50 but not at age 60 or 70 was associated with increased risk of dementia, confirmed in Cox regression analyses adjusted for sociodemographic factors, health behaviours, and time varying chronic conditions [hazard ratio (HR) 1.38; 95% confidence interval (95% CI) 1.11, 1.70]. Diastolic blood pressure was not associated with dementia. Participants with longer exposure to hypertension (SBP ≥ 130 mmHg) between mean ages of 45 and 61 years had an increased risk of dementia compared to those with no or low exposure to hypertension (HR 1.29, 95% CI 1.00, 1.66). In multi-state models, SBP ≥ 130 mmHg at 50 years of age was associated with greater risk of dementia in those free of CVD over the follow-up (HR 1.47, 95% CI 1.15, 1.87). Conclusion Systolic blood pressure ≥130 mmHg at age 50, below the conventional ≥140 mmHg threshold used to define hypertension, is associated with increased risk of dementia; in these persons this excess risk is independent of CVD.
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Affiliation(s)
- Jessica G Abell
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
| | - Adam G Tabak
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Faculty of Medicine, 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Aurore Fayosse
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, London, UK
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14
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Circadian Rhythm and Alzheimer's Disease. Med Sci (Basel) 2018; 6:medsci6030052. [PMID: 29933646 PMCID: PMC6164904 DOI: 10.3390/medsci6030052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disorder with a growing epidemiological importance characterized by significant disease burden. Sleep-related pathological symptomatology often accompanies AD. The etiology and pathogenesis of disrupted circadian rhythm and AD share common factors, which also opens the perspective of viewing them as a mutually dependent process. This article focuses on the bi-directional relationship between these processes, discussing the pathophysiological links and clinical aspects. Common mechanisms linking both processes include neuroinflammation, neurodegeneration, and circadian rhythm desynchronization. Timely recognition of sleep-specific symptoms as components of AD could lead to an earlier and correct diagnosis with an opportunity of offering treatments at an earlier stage. Likewise, proper sleep hygiene and related treatments ought to be one of the priorities in the management of the patient population affected by AD. This narrative review brings a comprehensive approach to clearly demonstrate the underlying complexities linking AD and circadian rhythm disruption. Most clinical data are based on interventions including melatonin, but larger-scale research is still scarce. Following a pathophysiological reasoning backed by evidence gained from AD models, novel anti-inflammatory treatments and those targeting metabolic alterations in AD might prove useful for normalizing a disrupted circadian rhythm. By restoring it, benefits would be conferred for immunological, metabolic, and behavioral function in an affected individual. On the other hand, a balanced circadian rhythm should provide greater resilience to AD pathogenesis.
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15
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Dos Santos Matioli MNP, Suemoto CK, Rodriguez RD, Farias DS, da Silva MM, Leite REP, Ferretti-Rebustini REL, Farfel JM, Pasqualucci CA, Jacob Filho W, Arvanitakis Z, Naslavsky MS, Zatz M, Grinberg LT, Nitrini R. Diabetes is Not Associated with Alzheimer's Disease Neuropathology. J Alzheimers Dis 2018; 60:1035-1043. [PMID: 28984587 DOI: 10.3233/jad-170179] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous evidence linking diabetes to Alzheimer's disease (AD) neuropathology is mixed and scant data are available from low- and middle-income countries. OBJECTIVE To investigate the association between diabetes and AD neuropathology in a large autopsy study of older Brazilian adults. METHODS In this cross-sectional study, diabetes was defined by diagnosis during life or use of antidiabetic medication. A standardized neuropathological examination was performed using immunohistochemistry. The associations of diabetes with Consortium to Establish and Registry for Alzheimer Disease (CERAD) scores for neuritic plaques and Braak-Braak (BB) scores for neurofibrillary tangles were investigated using multivariable ordinal logistic regression. We investigated effect modification of education, race, and APOE on these associations. RESULTS Among 1,037 subjects (mean age = 74.4±11.5 y; mean education = 4.0±3.7 y; 48% male, 61% White), diabetes was present in 279 subjects. Diabetes was not associated with BB (OR = 1.12, 95% CI = 0.81-1.54, p = 0.48) or with CERAD (OR = 0.97, 95% CI = 0.68-1.38, p = 0.86) scores on analyses adjusted for sociodemographic and clinical variables. We observed effect modification by the APOE allele ɛ4 on the association between diabetes mellitus and BB scores. CONCLUSION No evidence of an association between diabetes and AD neuropathology was found in a large sample of Brazilians; however, certain subgroups, such as APOE allele ɛ4 carriers, had higher odds of accumulation of neurofibrillary tangles.
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Affiliation(s)
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.,Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Roberta Diehl Rodriguez
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.,Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniela Souza Farias
- Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Magnólia Moreira da Silva
- Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Renata Elaine Paraizo Leite
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.,Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | | | - José Marcelo Farfel
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.,Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos Augusto Pasqualucci
- Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob Filho
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.,Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Michel Satya Naslavsky
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Lea Tenenholz Grinberg
- Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil.,Department of Neurology, University of California, San Francisco, CA, USA
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.,Brain Bank of the Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
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16
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Alonso R, Pisa D, Fernández-Fernández AM, Carrasco L. Infection of Fungi and Bacteria in Brain Tissue From Elderly Persons and Patients With Alzheimer's Disease. Front Aging Neurosci 2018; 10:159. [PMID: 29881346 PMCID: PMC5976758 DOI: 10.3389/fnagi.2018.00159] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/08/2018] [Indexed: 12/17/2022] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia in elderly people. The etiology of this disease remains a matter of intensive research in many laboratories. We have advanced the idea that disseminated fungal infection contributes to the etiology of AD. Thus, we have demonstrated that fungal proteins and DNA are present in nervous tissue from AD patients. More recently, we have reported that bacterial infections can accompany these mycoses, suggesting that polymicrobial infections exist in AD brains. In the present study, we have examined fungal and bacterial infection in brain tissue from AD patients and control subjects by immunohistochemistry. In addition, we have documented the fungal and bacterial species in brain regions from AD patients and control subjects by next-generation sequencing (NGS). Our results from the analysis of ten AD patients reveal a variety of fungal and bacterial species, although some were more prominent than others. The fungal genera more prevalent in AD patients were Alternaria, Botrytis, Candida, and Malassezia. We also compared these genera with those found in elderly and younger subjects. One of the most prominent genera in control subjects was Fusarium. Principal component analysis clearly indicated that fungi from frontal cortex samples of AD brains clustered together and differed from those of equivalent control subjects. Regarding bacterial infection, the phylum Proteobacteria was the most prominent in both AD patients and controls, followed by Firmicutes, Actinobacteria, and Bacteroides. At the family level, Burkholderiaceae and Staphylococcaceae exhibited higher percentages in AD brains than in control brains. These findings could be of interest to guide targeted antimicrobial therapy for AD patients. Moreover, the variety of microbial species in each patient may constitute a basis for a better understanding of the evolution and severity of clinical symptoms in each patient.
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Affiliation(s)
| | | | | | - Luis Carrasco
- Centro de Biología Molecular “Severo Ochoa”, Consejo Superior de Investigaciones Científicas y Universidad Autónoma de Madrid, Madrid, Spain
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17
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Osborn KE, Liu D, Samuels LR, Moore EE, Cambronero FE, Acosta LMY, Bell SP, Babicz MA, Gordon EA, Pechman KR, Davis LT, Gifford KA, Hohman TJ, Blennow K, Zetterberg H, Jefferson AL. Cerebrospinal fluid β-amyloid 42 and neurofilament light relate to white matter hyperintensities. Neurobiol Aging 2018; 68:18-25. [PMID: 29702372 DOI: 10.1016/j.neurobiolaging.2018.03.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/12/2022]
Abstract
White matter hyperintensities (WMHs) are associated with poorer brain health, but their pathophysiological substrates remain elusive. To better understand the mechanistic underpinnings of WMHs among older adults, this study examined in vivo cerebrospinal fluid biomarkers of β-amyloid42 deposition (Aβ42), hyperphosphorylated tau pathology, neurodegeneration (total tau), and axonal injury (neurofilament light [NFL]) in relation to log-transformed WMHs volume. Participants free of clinical stroke and dementia were drawn from the Vanderbilt Memory & Aging Project (n = 148, 72 ± 6 years). Linear regression models adjusted for age, sex, race/ethnicity, education, intracranial volume, modified Framingham Stroke Risk Profile (excluding points assigned for age), cognitive diagnosis, and APOE-ε4 carrier status. Aβ42 (β = -0.001, p = 0.007) and NFL (β = 0.0003, p = 0.01) concentrations related to WMHs but neither hyperphosphorylated tau nor total tau associations with WMHs reached statistical significance (p-values > 0.21). In a combined model, NFL accounted for 3.2% of unique variance in WMHs and Aβ42 accounted for an additional 4.3% beyond NFL, providing novel evidence of the co-occurrence of at least 2 distinct pathways for WMHs among older adults, including amyloid deposition and axonal injury.
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Affiliation(s)
- Katie E Osborn
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dandan Liu
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth E Moore
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Francis E Cambronero
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lealani Mae Y Acosta
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan P Bell
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Divisions of Cardiovascular and Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michelle A Babicz
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth A Gordon
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly R Pechman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Taylor Davis
- Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine A Gifford
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Angela L Jefferson
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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18
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Marseglia A, Fratiglioni L, Laukka EJ, Santoni G, Pedersen NL, Bäckman L, Xu W. Early Cognitive Deficits in Type 2 Diabetes: A Population-Based Study. J Alzheimers Dis 2018; 53:1069-78. [PMID: 27314527 PMCID: PMC4981902 DOI: 10.3233/jad-160266] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Evidence links type 2 diabetes to dementia risk. However, our knowledge on the initial cognitive deficits in diabetic individuals and the factors that might promote such deficits is still limited. This study aimed to identify the cognitive domains initially impaired by diabetes and the factors that play a role in this first stage. Within the population-based Swedish National Study on Aging and Care–Kungsholmen, 2305 cognitively intact participants aged ≥60 y were identified. Attention/working memory, perceptual speed, category fluency, letter fluency, semantic memory, and episodic memory were assessed. Diabetes (controlled and uncontrolled) and prediabetes were ascertained by clinicians, who also collected information on vascular disorders (hypertension, heart diseases, and stroke) and vascular risk factors (VRFs, including smoking and overweight/obesity). Data were analyzed with linear regression models. Overall, 196 participants (8.5%) had diabetes, of which 144 (73.5%) had elevated glycaemia (uncontrolled diabetes); 571 (24.8%) persons had prediabetes. In addition, diabetes, mainly uncontrolled, was related to lower performance in perceptual speed (β – 1.10 [95% CI – 1.98, – 0.23]), category fluency (β – 1.27 [95% CI – 2.52, – 0.03]), and digit span forward (β – 0.35 [95% CI – 0.54, – 0.17]). Critically, these associations were present only among APOEɛ4 non–carriers. The associations of diabetes with perceptual speed and category fluency were present only among participants with VRFs or vascular disorders. Diabetes, especially uncontrolled diabetes, is associated with poorer performance in perceptual speed, category fluency, and attention/primary memory. VRFs, vascular disorders, and APOE status play a role in these associations.
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Affiliation(s)
- Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Giola Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, China
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19
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Matioli MNPDS, Suemoto CK, Rodriguez RD, Farias DS, da Silva MM, Leite REP, Ferretti-Rebustini REL, Pasqualucci CA, Jacob W, Grinberg LT, Nitrini R. Association between diabetes and causes of dementia: Evidence from a clinicopathological study. Dement Neuropsychol 2017; 11:406-412. [PMID: 29354221 PMCID: PMC5769999 DOI: 10.1590/1980-57642016dn11-040010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/16/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a risk factor for dementia, especially for vascular dementia (VaD), but there is no consensus on diabetes as a risk factor for Alzheimer's disease (AD) and other causes of dementia. OBJECTIVE To explore the association between diabetes and the neuropathological etiology of dementia in a large autopsy study. METHODS Data were collected from the participants of the Brain Bank of the Brazilian Aging Brain Study Group between 2004 and 2015. Diagnosis of diabetes was reported by the deceased's next-of-kin. Clinical dementia was established when CDR ≥ 1 and IQCODE > 3.41. Dementia etiology was determined by neuropathological examination using immunohistochemistry. The association of diabetes with odds of dementia was investigated using multivariate logistic regression. RESULTS We included 1,037 subjects and diabetes was present in 279 participants (27%). The prevalence of dementia diagnosis was similar in diabetics (29%) and non-diabetics (27%). We found no association between diabetes and dementia (OR = 1.22; 95%CI = 0.81-1.82; p = 0.34) on the multivariate analysis. AD was the main cause of dementia in both groups, while VaD was the second-most-frequent cause in diabetics. Other mixed dementia was the second-most-common cause of dementia and more frequent among non-diabetics (p = 0.03). CONCLUSION Diabetes was not associated with dementia in this large clinicopathological study.
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Affiliation(s)
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, SP, Brazil
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
| | - Roberta Diehl Rodriguez
- Department of Neurology, University of São Paulo Medical School , São Paulo, SP, Brazil
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
| | - Daniela Souza Farias
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
| | - Magnólia Moreira da Silva
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
| | - Renata Elaine Paraizo Leite
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, SP, Brazil
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
| | - Renata Eloah Lucena Ferretti-Rebustini
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
- Medical-surgical Nursing Department, University of São Paulo School of Nursing, São Paulo, SP, Brazil
| | | | - Wilson Jacob
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, SP, Brazil
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
| | - Lea Tenenholz Grinberg
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School , São Paulo, SP, Brazil
- Aging Brain Study Group from the University of São Paulo Medical School - LIM/22, São Paulo, SP, Brazil
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20
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Investigation of gene expression and serum levels of PIN1 and eNOS with high blood pressure in patients with Alzheimer disease. J Clin Neurosci 2017; 43:77-81. [DOI: 10.1016/j.jocn.2017.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/22/2017] [Indexed: 11/17/2022]
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21
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Chatterjee S, Peters SAE, Woodward M, Mejia Arango S, Batty GD, Beckett N, Beiser A, Borenstein AR, Crane PK, Haan M, Hassing LB, Hayden KM, Kiyohara Y, Larson EB, Li CY, Ninomiya T, Ohara T, Peters R, Russ TC, Seshadri S, Strand BH, Walker R, Xu W, Huxley RR. Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia. Diabetes Care 2016; 39:300-7. [PMID: 26681727 PMCID: PMC4722942 DOI: 10.2337/dc15-1588] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 10/20/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes confers a greater excess risk of cardiovascular disease in women than in men. Diabetes is also a risk factor for dementia, but whether the association is similar in women and men remains unknown. We performed a meta-analysis of unpublished data to estimate the sex-specific relationship between women and men with diabetes with incident dementia. RESEARCH DESIGN AND METHODS A systematic search identified studies published prior to November 2014 that had reported on the prospective association between diabetes and dementia. Study authors contributed unpublished sex-specific relative risks (RRs) and 95% CIs on the association between diabetes and all dementia and its subtypes. Sex-specific RRs and the women-to-men ratio of RRs (RRRs) were pooled using random-effects meta-analyses. RESULTS Study-level data from 14 studies, 2,310,330 individuals, and 102,174 dementia case patients were included. In multiple-adjusted analyses, diabetes was associated with a 60% increased risk of any dementia in both sexes (women: pooled RR 1.62 [95% CI 1.45-1.80]; men: pooled RR 1.58 [95% CI 1.38-1.81]). The diabetes-associated RRs for vascular dementia were 2.34 (95% CI 1.86-2.94) in women and 1.73 (95% CI 1.61-1.85) in men, and for nonvascular dementia, the RRs were 1.53 (95% CI 1.35-1.73) in women and 1.49 (95% CI 1.31-1.69) in men. Overall, women with diabetes had a 19% greater risk for the development of vascular dementia than men (multiple-adjusted RRR 1.19 [95% CI 1.08-1.30]; P < 0.001). CONCLUSIONS Individuals with type 2 diabetes are at ∼60% greater risk for the development of dementia compared with those without diabetes. For vascular dementia, but not for nonvascular dementia, the additional risk is greater in women.
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Affiliation(s)
| | - Sanne A E Peters
- The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Mark Woodward
- The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, U.K. The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Silvia Mejia Arango
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, México
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, U.K. Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, U.K. Alzheimer Scotland Dementia Research Centre, The University of Edinburgh, Edinburgh, U.K
| | - Nigel Beckett
- Section of Care of the Elderly, Faculty of Medicine, Imperial College London, London, U.K
| | - Alexa Beiser
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Amy R Borenstein
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Mary Haan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Linda B Hassing
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Kathleen M Hayden
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Chung-Yi Li
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Tawian
| | - Toshiharu Ninomiya
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Ohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ruth Peters
- Section of Care of the Elderly, Faculty of Medicine, Imperial College London, London, U.K
| | - Tom C Russ
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, U.K. Alzheimer Scotland Dementia Research Centre, The University of Edinburgh, Edinburgh, U.K. Scottish Dementia Clinical Research Network, NHS Scotland, Edinburgh, U.K. Division of Psychiatry, The University of Edinburgh, Edinburgh, U.K
| | - Sudha Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | | | - Rod Walker
- Group Health Research Institute, Seattle, WA
| | - Weili Xu
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden School of Public Health, Tianjin Medical University, Tianjin, China
| | - Rachel R Huxley
- The George Institute for Global Health, University of Sydney, Sydney, Australia School of Public Health, Curtin University, Perth, Australia
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22
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Seifan A, Schelke M, Obeng-Aduasare Y, Isaacson R. Early Life Epidemiology of Alzheimer's Disease--A Critical Review. Neuroepidemiology 2015; 45:237-54. [PMID: 26501691 DOI: 10.1159/000439568] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As adult brain structure is primarily established in early life, genetic and environmental exposures in infancy and childhood influence the risk for Alzheimer disease (AD). In this systematic review, we identified several early life risk factors and discussed the evidence and underlying mechanism for each. SUMMARY Early risk factors for AD may alter brain anatomy, causing vulnerability to AD-related dementia later in life. In the perinatal period, both genes and learning disabilities have been associated with the development of distinct AD phenotypes. During early childhood, education and intellect, as well as body growth, may predispose to AD through alterations in cognitive and brain reserve, though the specific mediators of neural injury are disputed. Childhood socioeconomic status (SES) may predispose to AD by influencing adult SES and cognition. Association of these risk factors with underlying AD pathology (rather than just clinical diagnosis) has not been sufficiently examined. KEY MESSAGES Factors that impede or alter brain growth during early life could render certain brain regions or networks selectively vulnerable to the onset, accumulation or spread of AD-related pathology during later life. Careful life-course epidemiology could provide clues as to why the brain systematically degenerates during AD.
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Affiliation(s)
- Alon Seifan
- Alzheimer Prevention Clinic and Memory Disorders Program, Department of Neurology Weill Cornell Medical College, New York, N.Y., USA
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23
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Ferretti-Rebustini REDL, Jacob-Filho W, Suemoto CK, Farfel JM, Leite REP, Grinberg LT, Pasqualucci CA, Nitrini R. Factors associated with morphometric brain changes in cognitively normal aging. Dement Neuropsychol 2015; 9:103-109. [PMID: 29213951 PMCID: PMC5619348 DOI: 10.1590/1980-57642015dn92000004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/04/2015] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE Cognitive impairment is associated with reductions in brain weight and volume. The factors related to morphometric brain changes in cognitively normal aging remain unknown. We aimed to identify which clinical factors are associated with morphometric brain changes in cognitively normal aging. METHODS A cross-sectional study of 414 subjects, ≥50 years old submitted to clinical assessment and brain autopsy, after informed consent, was carried out at the São Paulo Autopsy Service, Brazil. Data on cognitive and functional evaluations were collected through structured interview applied to the next-of-kin. Brain weight (g) and volume (mL) measurements were obtained and adjusted for head circumference (cm). Associations between brain weight/volume and related factors were obtained through univariate and multivariate analysis. RESULTS Participants were predominantly male (60.4%), Caucasian (69%), with mean age of 67.1 ± 10.9 years. Mean brain weight was 1219.2 ± 140.9 g, and mean brain volume was 1217.1 ± 152.3 mL. Head circumference was independently associated with low brain weight (p<0.001) and volume (p<0.001). Total and adjusted brain weight and volume decreased in some conditions. Female gender (p<0.001), hypertension (p<0.009), coronary artery disease (p<0.013) and walking assistance (p<0.011) were associated with lower adjusted brain weight while schooling was associated with higher adjusted brain weight (p<0.003). Female gender (p<0.001), age (p<0.001) and hypertension (p<0.011) were associated with low adjusted brain volume. CONCLUSION Morphometric brain changes occur despite the absence of cognitive impairment and were predominantly associated with age, female gender, mobility impairment and cardiovascular conditions. Schooling may be a protective factor.
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Affiliation(s)
- Renata Eloah de Lucena Ferretti-Rebustini
- BSN, RN, CNS, Ph.D, Medical-Surgical Nursing Department.
University of São Paulo School of Nursing. São Paulo SP, Brazil;
Physiopathology on Aging Lab/ SGHC - LIM 22. University of São Paulo School
of Medicine. São Paulo SP, Brazil
| | - Wilson Jacob-Filho
- MD, Ph.D, Physiopathology on Aging Lab/SGHC - LIM 22.
University of São Paulo School of Medicine. São Paulo SP, Brazil.
Division of Geriatrics of the Clinicas Hospital. University of São Paulo
School of Medicine. São Paulo SP, Brazil
| | - Claudia Kimie Suemoto
- MD, Ph.D, Physiopathology on Aging Lab/SGHC - LIM 22.
University of São Paulo School of Medicine. São Paulo SP, Brazil.
Division of Geriatrics of the Clinicas Hospital. University of São Paulo
School of Medicine. São Paulo SP, Brazil
| | - José Marcelo Farfel
- MD, Ph.D, Physiopathology on Aging Lab/SGHC - LIM 22.
University of São Paulo School of Medicine. São Paulo SP, Brazil.
Division of Geriatrics of the Clinicas Hospital. University of São Paulo
School of Medicine. São Paulo SP, Brazil
| | - Renata Elaine Paraiso Leite
- BSc, Ph.D, Physiopathology on Aging Lab/ SGHC - LIM 22.
University of São Paulo School of Medicine. São Paulo SP,
Brazil
| | - Lea Tenenholz Grinberg
- MD, Ph.D, Physiopathology on Aging Lab/ SGHC - LIM 22.
University of São Paulo School of Medicine. São Paulo SP, Brazil;
Department of Pathology. University of São Paulo School of Medicine.
São Paulo SP, Brazil
| | - Carlos Augusto Pasqualucci
- MD, Ph.D, Physiopathology on Aging Lab/ SGHC - LIM 22.
University of São Paulo School of Medicine. São Paulo SP, Brazil;
Department of Pathology. University of São Paulo School of Medicine.
São Paulo SP, Brazil
| | - Ricardo Nitrini
- MD, Ph.D, Physiopathology on Aging Lab/ SGHC - LIM 22.
University of São Paulo School of Medicine. São Paulo SP, Brazil.
Department of Neurology. University of São Paulo School of Medicine
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Li X, Song D, Leng SX. Link between type 2 diabetes and Alzheimer's disease: from epidemiology to mechanism and treatment. Clin Interv Aging 2015; 10:549-60. [PMID: 25792818 PMCID: PMC4360697 DOI: 10.2147/cia.s74042] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of this paper is to provide a comprehensive review of the epidemiological evidence linking type 2 diabetes mellitus and its related conditions, including obesity, hyperinsulinemia, and metabolic syndrome, to Alzheimer’s disease (AD). Several mechanisms could help to explain this proposed link; however, our focus is on insulin resistance and deficiency. Studies have shown that insulin resistance and deficiency can interact with amyloid-β protein and tau protein phosphorylation, each leading to the onset and development of AD. Based on those epidemiological data and basic research, it was recently proposed that AD can be considered as “type 3 diabetes”. Special attention has been paid to determining whether antidiabetic agents might be effective in treating AD. There has been much research both experimental and clinical on this topic. We mainly discuss the clinical trials on insulin, metformin, thiazolidinediones, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors in the treatment of AD. Although the results of these trials seem to be contradictory, this approach is also full of promise. It is worth mentioning that the therapeutic effects of these drugs are influenced by the apolipoprotein E (APOE)-ε4 genotype. Patients without the APOE-ε4 allele showed better treatment effects than those with this allele.
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Affiliation(s)
- Xiaohua Li
- Dalian Medical University, Dalian, People's Republic of China
| | - Dalin Song
- Department of Geriatrics, Qingdao Municipal Hospital, Qingdao, People's Republic of China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jefferson AL, Beiser AS, Himali JJ, Seshadri S, O'Donnell CJ, Manning WJ, Wolf PA, Au R, Benjamin EJ. Low cardiac index is associated with incident dementia and Alzheimer disease: the Framingham Heart Study. Circulation 2015; 131:1333-9. [PMID: 25700178 DOI: 10.1161/circulationaha.114.012438] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cross-sectional epidemiological and clinical research suggests that lower cardiac index is associated with abnormal brain aging, including smaller brain volumes, increased white matter hyperintensities, and worse cognitive performances. Lower systemic blood flow may have implications for dementia among older adults. METHODS AND RESULTS A total of 1039 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, and dementia formed our sample (age, 69±6 years; 53% women). Multivariable-adjusted proportional hazard models adjusting for Framingham Stroke Risk Profile score (age, sex, systolic blood pressure, antihypertensive medication, diabetes mellitus, cigarette smoking, cardiovascular disease history, atrial fibrillation), education, and apolipoprotein E4 status related cardiac magnetic resonance imaging-assessed cardiac index (cardiac output divided by body surface area) to incident all-cause dementia and Alzheimer disease (AD). Over the median 7.7-year follow-up period, 32 participants developed dementia, including 26 cases of AD. Each 1-SD unit decrease in cardiac index increased the relative risk of both dementia (hazard ratio [HR]=1.66; 95% confidence interval [CI], 1.11-2.47; P=0.013) and AD (HR=1.65; 95% CI, 1.07-2.54; P=0.022). Compared with individuals with normal cardiac index, individuals with clinically low cardiac index had a higher relative risk of dementia (HR=2.07; 95% CI, 1.02-4.19; P=0.044). If participants with clinically prevalent cardiovascular disease and atrial fibrillation were excluded (n=184), individuals with clinically low cardiac index had a higher relative risk of both dementia (HR=2.92; 95% CI, 1.34-6.36; P=0.007) and AD (HR=2.87; 95% CI, 1.21-6.80; P=0.016) compared with individuals with normal cardiac index. CONCLUSION Lower cardiac index is associated with an increased risk for the development of dementia and AD.
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Affiliation(s)
- Angela L Jefferson
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Alexa S Beiser
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jayandra J Himali
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sudha Seshadri
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christopher J O'Donnell
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Warren J Manning
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Philip A Wolf
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rhoda Au
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emelia J Benjamin
- From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Ge T, Nichols TE, Ghosh D, Mormino EC, Smoller JW, Sabuncu MR. A kernel machine method for detecting effects of interaction between multidimensional variable sets: an imaging genetics application. Neuroimage 2015; 109:505-514. [PMID: 25600633 DOI: 10.1016/j.neuroimage.2015.01.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 01/06/2015] [Accepted: 01/09/2015] [Indexed: 11/19/2022] Open
Abstract
Measurements derived from neuroimaging data can serve as markers of disease and/or healthy development, are largely heritable, and have been increasingly utilized as (intermediate) phenotypes in genetic association studies. To date, imaging genetic studies have mostly focused on discovering isolated genetic effects, typically ignoring potential interactions with non-genetic variables such as disease risk factors, environmental exposures, and epigenetic markers. However, identifying significant interaction effects is critical for revealing the true relationship between genetic and phenotypic variables, and shedding light on disease mechanisms. In this paper, we present a general kernel machine based method for detecting effects of the interaction between multidimensional variable sets. This method can model the joint and epistatic effect of a collection of single nucleotide polymorphisms (SNPs), accommodate multiple factors that potentially moderate genetic influences, and test for nonlinear interactions between sets of variables in a flexible framework. As a demonstration of application, we applied the method to the data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to detect the effects of the interactions between candidate Alzheimer's disease (AD) risk genes and a collection of cardiovascular disease (CVD) risk factors, on hippocampal volume measurements derived from structural brain magnetic resonance imaging (MRI) scans. Our method identified that two genes, CR1 and EPHA1, demonstrate significant interactions with CVD risk factors on hippocampal volume, suggesting that CR1 and EPHA1 may play a role in influencing AD-related neurodegeneration in the presence of CVD risks.
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Affiliation(s)
- Tian Ge
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital / Harvard Medical School, Charlestown, MA 02129, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Thomas E Nichols
- Department of Statistics & Warwick Manufacturing Group, The University of Warwick, Coventry CV4 7AL, UK
| | - Debashis Ghosh
- Department of Statistics, The Pennsylvania State University, PA 16802, USA
| | - Elizabeth C Mormino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02138, USA
| | - Mert R Sabuncu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital / Harvard Medical School, Charlestown, MA 02129, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Bradford D, Tschanz JT, Smith KR, Østbye T, Corcoran C, Welsh-Bohmer KA, Norton MC. Impact of offspring death on cognitive health in late life: the Cache County study. Am J Geriatr Psychiatry 2014; 22:1307-15. [PMID: 23954042 PMCID: PMC3923854 DOI: 10.1016/j.jagp.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 04/21/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Experiencing the death of a child is associated with negative short-term mental health consequences, but less is known about cognitive outcomes and whether such associations extend to late life. We tested the hypothesis that experiencing an offspring death (OD) is associated with an increased rate of cognitive decline in late life. METHODS This population-based longitudinal study observed four cognitive statuses spaced 3-4 years apart, linked to an extensive database containing objective genealogic and vital statistics data. Home visits were conducted with 3,174 residents of a rural county in northern Utah, initially without dementia, aged 65-105. Cognitive status was measured with the Modified Mini-Mental State Exam at baseline and at 3-, 7-, and 10-year follow-ups. OD was obtained from the Utah Population Database, which contains statewide birth and death records. RESULTS In linear mixed models, controlling for age, gender, education, and apolipoprotein E status, subjects who experienced OD while younger than age 31 years experienced a significantly faster rate of cognitive decline in late life, but only if they had an ε4 allele. Reclassifying all OD (regardless of age) according to subsequent birth of another child, OD was only related to faster cognitive decline when there were no subsequent births. CONCLUSION Experiencing OD in early adulthood has a long-term association with cognitive functioning in late life, with a gene-environment interaction at the apolipoprotein E locus. Subsequent birth of another child attenuates this association.
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Affiliation(s)
- Daylee Bradford
- Department of Family Consumer and Human Development, Utah State University
| | - JoAnn T. Tschanz
- Department of Psychology, Center for Epidemiologic Studies, Utah State University
| | - Ken R. Smith
- Department of Family and Consumer Studies; Population Sciences, Huntsman Cancer Institute, University of Utah
| | - Truls Østbye
- Duke Global Health Institute, Duke University, and Duke – NUS Graduate Medical School, Singapore
| | - Chris Corcoran
- Department of Mathematics and Statistics, Center for Epidemiologic Studies, Utah State University
| | | | - Maria C. Norton
- Department of Family Consumer and Human Development, Utah State University,Department of Psychology, Center for Epidemiologic Studies, Utah State University
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Cognitive impairment and cardiovascular diseases in the elderly. A heart-brain continuum hypothesis. Ageing Res Rev 2014; 18:41-52. [PMID: 25107566 DOI: 10.1016/j.arr.2014.07.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/09/2014] [Accepted: 07/17/2014] [Indexed: 12/30/2022]
Abstract
The aging population is increasing and, therefore, a higher prevalence of cardiac disease is emerging; including hypertension, coronary artery disease, atrial fibrillation and chronic heart failure. Large cohort studies have revealed a relationship among increased risk for cognitive impairment and dementia in cardiovascular diseases probably due to embolic stroke or chronic cerebral hypoperfusion. Thus, the aim of the present review is to overview the studies that investigate the presence and/or the development of cognitive impairments and dementia in patients with varied types of cardiovascular disease. Finally, a continuum among hypertension, coronary artery disease, atrial fibrillation and chronic heart failure with to the development of cognitive impairment and progression to dementia has been hypothesized.
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Incidence rates of dementia, Alzheimer disease, and vascular dementia in the Japanese American population in Seattle, WA: the Kame Project. Alzheimer Dis Assoc Disord 2014; 28:23-9. [PMID: 24045327 DOI: 10.1097/wad.0b013e3182a2e32f] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are few studies on the incidence of dementia in representative minority populations in the United States; however, no population-based study has been conducted on Japanese American women. We identified 3045 individuals aged 65+ with at least 1 parent of Japanese descent living in King County, WA in the period 1992 to 1994, of whom 1836 were dementia-free and were examined every 2 years (1994 to 2001) to identify incident cases of all dementias, Alzheimer disease (AD), vascular dementia (VaD), and other dementias. Cox regression was used to examine associations with age, sex, years of education, and apolipoprotein (APOE)-ε4. Among 173 incident cases of dementia, the overall rate was 14.4/1000/y, with rates being slightly higher among women (15.9/1000) than men (12.5/1000). Rates roughly doubled every 5 years for dementia and AD; the age trend for VaD and other dementias was less consistent. Sex was not significantly related to incidence of dementia or its subtypes in adjusted models. There was a trend for an inverse association with increasing years of education. APOE-ε4 was a strong risk factor for all dementias [hazard ratio (HR)=2.89; 95% confidence interval (CI), 1.88-4.46], AD (HR=3.27; 95% CI, 2.03-5.28), and VaD (HR=3.33; 95% CI, 1.34-8.27). This study is the first to report population-based incidence rates for both Japanese American men and women.
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Caracciolo B, Xu W, Collins S, Fratiglioni L. Cognitive decline, dietary factors and gut–brain interactions. Mech Ageing Dev 2014; 136-137:59-69. [DOI: 10.1016/j.mad.2013.11.011] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/16/2013] [Accepted: 11/28/2013] [Indexed: 02/08/2023]
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Alonso R, Pisa D, Rábano A, Carrasco L. Alzheimer's disease and disseminated mycoses. Eur J Clin Microbiol Infect Dis 2014; 33:1125-32. [PMID: 24452965 DOI: 10.1007/s10096-013-2045-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/29/2013] [Indexed: 12/31/2022]
Abstract
Alzheimer's disease (AD) is characterized by the presence in the brain of amyloid plaques and neurofibrillary tangles that provoke neuronal cell death, vascular dysfunction and inflammatory processes. In the present work, we have analyzed the existence of fungal infection in AD patients. A number of tests have been carried out in blood serum, including the detection of antibodies against several yeast species and fungal proteins, and also the presence of fungal (1,3)-β-glucan. Results from this analysis indicate that there is disseminated fungal infection in the majority of AD patients tested. Of interest, several AD patients contain high levels of fungal polysaccharides in peripheral blood, reflecting that disseminated fungal infection occurs in these patients. Together, these results suggest the presence of disseminated mycoses in blood serum from AD patients. To our knowledge these findings represent the first evidence that fungal infection is detectable in blood samples in AD patients. The possibility that this may represent a risk factor or may contribute to the etiological cause of AD is discussed.
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Affiliation(s)
- R Alonso
- Centro de Biología Molecular Severo Ochoa CSIC-UAM, Universidad Autónoma de Madrid, C / Nicolás Cabrera, 1, Cantoblanco, 28049, Madrid, Spain
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Melrose RJ, Brewster P, Marquine MJ, MacKay-Brandt A, Reed B, Farias ST, Mungas D. Early life development in a multiethnic sample and the relation to late life cognition. J Gerontol B Psychol Sci Soc Sci 2014; 70:519-31. [PMID: 24389122 DOI: 10.1093/geronb/gbt126] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/12/2013] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Poor quality of early life conditions has been associated with poorer late life cognition and increased risk of dementia. Early life physical development can be captured using adult measures of height and head circumference. Availability of resources may be reflected by socioeconomic indicators, such as parental education and family size. We sought to determine the association between early life development and experience and late life semantic memory, episodic memory, and executive functioning abilities, as well as rate of cognitive decline. METHOD This study was conducted using the UC Davis Aging Diversity cohort, an ethnically diverse sample of Caucasian, African American, and Hispanic individuals from northern California. We used latent variable modeling to measure growth and childhood socioeconomic environment (SES) and examine their associations with longitudinal cognitive outcomes using mixed effects modeling. RESULTS Growth was positively related to higher childhood SES. Higher childhood SES was associated with better semantic memory. Both low growth and low SES were associated with increased rate of cognitive decline. DISCUSSION These findings demonstrate that early life experiences influence the trajectory of cognitive aging. Early life development and experience appears to provide a distal basis upon which additional risk and protective factors interact in the development of dementia.
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Affiliation(s)
- Rebecca J Melrose
- VA Greater Los Angeles Healthcare System, California. Department of Psychiatry & Biobehavioral Sciences at the David Geffen School of Medicine, University of California, Los Angeles.
| | - Paul Brewster
- Department of Psychology, University of Victoria, British Columbia, Canada
| | | | - Anna MacKay-Brandt
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York
| | - Bruce Reed
- Department of Neurology, School of Medicine, University of California, Davis
| | - Sarah T Farias
- Department of Neurology, School of Medicine, University of California, Davis
| | - Dan Mungas
- Department of Neurology, School of Medicine, University of California, Davis
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Tschanz JT, Norton MC, Zandi PP, Lyketsos CG. The Cache County Study on Memory in Aging: factors affecting risk of Alzheimer's disease and its progression after onset. Int Rev Psychiatry 2013; 25:673-85. [PMID: 24423221 PMCID: PMC4089882 DOI: 10.3109/09540261.2013.849663] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Cache County Study on Memory in Aging is a longitudinal, population-based study of Alzheimer's disease (AD) and other dementias. Initiated in 1995 and extending to 2013, the study has followed over 5,000 elderly residents of Cache County, Utah (USA) for over twelve years. Achieving a 90% participation rate at enrolment, and spawning two ancillary projects, the study has contributed to the literature on genetic, psychosocial and environmental risk factors for AD, late-life cognitive decline, and the clinical progression of dementia after its onset. This paper describes the major study contributions to the literature on AD and dementia.
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Affiliation(s)
- JoAnn T. Tschanz
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University
| | - Maria C. Norton
- Center for Epidemiologic Studies, Utah State University,Department of Family, Consumer & Human Development, Utah State University
| | - Peter P. Zandi
- Bloomberg School of Public Health, Johns Hopkins University
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Tschanz JT, Pfister R, Wanzek J, Corcoran C, Smith K, Tschanz BT, Steffens DC, Østbye T, Welsh-Bohmer KA, Norton MC. Stressful life events and cognitive decline in late life: moderation by education and age. The Cache County Study. Int J Geriatr Psychiatry 2013; 28:821-30. [PMID: 23037866 PMCID: PMC3706540 DOI: 10.1002/gps.3888] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 09/05/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Stressful life events (SLE) have been associated with increased dementia risk, but their association with cognitive decline has been inconsistent. In a longitudinal population-based study of older individuals, we examined the association between SLE and cognitive decline, and the role of potential effect modifiers. METHODS A total of 2665 non-demented participants of the Cache County Memory Study completed an SLE questionnaire at Wave 2 and were revisited 4 and 7 years later. The events were represented via several scores: total number, subjective rating (negative, positive, and unexpected), and a weighted summary based on their impact. Cognition was assessed at each visit with the modified Mini-Mental State Exam. General linear models were used to examine the association between SLE scores and cognition. Effect modification by age, education, and APOE genotype was tested. RESULTS Years of formal education (p = 0.006) modified the effect of number of SLE, and age (p = 0.009) modified the effect of negative SLE on the rate of cognitive decline. Faster decline was observed among those with fewer years of education experiencing more SLE and also among younger participants experiencing more negative SLE. There was no association between other indicators of SLE and cognitive decline. APOE genotype did not modify any of the aforementioned associations. CONCLUSIONS The effects of SLE on cognition in late life are complex and vary by individual factors such as age and education. These results may explain some of the contradictory findings in the literature.
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Affiliation(s)
- JoAnn T. Tschanz
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University
| | | | | | - Chris Corcoran
- Center for Epidemiologic Studies, Utah State University,Department of Mathematics and Statistics, Utah State University
| | - Ken Smith
- Department of Family and Human Development, University of Utah
| | | | | | | | - Kathleen A. Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University,The Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University
| | - Maria C. Norton
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University,Department of Family, Consumer and Human Development, Utah State University
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Wang CY, Xie JW, Wang T, Xu Y, Cai JH, Wang X, Zhao BL, An L, Wang ZY. Hypoxia-triggered m-calpain activation evokes endoplasmic reticulum stress and neuropathogenesis in a transgenic mouse model of Alzheimer's disease. CNS Neurosci Ther 2013; 19:820-33. [PMID: 23889979 DOI: 10.1111/cns.12151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/25/2013] [Accepted: 06/16/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that endoplasmic reticulum (ER) stress is activated in Alzheimer's disease (AD) brains. ER stress-triggered unfolded protein response (UPR) leads to tau phosphorylation and neuronal death. AIMS In this study, we tested the hypothesis that hypoxia-induced m-calpain activation is involved in ER stress-mediated AD pathogenesis. METHOD We employed a hypoxic exposure in APP/PS1 transgenic mice and SH-SY5Y cells overexpressing human Swedish mutation APP (APPswe). RESULTS We observed that hypoxia impaired spatial learning and memory in the APP/PS1 mouse. In the transgenic mouse brain, hypoxia increased the UPR, upregulated apoptotic signaling, enhanced the activation of calpain and glycogen synthase kinase-3β (GSK3β), and increased tau hyperphosphorylation and β-amyloid deposition. In APPswe cells, m-calpain silencing reduced hypoxia-induced cellular dysfunction and resulted in suppression of GSK3β activation, ER stress and tau hyperphosphorylation reduction as well as caspase pathway suppression. CONCLUSION These findings demonstrate that hypoxia-induced abnormal calpain activation may increase ER stress-induced apoptosis in AD pathogenesis. In contrast, a reduction in the expression of the m-calpain isoform reduces ER stress-linked apoptosis that is triggered by hypoxia. These findings suggest that hypoxia-triggered m-calpain activation is involved in ER stress-mediated AD pathogenesis. m-calpain is a potential target for AD therapeutics.
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Affiliation(s)
- Chun-Yan Wang
- Department of Pathophysiology, Key Laboratory of Medical Cell Biology of Ministry of Education of China, China Medical University, Shenyang, China; Medical Research Laboratory, Jilin Medical College, Jilin, China
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Gudala K, Bansal D, Schifano F, Bhansali A. Diabetes mellitus and risk of dementia: A meta-analysis of prospective observational studies. J Diabetes Investig 2013; 4:640-50. [PMID: 24843720 PMCID: PMC4020261 DOI: 10.1111/jdi.12087] [Citation(s) in RCA: 426] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/16/2013] [Accepted: 03/01/2013] [Indexed: 12/14/2022] Open
Abstract
AIMS/INTRODUCTION The aim of the present study was to investigate the association between diabetes and the risk of all type dementia (ATD), Alzheimer's disease (AD) and vascular dementia (VaD). MATERIALS AND METHODS Prospective observational studies describing the incidence of ATD, AD and VaD in patients with diabetes mellitus were extracted from PubMed, EMBASE and other databases up to January 2012. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the random-effects model. Subgroup analyses and sensitivity analysis were also carried out. RESULTS A total of 28 studies contributed to the analysis. Pooled RR of developing ATD (n = 20) was 1.73 (1.65-1.82, I (2) = 71.2%), AD (n = 20) was 1.56 (1.41-1.73, I (2) = 9.8%) and VaD (n = 13) was 2.27 (1.94-2.66, I (2) = 0%) in patients with diabetes mellitus. Higher and medium quality studies did not show any significant difference for pooled RR for ATD, AD or VaD. Sensitivity analyses showed robustness of pooled RR among ATD, AD and VaD, showing no single study had a major impact on pooled RR. CONCLUSIONS The results showed a 73% increased risk of ATD, 56% increase of AD and 127% increase of VaD in diabetes patients.
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Affiliation(s)
- Kapil Gudala
- Clinical Research Unit Department of Pharmacy Practice National Institute of Pharmaceutical Education and Research Mohali India
| | - Dipika Bansal
- Clinical Research Unit Department of Pharmacy Practice National Institute of Pharmaceutical Education and Research Mohali India
| | - Fabrizio Schifano
- Clinical Pharmacology and Therapeutics University of Hertfordshire Hertfordshire UK
| | - Anil Bhansali
- Department of Endocrinology Postgraduate Institute of Medical Education and Research Chandigarh India
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Hypoxia Increases Aβ-Induced Tau Phosphorylation by Calpain and Promotes Behavioral Consequences in AD Transgenic Mice. J Mol Neurosci 2013; 51:138-47. [DOI: 10.1007/s12031-013-9966-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
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38
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Vagelatos NT, Eslick GD. Type 2 diabetes as a risk factor for Alzheimer's disease: the confounders, interactions, and neuropathology associated with this relationship. Epidemiol Rev 2013; 35:152-60. [PMID: 23314404 DOI: 10.1093/epirev/mxs012] [Citation(s) in RCA: 223] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2013] [Indexed: 12/24/2022] Open
Abstract
We performed a systematic review and meta-analysis to explore whether type 2 diabetes mellitus (T2DM) increases the risk of Alzheimer's disease (AD). We also reviewed interactions with smoking, hypertension, and apolipoprotein E ɛ4. Using a series of databases (MEDLINE, EMBASE, PubMed, Current Contents Connect, and Google Scholar), we identified a total of 15 epidemiologic studies. Fourteen studies reported positive associations, of which 9 were statistically significant. Risk estimates ranged from 0.83 to 2.45. The pooled adjusted risk ratio was 1.57 (95% confidence interval: 1.41, 1.75), with a population-attributable risk of 8%. Smoking and hypertension, when comorbid with T2DM, had odds of 14 and 3, respectively. Of the 5 studies that investigated the interaction between T2DM and apolipoprotein E ɛ4, 4 showed positive associations, of which 3 were significant, with odds ranging from 2.4 to 4.99. The pooled adjusted risk ratio was 2.91 (95% confidence interval: 1.51, 5.61). Risk estimates were presented in the context of a key confounder-cerebral infarcts-which are more common in those with T2DM and might contribute to the manifestation of clinical AD. We provide evidence from clinico-neuropathologic studies that demonstrates the following: First, cerebral infarcts are more common than AD-type pathology in those with T2DM and dementia. Second, those with dementia at postmortem are more likely to have both AD-type and cerebrovascular pathologies. Finally, cerebral infarcts reduce the number of AD lesions required for the manifestation of clinical dementia, but they do not appear to interact synergistically with AD-type pathology. Therefore, the increased risk of clinically diagnosed AD seems to be mediated through cerebrovascular pathology.
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Onishi M, Rakugi H. [The standard value of hypertension from the view of independence]. Nihon Ronen Igakkai Zasshi 2013; 50:172-175. [PMID: 23979231 DOI: 10.3143/geriatrics.50.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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40
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Mayeux R, Stern Y. Epidemiology of Alzheimer disease. Cold Spring Harb Perspect Med 2012; 2:cshperspect.a006239. [PMID: 22908189 DOI: 10.1101/cshperspect.a006239] [Citation(s) in RCA: 563] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The global prevalence of dementia has been estimated to be as high as 24 million, and is predicted to double every 20 years until at least 2040. As the population worldwide continues to age, the number of individuals at risk will also increase, particularly among the very old. Alzheimer disease is the leading cause of dementia beginning with impaired memory. The neuropathological hallmarks of Alzheimer disease include diffuse and neuritic extracellular amyloid plaques in brain that are frequently surrounded by dystrophic neurites and intraneuronal neurofibrillary tangles. The etiology of Alzheimer disease remains unclear, but it is likely to be the result of both genetic and environmental factors. In this review we discuss the prevalence and incidence rates, the established environmental risk factors, and the protective factors, and briefly review genetic variants predisposing to disease.
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Affiliation(s)
- Richard Mayeux
- Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY 10032, USA
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41
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Dodge HH, Chang CCH, Kamboh IM, Ganguli M. Risk of Alzheimer's disease incidence attributable to vascular disease in the population. Alzheimers Dement 2012; 7:356-60. [PMID: 21575878 DOI: 10.1016/j.jalz.2010.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 10/31/2010] [Accepted: 12/06/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although Alzheimer's disease (AD) is a neurodegenerative disorder, there is growing interest in the influence of vascular factors on its incidence. METHODS In a population-based longitudinal epidemiological study, we fit Cox proportional hazard models to examine the risk of incident dementia and AD associated with self-reported vascular disease. The population-attributable risk percent (percent of the incidence of dementia and AD in the population that would be eliminated if vascular disease was eliminated) was calculated using the adjusted hazard ratios (HR). RESULTS Of 822 eligible participants, 94 individuals developed incident dementia, with 79 having AD (probable/possible AD) during the follow-up period of on average 8 years. Stroke/transient ischemic attack history was associated with incident dementia (HR=2.6) as well as AD (HR=2.4) among non-apolipoprotein E ɛ4 carriers. CONCLUSIONS At the community level, the risk of dementia could be potentially reduced by 10.8% by eliminating overt cerebrovascular disease, and the risk of AD by 9.1% for non-apolipoprotein E ɛ4 carriers.
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Affiliation(s)
- Hiroko H Dodge
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
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Hagberg H, Gressens P, Mallard C. Inflammation during fetal and neonatal life: implications for neurologic and neuropsychiatric disease in children and adults. Ann Neurol 2012; 71:444-57. [PMID: 22334391 DOI: 10.1002/ana.22620] [Citation(s) in RCA: 381] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/05/2011] [Accepted: 07/15/2011] [Indexed: 01/06/2023]
Abstract
Inflammation is increasingly recognized as being of both physiological and pathological importance in the immature brain. The rationale of this review is to present an update on this topic with focus on long-term consequences of inflammation during childhood and in adults. The immature brain can be exposed to inflammation in connection with viral or bacterial infection during pregnancy or as a result of sterile central nervous system (CNS) insults. Through efficient anti-inflammatory and reparative processes, inflammation may resolve without any harmful effects on the brain. Alternatively, inflammation contributes to injury or enhances CNS vulnerability. Acute inflammation can also be shifted to a chronic inflammatory state and/or adversely affect brain development. Hypothetically, microglia are the main immunocompetent cells in the immature CNS, and depending on the stimulus, molecular context, and timing, these cells will acquire various phenotypes, which will be critical regarding the CNS consequences of inflammation. Inflammation has long-term consequences and could speculatively modify the risk of a variety of neurological disorders, including cerebral palsy, autism spectrum disorders, schizophrenia, multiple sclerosis, cognitive impairment, and Parkinson disease. So far, the picture is incomplete, and data mostly experimental. Further studies are required to strengthen the associations in humans and to determine whether novel therapeutic interventions during the perinatal period can influence the occurrence of neurological disease later in life.
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Affiliation(s)
- Henrik Hagberg
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden.
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Abstract
The incidence of dementia increases steeply with age in older people, although from the tenth decade the slope may be smoother, perhaps reflecting different pathological processes in the oldest old. The prevalence depends upon interaction of age with other factors (e.g., comorbidities, genetic or environmental factors) that in turn are subject to change. If onset of dementia could be postponed by modulating its risk factors, this could significantly affect its incidence. Analysis of risk and protection factors should take into account the critical period during which these factors play a role. For example, the impact of education and diabetes mellitus occurs in early- and midlife, respectively, while maintaining optimal physical and mental activity and controlling vascular factors later in life may slow the rate of cognitive decline. Modifying factors need to be evaluated for different clinical groups, taking into account genetic background, age, and duration at exposure. The aim of the present article is to try to take stock of epidemiological data concerning factors affecting the prevalence of dementia and predict future developments, as well as to look for possible interventions that could affect outcome.
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Affiliation(s)
- T A Treves
- Memory Disorders Clinic, Rabin Medical Center, Petach Tikva, Israel
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Hypertension and dementia in the elderly: the leisure world cohort study. Int J Hypertens 2011; 2012:205350. [PMID: 22229084 PMCID: PMC3249771 DOI: 10.1155/2012/205350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/04/2011] [Indexed: 01/30/2023] Open
Abstract
Recent studies have highlighted the deleterious role of cardiovascular risk factors, including hypertension, on the incidence of dementia. Although midlife hypertension is associated with later development of dementia, the role of late-life hypertension remains unclear. We explored the association of hypertension and its treatment with incident dementia in 13978 older (median = 74 years) adults followed from 1981 to 2010 (median = 13 years) and calculated risk estimates using Cox regression analysis in two age groups (<75 and 75+ years) in men and women separately. Dementia status was determined from in-person evaluations, followup questionnaires, hospital data, and death certificates. In the older women, current users of blood pressure medication at baseline had a 26% increased risk of dementia (95% CI 1.06–1.51). In the younger men, those with untreated hypertension and those with past use of blood pressure medication use had about a 30% nonsignificant increased risk of dementia. High blood pressure and its treatment appear to have different effects in men and women and in the old and older.
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Ninomiya T, Ohara T, Hirakawa Y, Yoshida D, Doi Y, Hata J, Kanba S, Iwaki T, Kiyohara Y. Midlife and Late-Life Blood Pressure and Dementia in Japanese Elderly. Hypertension 2011; 58:22-8. [DOI: 10.1161/hypertensionaha.110.163055] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The associations between blood pressure and dementia have been inconclusive. We followed up a total of 668 community-dwelling Japanese individuals without dementia, aged 65 to 79 years, for 17 years and examined the associations of late-life and midlife hypertension with the risk of vascular dementia and Alzheimer disease using the Cox proportional hazards model. During the follow-up, 76 subjects experienced vascular dementia and 123 developed Alzheimer disease. The age- and sex-adjusted incidence of vascular dementia significantly increased with elevated late-life blood pressure levels (normal: 2.3, prehypertension: 8.4, stage 1 hypertension: 12.6, and stage 2 hypertension: 18.9 per 1000 person-years;
P
trend
<0.001), whereas no such association was observed for Alzheimer disease (
P
trend
=0.88). After adjusting for potential confounding factors, subjects with prehypertension and stage 1 or stage 2 hypertension had 3.0-fold, 4.5-fold, and 5.6-fold greater risk of vascular dementia, respectively, compared with subjects with normal blood pressure. Likewise, there was a positive association of midlife blood pressure levels with the risk of vascular dementia but not with the risk of Alzheimer disease. Compared with those without hypertension in both midlife and late life, subjects with midlife hypertension had an ≈5-fold greater risk of vascular dementia, regardless of late-life blood pressure levels. Our findings suggest that midlife hypertension and late-life hypertension are significant risk factors for the late-life onset of vascular dementia but not for that of Alzheimer disease in a general Japanese population. Midlife hypertension is especially strongly associated with a greater risk of vascular dementia, regardless of late-life blood pressure levels.
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Affiliation(s)
- Toshiharu Ninomiya
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Ohara
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichiro Hirakawa
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daigo Yoshida
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasufumi Doi
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Iwaki
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Kiyohara
- From the Departments of Medicine and Clinical Science (T.N., Y.H., Y.D., J.H.) and Environmental Medicine (T.N., T.O., Y.H., D.Y., Y.D., J.H., Y.K.), Neuropsychiatry (T.O., S.K.), and Neuropathology (T.I.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ohara T, Ninomiya T, Kubo M, Hirakawa Y, Doi Y, Hata J, Iwaki T, Kanba S, Kiyohara Y. Apolipoprotein genotype for prediction of Alzheimer's disease in older Japanese: the Hisayama Study. J Am Geriatr Soc 2011; 59:1074-9. [PMID: 21649613 DOI: 10.1111/j.1532-5415.2011.03405.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To estimate the effects of the apolipoprotein E (APOE)-ɛ4 allele on the development of dementia and to elucidate its usefulness in the risk prediction of dementia in Japanese. DESIGN Prospective cohort study. SETTING The Hisayama Study, in Japan. PARTICIPANTS Five hundred twenty-three participants with deoxyribonucleic acid samples from a population of 1,073 community-dwelling participants without dementia aged 60 to 79. MEASUREMENTS The risk estimates of the APOE-ɛ4 allele on the development of all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD). RESULTS During 17 years of follow-up, 136 participants developed dementia, 81 of whom had AD and 39 VaD. After adjusting for age, sex, education, smoking, alcohol intake, systolic blood pressure, use of antihypertensive agents, glycosylated hemoglobin, serum total cholesterol, body mass index, and regular exercise, the risks of all-cause dementia and AD were significantly higher in APOE-ɛ4 carriers than in noncarriers, but no such association was observed for VaD (all-cause dementia: hazard ratio (HR)=1.81, P=.004; AD: HR=3.42, P<.001; VaD: HR=1.08, P=.86). The area under the receiver operating characteristic curve was significantly greater when the APOE genotype was incorporated into a model with potential risk factors for AD (0.74 vs 0.68, P=.02). Other measures of model discrimination (net reclassification improvement: 0.18, P=.01; integrated discrimination improvement: 6.25, P<.001) also confirmed this improvement in AD risk assessment. CONCLUSION The APOE-ɛ4 allele is a risk factor for AD in the Japanese population. Information on APOE genotype improves AD risk assessment substantially beyond a model based on potential risk factors.
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Affiliation(s)
- Tomoyuki Ohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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He J, Iosif AM, Lee DY, Martinez O, Chu S, Carmichael O, Mortimer JA, Zhao Q, Ding D, Guo Q, Galasko D, Salmon DP, Dai Q, Wu Y, Petersen RC, Hong Z, Borenstein AR, DeCarli C. Brain structure and cerebrovascular risk in cognitively impaired patients: Shanghai Community Brain Health Initiative-pilot phase. ACTA ACUST UNITED AC 2010; 67:1231-7. [PMID: 20937951 DOI: 10.1001/archneurol.2010.230] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the associations among brain morphologic changes as seen on magnetic resonance imaging (MRI), cerebrovascular risk (CVR), and clinical diagnosis and cognition in elderly patients with mild cognitive impairment and dementia living in urban Shanghai. DESIGN Cross-sectional study performed from May 1, 2007, to November 31, 2008. SETTING Memory Disorders Clinic of the Huashan Hospital and the Shanghai community. PARTICIPANTS Ninety-six older people: 32 with normal cognition (NC), 30 with amnestic mild cognitive impairment (aMCI), and 34 with dementia. MAIN OUTCOME MEASURES For each patient, we administered a neurologic and physical examination, neuropsychological evaluation, and brain MRI and genotyped the apolipoprotein E-ε4 (APOE-ε4) gene. The volumes determined by MRI were assessed using a semiautomatic method. RESULTS Brain volume was significantly smaller in the dementia patients compared with the NC (P < .001) and aMCI patients (P = .04). Hippocampal volume (HV) was lower and white matter hyperintensity (WMH) volume was higher in those with aMCI (HV: P = .03; WMH volume: P = .04) and dementia (HV: P < .001; WMH volume: P = .002) compared with NC participants. The presence of APOE-ε4 was significantly associated with reduced HV (P = .02). Systolic blood pressure was positively associated with CVR score (P = .04); diastolic blood pressure (P = .02) and CVR score (P = .04) were positively associated with WMH volume. The WMH volume (P = .03) and CVR score (P = .03) were higher among dementia patients compared with NC participants. CONCLUSIONS Brain structure changes seen on MRI were significantly associated with clinical diagnosis. In addition, blood pressure was highly associated with CVR score and WMH volume. These results suggest that MRI is a valuable measure of brain injury in a Chinese cohort and can serve to assess the effects of various degenerative and cerebrovascular diseases.
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Affiliation(s)
- Jing He
- Department of Neurology, University of California at Davis, Sacramento, CA 95817, USA
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Abstract
Heart failure has served as a clinically useful model for understanding how cardiac dysfunction is associated with neuroanatomic and neuropsychological changes in aging adults, theoretically because systemic hypoperfusion disrupts cerebral perfusion, contributing to clinical brain injury. This review summarizes more recent data suggesting that subtle cardiac dysfunction or low normal levels of cardiac function, as quantified by cardiac output, are related to cognitive and neuroimaging markers of abnormal brain aging in the absence of heart failure or severe cardiomyopathy. Additional work is required, but such associations suggest that reduced cardiac output may be a risk factor for Alzheimer's disease (AD) and abnormal brain aging through the propagation or exacerbation of neurovascular processes, microembolism due to thrombosis, and AD neuropathological processes. Such mechanistic pathways are discussed in the context of a theoretical model that posits a direct pathway of injury between cardiac output and abnormal brain aging (i.e., reduced systemic blood flow disrupts cerebral blood flow homeostasis), contributing to clinical brain injury, independent of shared risk factors for both cardiac dysfunction and abnormal brain aging.
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Affiliation(s)
- Angela L Jefferson
- Department of Neurology, Alzheimer's Disease Center, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA 02118, USA.
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49
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Perneczky R, Wagenpfeil S, Lunetta KL, Cupples LA, Green RC, Decarli C, Farrer LA, Kurz A. Head circumference, atrophy, and cognition: implications for brain reserve in Alzheimer disease. Neurology 2010; 75:137-42. [PMID: 20625166 DOI: 10.1212/wnl.0b013e3181e7ca97] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical and epidemiologic studies suggest that patients with Alzheimer disease (AD) with larger head circumference have better cognitive performance at the same level of brain pathology than subjects with smaller head circumference. METHODS A total of 270 patients with AD participating in the Multi-Institutional Research in Alzheimer's Genetic Epidemiology (MIRAGE) study underwent cognitive testing, APOE genotyping, and MRI of the brain in a cross-sectional study. Linear regression analysis was used to examine the association between cerebral atrophy, as a proxy for AD pathology, and level of cognitive function, adjusting for age, duration of AD symptoms, gender, head circumference, APOE genotype, diabetes mellitus, hypertension, major depression, and ethnicity. An interaction term between atrophy and head circumference was introduced to explore if head circumference modified the association between cerebral atrophy and cognition. RESULTS There was a significant inverse association between atrophy and cognitive function, and a significant interaction between atrophy and head circumference. With greater levels of atrophy, cognition was higher for individuals with greater head circumference. CONCLUSION This study suggests that larger head circumference is associated with less cognitive impairment in the face of cerebral atrophy. This finding supports the notion that head circumference (and presumably brain size) offers protection against AD symptoms through enhanced brain reserve.
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Affiliation(s)
- R Perneczky
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.
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50
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Chen CH, Mizuno T, Elston R, Kariuki MM, Hall K, Unverzagt F, Hendrie H, Gatere S, Kioy P, Patel NB, Friedland RP, Kalaria RN. A comparative study to screen dementia and APOE genotypes in an ageing East African population. Neurobiol Aging 2010; 31:732-40. [PMID: 18703255 PMCID: PMC2857314 DOI: 10.1016/j.neurobiolaging.2008.06.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 06/22/2008] [Accepted: 06/27/2008] [Indexed: 11/27/2022]
Abstract
Previous studies have established cross-cultural methods to screen for ageing- related dementia and susceptibility genes, in particular Alzheimer's disease (AD) among the Canadian Cree, African Americans and Yoruba in Nigeria. We determined whether the Community Screening Interview for Dementia (CSID), translated into Kikuyu, a major language of Kenya, could be used to evaluate dementia of the Alzheimer type. Using two sets of coefficients of cognitive and informant scores, two discriminant function (DF) scores were calculated for each of 100 elderly (>65 years) Nyeri Kenyans. When the cut-off points were selected for 100% sensitivities, the specificities of the DF scores were remarkably similar (93.75%) in the Kenyan sample. We propose the adapted CSID can be utilised to detect dementia among East Africans. We also show that apolipoprotein E epsilon 4 allele frequencies were high (approximately 30%) and not different between normal subjects and those with probable AD. There was no evidence to suggest years of education or vascular factors were associated with dementia status.
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Affiliation(s)
- Chien-Hsiun Chen
- Laboratory of Neuro geriatrics, Department of Neurology and Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Toshiki Mizuno
- Department of Neurology, Kyoto Prefectural University, Kyoto, Japan
| | - Robert Elston
- Laboratory of Neuro geriatrics, Department of Neurology and Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Kathleen Hall
- Departments of Psychiatry and Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fred Unverzagt
- Departments of Psychiatry and Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hugh Hendrie
- Departments of Psychiatry and Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samuel Gatere
- Avenue Hospital, First Avenue Parklands, Nairobi, Kenya
| | - Paul Kioy
- Department of Medical Physiology, University of Nairobi, Kenya
| | - Nilesh B. Patel
- Department of Medical Physiology, University of Nairobi, Kenya
| | - Robert P. Friedland
- Laboratory of Neuro geriatrics, Department of Neurology and Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Raj N. Kalaria
- Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, United Kingdom
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